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研究生:江芸薇
研究生(外文):Yun-Wei Chiang
論文名稱:青年長期使用長效型散瞳劑對於其近視發展及視覺功能之影響:回溯型研究
論文名稱(外文):Myopia progression and visual function in young adults with long-term use of atropine: a retrospective cohort study.
指導教授:郭寶錚郭寶錚引用關係郭蕙瑛
指導教授(外文):Bo-Jein KuoHui-Ying Kuo
口試委員:黃宣瑜孫涵瑛
口試委員(外文):Shuan-Yu HuangHan-Yin Sun
口試日期:2016-06-14
學位類別:碩士
校院名稱:國立中興大學
系所名稱:生命科學院碩士在職專班
學門:生命科學學門
學類:生物學類
論文種類:學術論文
論文出版年:2017
畢業學年度:105
語文別:中文
論文頁數:72
中文關鍵詞:近視散瞳劑視覺功能
外文關鍵詞:MyopiaAtropinevisual function
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目的:本研究主要目的在於長期使用長效型散瞳劑控制近視的發展與其視覺功能之分析。
方法:本研究共分為兩階段,第一階段以問卷方式調查18-28歲青年是否曾經使用過控制近視藥水(散瞳劑),依照其問卷結果將受測者分為未曾點用組(完全沒使用過藥水)、短期點用組(曾經使用過藥水1-2年)及長期點用組(使用藥水超過3年)並分析目前其近視度數發展。在第二階段則招募了40名18-28歲的青年,其中19名為長期使用(>3年)散瞳劑做為控制近視方法且已經停止使用藥水半年以上(以下稱長期點用組)與21名從未使用過散瞳劑或其他方法做為控制近視方法(以下稱未曾點用組)的兩個組別。分別比較屈光度(使用開放式自動驗光機ShinNippon SRW-5000)、眼軸長度(使用bio meter AL-100)去比較兩組的近視發展程度,視覺功能方面則測量瞳孔大小、調節力、調節彈性、眼位。
結果:在第一階段結果發現在短期點用組與長期點用組中近視度數達統計上的差異(分別為:-5.28 ± 0.25 D V.S. -4.51 ± 0.20 D, p = 0.047);在未曾點用組及長期點用組互相比較則兩組間未達統計上的差異(分別為:-4.09 ± 0.19 D V.S. -4.51 ± 0.20 D)。在第二階段結果發現長期點用組與未曾點用組(分別右眼:-3.64 ± 2.11 DV.S. -4.76 ± 2.58 D, p = 0.145;左眼分別為-3.88 ± 2.38 D V.S. -4.51 ± 2.43 D , p = 0.414);兩組間無論在左眼或右眼的屈光度比較,並未有統計上的差異。。兩組的眼軸長度也是沒有統計上的差異的(右眼:25.47 ± 1.10 mm V.S. 25.43 ± 1.15 mm , p = 0.914 ; 左眼平均值為25.54 ± 1.19 mm V.S. 25.10 ± 1.09 mm , p = 0.228)。且瞳孔大小在亮室(右眼4.60 ± 0.83 mm V.S. 4.55 ± 0.66 mm,p = 0.854。左眼4.44 ± 1.16 mm V.S 4.36 ± 0.64 mm,p=0.807)或暗室(右眼6.68 ± 0.80 mm V.S. 6.74 ± 0.57 mm,p=0.782。左眼6.21± 1.04mm V.S. 6.58 ± 0.49 mm,p=0.177)也是沒有顯著差異的。但調節力表現在長期點用組有較低於未曾點用組,其調節力分別為12.55 ± 3.82 D V.S. 16.16 ± 4.76 D,p=0.01。長期點用組的遠距離眼位也較未曾點用組偏向內斜視2.26 ± 4.96∆ V.S. -1.26 ± 2.94∆, p=0.009。其調節彈性長期點用組也有較高的百分比有較差的反應,較差的反應可能是無法進行調節彈性測試(fail)或測驗結果低於10cpm(slow)的百比例,兩組表現較差的百分比分別為46.8 %和10.5 %。
結論:本研究屬於回溯型研究,結果顯示長期使用散瞳劑且在停點半年之後其屈光度、瞳孔大小與未使用過散瞳劑組別來說是沒有顯著上的差異。但在長期使用長效型散瞳劑的人可能會導致部分的視覺功能喪失,例如調節幅度或調節彈性,未來可能有提早老化的可能。
Purpose: The aim of this study is to investigate changes in myopia development and visual function in young adults after a prolonged use of atropine.
Method: 40 young adults aged 18-28 years were recruited and divided into two groups: 19 of them had been using atropine for myopia control over 3 years and had terminated atropine usage for at least six months before the examination; 22 participants had never used atropine or other myopia control methods. The refraction (using an open-field autorefractor, ShinNippon SRW-5000) and axial length (using bio meter AL-100) were measured to compare the rates of myopia progression between the prolonged atropine use group and non-atropine use group. Pupil size, phoria, binocular accommodative amplitude (using push-up test) and accommodative facility were also done for both groups.
Results: There were no significant differences in refractions (OD: -3.64 ± 2.11 D V.S. -4.76 ± 2.58 D , p = 0.145; OS: .-3.88 ± 2.38 D V.S -4.51 ± 2.43 D , p = 0.414) and in axial length(OD: 25.47 ± 1.10 mm V.S. 25.43 ± 1.15 mm, p = 0.914 ; OS: 25.10 ± 1.09 mm V.S. 25.54 ± 1.19 mm , p = 0.228) between the prolonged atropine use group and non-atropine use group. No significant differences in pupil sizes were found for both mesopic pupil size(OD: 6.68 ± 0.80 mm V.S. 6.74± 0.57 mm,p=0.782; OS: 6.58 ± 0.49 mm V.S. 6.21 ± 1.04mm,p=0.177)and photopic pupil size (OD: 4.60 ± 0.83 mm V.S. 4.55 ± 0.66 mm,p = 0.854 ; OS: 4.44 ± 1.16 mm V.S 4.36 ± 0.64 mm,p=0.807 ,p=0.177). In the aspects of visual function, the prolonged atropine use group had significant lower accommodative amplitudes (12.55 ± 3.82 D V.S. 16.16 ± 4.76 D,p=0.01), and a higher percentage that failed or had results < 10 cpm for the accommodative facility test (46.8 % V.S. 10.5 %) compared to the non-atropine group. They also showed more esophorias than the control group (2.26 ± 4.96∆ V.S. -1.26 ± 2.94∆, p=0.009).
Conclusions: It’s no significant difference between the prolonged atropine use group and non-atropine use group, however, significant declines in accommodation and other visual function exist. The occurrence of early presbyopia onset should be highly concerned in the myopes with long-term atropine treatment.
中文摘要 i
Abstract iii
第一章緒論 1
第一節國內外近視盛行率概況 1
第二節近視原因的相關研究 4
第三節近視的危險因子 9
第四節近視控制方法的成效及影響 12
第五節總結及研究動機 17
第二章研究方法 18
第一節研究設計 18
第二節研究樣本 19
第三節測量方法與實施程序 22
第四節統計方法 37
第三章結果 38
第一節第一階段:問卷調查及眼睛屈光度分析 38
第二節第二階段:眼屈光測量 42
第三節視覺功能分析比較 47
第四章討論 51
第一節研究方法差異性與限制 51
第二節Atropine使用情形與控制近視效果之探討 53
第三節 Atropine使用後的眼球生理與結構比較 56
第四節點用atropine後其視覺功能變化之探討 59
第五章結論 63
第六章未來研究 64
參考文獻 65
附件一 控制近視藥水使用情形之問卷調查單 68
附件二 受測者視覺功能檢查單 69
附件三 中山醫學大學附設醫院人體委員會 研究計畫許可書 70
附件四 人體試驗講習課程 結業證書 71
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