臺灣博碩士論文加值系統

前言：20/20的視力可能沒有一個好的高階視覺品質。有近視的人可藉由標準準分子雷射屈光矯正手術（laser in situ keratomileusis, LASIK）獲得較佳裸視力，但是其術後之高階視覺品質如何呢？目前眼科界評估視覺品質的方法僅病史的詢問及對比敏感功能測試兩種，但其均是主觀的檢測，無法客觀的顯示術後高階視覺品質之變化，本篇研究提出一種新的評估方法，來探討準分子雷射屈光矯正手術後之高階視覺品質的變化。方法：收集接受標準準分子鐳射屈光矯正手術的近視病患，其術前之檢查須無屈光異常以外的眼科疾病，術後裸視力均須達20/20或以上，且每一個人均完成術後1週、1個月、3個月一系列的追蹤檢查包括裸視力、波前像差分析儀、對比敏感測試等。結果：16個病患25隻眼睛納入本研究，其平均年齡為34歲，球面屈光當量為-7.0 ±1.8 D；術後1週（0.0±0.5 D）、1個月（-0.6±0.5 D）及3個月（-0.5±0.7 D）屈光度有明顯降低(P<0.05)。高階像差於術後有明顯增加（P＜0.05）；對比敏感功能於術後３個月在特定頻率（6、12、18 cpd）有明顯改善（P<0.05）；整體而言總像差之調變轉換函數於術後有明顯改善，但仍較理想的調變轉換函數為差，且於術後1個月及3個月時有明顯回退的現像；高階像差之調變轉換函數於術後有明顯的降低，但術後3個月於高頻部分(18 cpd)有明顯回復的現像。結論：準分子雷射屈光矯正手術後獲得較佳裸視力的研究個案，於本研究證實術後眼球光學變化可由調變轉換函數測得，同時顯示術後之高階光學品質變差，眼球高階像差於術後有明顯的增加，尤其是球面狀像差和慧星狀像差，而且調變轉換函數客觀指出術後眼球高階像差之變化，造成視網膜成像品質的變差。然而術後3個月夜間視覺品質有明顯改善，因此各層級像差變化對視覺品質的影響仍須進一步的研究。

Introduction: Visual acuity of 20/20 may not be a good quality of vision. Best visual acuity could be reached by standard laser in situ keratomileusis (LASIK) in myopic subjects. However, the visual quality may not be satisfied. This study would investigate the high visual quality by an objective method (modulation transfer function, MTF) and a subjective method (contrast sensitivity function, CSF) after surgery. Methods: The twenty-five normal patients（free of systemic diseases and ocular diseases）were enrolled for this study. And strictly, only the subjects, whose uncorrected visual acuity (UCVA) were 20/20 or better after surgery, were qualified to be candidates of this study. A series of ophthalmologic examinations including UCVA、best corrected visual acuity (BCVA)、wavefront aberrometer、and CSF were performed before and at 1st week, 1st month, and 3rd month after the operation. LASIK operation was performed using a smart-beam, variable spot scanning (VSS) excimer laser, and was assisted by eye-tracker. (VISX STAR S3). Results : In subjects (n=25 eyes), the mean age was 34 ± 5.9 yrs (22 ~ 41yrs) and the pre-op refractive error (spherical equivalent) was -7.00 ± 1.8 diopters (D). The residual refractive error was stable at 1st month (-0.6 ± 0.5D ) after LASIK operation. The daytime CSF at 1.5 cycles per degree (cpd) and night-time CSF at 6, 12, and 18 cpd were significantly increased at 3rd month after LASIK treatment. MTF of all aberrations was significantly increased after surgery. However, the postoperative MTF of all aberrations was lower than the operative goal (only pre-op higher order aberrations). The change of higher order aberrations after LASIK operation made a decrease in MTF. And the postoperative lower order aberrations made more decreasing in MTF. Conclusions: This result suggested that the optic change of eyes can be determined objectively by MTF. We found the higher order aberrations were induced after surgery, especially in coma-like and spherical-like aberrations. These aberrations caused a decrease in optic quality. However, the improvement of night-time CSF at specific frequency was noticed at 3rd month after surgery. Therefore, the role of individual aberration in visual quality needs to be further explored.

正文目錄 …... …...Ⅰ
表目錄 ………………….Ⅲ
圖目錄 …………………Ⅳ
中文摘要 ………………………………………Ⅵ
英文摘要 …………………………………………………………………….. Ⅷ
第一章 緒言……………………………………………………………… 01
第一節 研究背景………………………………………………………01
第二節 視覺功能的認知……………………………………………..07
第三節 屈光矯正手術的發展史………………………………………13
第四節 屈光矯正手術對視覺功能的影響 ………………………….16
第五節 研究動機……………………………………...............19
第六節 研究目的………………………………………………………20
第二章 研究材料與方法………………………………………………… 21
第一節 研究對象………………………………………………………21
第二節 研究器材………………………………………………………23
第三節 LASIK手術的步驟…………………………………………… 25
第四節 研究流程與方法…………………………………………… 27
第五節 資料分析……………………………………………………. 30
第三章 結果……………………………………………………………… 31
第一節 裸視力與屈光度……………………………………………..31
第二節 LASIK術後眼球像差之變化………………………………… 33
第三節 LASIK術後對比敏感功能之變化…………………………… 35
第四節 LASIK術後調變轉換函數之變化…………………………… 37
第四章 討論……………………………………………………………… 40
第一節 裸視力與屈光度………………………………………………40
第二節 對比敏感功能之變化…………………………………………43
第三節 第三節 眼球像差及調變轉換函數………………………… 46
第五章 結論與建議……………………………………………………… 49
第六章 參考文獻………………………………………………………… 51
表 目 錄
頁次
表1 LASIK術後屈光度及裸視力的變化………………………………… 56
表2 各項眼球像差術後有差異者之變化情形……………………………57
圖 目 錄
頁次
圖1 眼睛光學系統之傳遞路徑..………………………………………......58
圖2 像差之示意圖…………………………………………………………59
圖3 Zernike像差樹狀圖……………………………………………….....60
圖4 光學系統之調變轉換函數……………………………………………61
圖5 簡化之眼球光學模型（reduced eye model）……………………. 62
圖6 對比敏感功能之Channel theory……………………………………63
圖7 LASIK手術原理之簡圖…………………………………………….....64
圖8 波前像差分析儀之Hartmann-Shack sensor…………………….....65
圖9 Zernike polynomial coefficients table………………………..66
圖10 視網膜之點擴散分佈圖……………………………………………… 67
圖11 對比敏感功能測試儀器及投影片…………………………………… 68
圖12 視網膜點擴散分佈圖之驗正………………………………………… 69
圖13 LASIK術後眼球總像差之變化……………………………………... 70
圖14 LASIK術後低階像差之變化…………………………………………71
圖15 LASIK術後高階像差之變化…………………………………………72
圖16 LASIK術後第三∼六層級的高階像差變化…………………………73
圖17 LASIK術前、後高階像差之分佈……………………………………74
圖18 日間之對比敏感功能……………………………………………….. 75
圖19 夜間之對比敏感功能……………………………………………….. 76
圖20 LASIK術前及術後總像差之調變轉換函數（MTF）的變化……….77
圖21 以術前總像差之調變轉換函數（MTF）為基準，LASIK術後 MTF之變化………………………………………………………… 78
圖22 以術前高階像差之MTF為基準，LASIK術後總像差之MTF 的變化……………………………………………………………... 79
圖23 LASIK術前及術後高階像差之ＭＴＦ的變化…………………… 80
圖24 以術前高階像差之MTF為基準，LASIK術後高階像差像差之 MTF的變化………………………………………………………... 81
圖25 LASIK術後眼球像差之MTF及CSF的變化程度………………… 82
圖26 LASIK術後1週CSF及眼球像差之MTF的變化程度比較……… 83
圖27 LASIK術後1個月CSF及眼球像差之MTF的變化程度比較…… 84
圖28 LASIK術後3個月CSF及眼球像差之MTF的變化程度比較…… 85

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