臺灣博碩士論文加值系統

近視一直都是國人健康的一個大問題。高度近視容易造成一些併發症例如:視網膜剝離和黃斑部病變及青光眼和白內障等等，因此提早預防孩童的近視惡化成高度近視是很重要的。在台灣臨床上被用來減緩和抑制度數增加主要的方法有兩種，散瞳劑和配戴角膜塑型隱形眼鏡(Orthokeratology Contact lens)；散瞳劑又叫作睫狀肌麻痺劑是一種副交感神經阻斷劑，目的是讓睫狀肌放鬆以減緩近視度數的增加，角膜塑型鏡片(Orthokeratology lens)則是利用逆幾何同心圓的設計去改變角膜的形狀，以減緩近視度數的增加。本研究主要目的是在探討這兩種方法對控制近視的成效。實驗經三軍總醫院人體實驗委員會審核同意進行研究，研究方法採用5年期病例回溯。所有收集的資料都來自於萬芳醫學中心、三軍總醫院、板橋信合美眼科診所、淡水睛采眼科診所、新竹陳志宏眼科診所等五個單位，共收集了有效樣本1388個眼睛，其中有738個眼睛配戴角膜塑型鏡片(研究組)，650個眼睛使用散瞳劑Atropine(控制組)，年齡層從7歲到12歲。結果顯示配戴角膜塑型鏡片五年後近視度數平均增加-0.55D，每年平均增加-0.11D ；散光度數平均增加-0.12D，每年平均增加-0.02D ；而散瞳劑在使用後平均近視度數增加為-1.75D，平均每年增加-0.35D散光度數平均增加-0.38D每年平均增加-0.07D。結果顯示使用角膜塑型鏡片和散瞳劑都可以有效控制近視度數的提升，但角膜塑型鏡片對學童近視的控制成效比使用散瞳劑好，受試者每年所增加的近視度數僅有散瞳劑的31.42%。所以角膜塑型鏡片的控制成效高於散瞳劑68.58%。

Myopia has been a big problem for the health of Chinese people. High myopia is prone to some complications such as retinal detachment and macular degeneration and glaucoma and cataract. Therefore, it is important to prevent children's myopia from increasing to high myopia. There are two main methods used in Taiwan to slow down and suppress the increase in diopters, namely using mydriatic agent and keratoplasty contact lenses. The mydriatic agent, also known as the ciliary muscle paralysis agents, are parasympathetic blockers. It is to relax the ciliary muscle to slow down the increase of myopia. The orthokeratology lens uses the design of inverse geometric concentric circle to change the shape of the cornea, thereby slowing the progression of myopia. The main purpose of this study was to compare the effectiveness of these two methods in controlling myopia. The project was reviewed and approved by the Human Body Experimental Committee of the Three Military General Hospital. A 5-year backtracking random sampling was use. All the collected datas came from Wanfang Medical Center, Sanjun General Hospital, Banqiao Xinhe Eye Clinic, Danshui Eye Ophthalmology Clinic, and Hsinchu Chen Zhihong Eye Clinic. A total of 1388 eyes were collected, including 738 eyes fitted with Ortho-K lenses (study group) and 650 eyes treated with the Atropine (control group). The age of subjects ranged from 7 to 12 years old. The results showed that the average total myopia and astigmatism increased -0.55D and -0.12D with five years of wearing Ortho-K lenses, and the average increase was -0.11D and -0.02D per year; while the average total myopia and astigmatism increased by -1.75D and -0.38D after five years of using Atropine , with an average annual progression of -0.35D and -0.07D per year. Therefore, The current results indicate either Ortho-K lenses or mydriatic agents can control myopia progression. However, Ortho-K lenses showes better control then Atropine, with the former only 68.58% of the latter。

目錄
論文口試委員審定書 I
誌　謝 II
中文摘要 IV
英文摘要 VI
目錄 VIII
圖目錄 XII
表目錄 XV

第一章 文獻回顧 1
1.1 前言 1
1.2 研究背景與動機 3
1.3 近視(Myopia)簡介 5
1.3.1近視的分類 5
1.3.2常見之近視併發症 8
1.4 角膜塑型隱形眼鏡(Orthokeratology contact lenses) 8
1.4.1塑型隱形眼鏡(OK Lens)的結構與設計 9
1.4.2角膜塑型隱形眼鏡(Orthokeratology contact lenses)與
超透氧硬式隱形眼鏡(Rigid gas permeable; RGP)之差
別 10
1.4.3角膜塑型隱形眼鏡(OK Lens)的矯正原理 13
1.5 散瞳劑(Mydriatic) 13

第二章 材料與方法 16
2.1 研究方法 16
2.2 研究單位檢查儀器與使用目的 17
2.3 條件設計(接受與排除) 17
2.4 篩選受試者 21
2.4.1控制組：散瞳劑組(Mydriatic) 21
2.4.2研究組：角膜塑型鏡片組(OK Lenses) 21
2.5 塑形鏡片材料 22
2.6 鏡片設計參數 22
2.7 鏡片材質之物理作用及特性 23
2.7.1物理作用 23
2.7.2物理特性 24
2.8 禁止配戴之原因 24

第三章 結果與討論 26
3.1 受試者資料分布結構 26
3.1.1角膜塑形鏡片(研究組)資料分布結構 26
3.1.2散瞳劑(控制組)資料結構分析 27
3.2 角膜塑型鏡片(研究組)控制成效結果分析 37
3.2.1角膜塑型鏡片(研究組)對近視度數控制成效 37
3.2.2角膜塑型鏡片(研究組)對散光度數控制成效 38
3.2.3角膜塑型鏡片不同年齡層對近視和散光控制成效之
分析 38
3.2.4角膜塑型鏡片(研究組)年齡層與控制成效的相關性 40
3.2.5角膜塑型鏡片組在不同性別對近視和散光度數控制
成效之分析 41
3.3 散瞳劑(控制組)對近視度數之控制成效 45
3.3.1 0.125%與0.3%Atropine對近視度數控制成效之比
較 45
3.3.2散瞳劑(控制組)不同年齡層對近視及散光的控制成
效之分析 46
3.3.3散瞳劑不同性別對近視和散光度數控制成效之分析 48
3.3.4散瞳劑不同濃度不同性別對近視和散光度數控制成
效之分析 49
3.3.5散瞳劑(控制組)年齡層與控制成效的相關性 55
3.3.6散瞳劑(控制組)使用前後的散光度數分析比對 56
3.4 角膜塑型鏡片和散瞳劑對近視度數控制成效之比較 56

第四章 討論與結論 65
4.1 研究心得與建議 71
4.1.1研究心得 71
4.1.2研究建議 72

參考文獻 74
一、英文部分 74
二、中文部分 79

 


圖目錄
圖1- 1 近視的種類 11
圖1- 2 配戴鏡片前角膜和鏡片的相對位置 11
圖1- 3 配戴鏡片後角膜和鏡片的相對位置 12
圖1- 4 角膜塑型隱形鏡片主要的設計個弧區的相對位置 12
圖1- 5 角膜塑型隱形眼鏡經顯影染色圖-多弧設計 15
圖1- 6 高透氧硬式隱形眼鏡經顯影染色圖-三弧設計 15
圖2- 1 Pentacam topography 角膜地圖儀 18
圖2- 2 Bausch -Lomb OB Scan topography角膜地圖儀 18
圖2- 3 Wavelight, Topolyzer-Vario角膜地圖儀 19
圖2- 4 TOPCON KR8900電腦驗驗光機 19
圖3- 1 角膜塑形鏡片(研究組)與散瞳劑(控制組)各年齡層之樣本分布 29
圖3- 2 散瞳劑組與角膜塑型鏡片組男女樣本之分布 31
圖3- 3 Atropine 0.125％與0.3％男女樣本之分布 31
圖3- 4 散瞳劑組男女使用前後平均近視度數之比較 32
圖3- 5 散瞳劑組男女使用前後平均散光度數之比較 32
圖3- 6 角膜塑型鏡片組男女使用前後平均近視與散光度數之比較 33
圖3- 7 角膜塑型鏡片使用前後各年齡層平均近視與散光度之分布 33
圖3- 8 散瞳劑組使用前後各年齡層平均近視與散光度之分布 34
圖3- 9 散瞳劑組不分濃度使用前後平均近視度數之比對。 34
圖3- 10 散瞳劑組不分濃度使用前後平均散光度數之比對 35
圖3- 11 角膜塑型鏡片組使用前後平均近視度數之比對 35
圖3- 12 角膜塑型鏡片組使用前後平均散光度數之比對 36
圖3- 13 角膜塑型鏡片組7歲受試者的使用前後平均近視度數之比較 36
圖3- 14 角膜塑型鏡片組8歲受試者的使用前後平均近視度數之比較 42
圖3- 15 角膜塑型鏡片組9歲受試者的使用前後平均近視度數之比較 42
圖3- 16 角膜塑型鏡片組10歲受試者的使用前後平均近視度數之比較。43
圖3- 17 角膜塑型鏡片組11歲受試者的使用前後平均近視度數之比較 43
圖3- 18 角膜塑型鏡片組12歲受試者的使用前後平均近視度數之比較 44
圖3- 19 Atropine 0.125%與0.3%樣本數之分布 51
圖3- 20 Atropine 0.125%與0.3%使用前後平均近視度數之比較 51
圖3- 21 Atropine 0.125%與0.3%使用前後平均散光度數之比較 52
圖3- 22 Atropine不分濃度各年齡層使用前後近視度數之比較 52
圖3- 23 Atropine不分濃度使用前後散光度數之比較 53
圖3- 24 Atropine 0.125%與0.3%使用後平均近視和散光度之比較 53
圖3- 25 Atropine不同濃度不同性別使用前後平均近視度數之比較 54
圖3- 26 Atropine不同濃度不同性別使用前後平均散光度數之比較 54
圖3- 27 角膜塑型鏡片使用後沒有增加0度至-0.25D的數量之分布 58
圖3- 28 角膜塑型鏡片使用後增加-0.50D度至-1.00D的數量之分布 59
圖3- 29 角膜塑型鏡片使用後增加-1.25D度至-2.00D的數量之分布 59
圖3- 30 散瞳劑使用後沒有增加0度至-0.25D的數量之分布 60
圖3- 31 散瞳劑組使用後增加-0.50D至-1.00D的數量之分布 60
圖3- 32 散瞳劑組使用後增加-1.25D至-2.00D的數量之分布 61
圖3- 33 散瞳劑與塑型鏡片使用後增加-2.25D至-3.00D的數量之分布 61
圖3- 34 散瞳劑與塑型鏡片使用後增加-3.25D至-4.00D的數量之分布 62
圖3- 35 散瞳劑與塑型鏡片使用後增加-4.25D至-5.00D的數量之分布 62
圖3- 36 散瞳劑與塑型鏡片使用後增加(-5.25D至-6.00D)的數量 63
圖3- 37 研究組與控制組使用後所增加的平均近視度數之比較 63
圖3- 38 研究組與控制組在每一個度數增加的級距數量之比較 64

表目錄
表1- 1 台灣地區六至十八歲的近視盛行率(1986-2010) 2
表1- 2 各國使用角膜塑型鏡片控制近視的研究 7
表2- 1配戴角膜塑型鏡片(研究組)受試者接受與排除之標準 20
表2- 2使用散瞳劑(控制組)受試者接受與排除之標準 20
表3- 1 樣本分布情形 29
表3- 2 角膜塑塑型鏡片各年齡層受試者數量的百分比 30
表3- 3 散瞳劑(控制組)各年齡層受試者數量百分比 30
表3- 4 角膜塑型鏡片(研究組)對受試者近視控制成效比對表 44
表3- 5 散瞳劑(控制組)使用前後控制成效之比對表 58
表3- 6研究組與控制組在每一個增加近視度數級距數量及百分比 64

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二、中文部分
49.施永豐，國內外屈光問題相關研究文獻探討-近視流行病學防治篩檢文獻
回顧計畫。
50.陳振豪，雙眼視機能異常診斷與治療。
51.蘇俊峰(2016)。眼睛解剖生理及常見疾病概要。