臺灣博碩士論文加值系統

使用低濃度長效散瞳劑在角膜塑型術中對學童近視控制成效之探討

研究生：王舜渙 指導教授：林哲揚 博士

元培醫事科技大學企業管理系碩士班

摘要
台灣孩童與青少年的近視比例高居世界第一，且近視比例亦隨年齡出現加快攀升的趨勢，對國民視力健康產生極大的威脅。目前公認最有效的近視控制辦法為角膜塑型片，然而，本研究欲探討使用角膜塑型片再加點低濃度長效散瞳劑的近視治療方式，是否比傳統上單獨使用角膜術型片有更好的效果。並回溯使用散瞳劑或配戴角膜塑型片的近視治療方式的安全性與療效。
本研究於竹北市麗明眼科中，收集符合資格標準的45位學童，其中19位學童配戴角膜塑型片加點濃度在0.125%以下之低濃度長效型散瞳劑眼藥水；另外26位學童只配戴角膜塑型片。這些學童是以首次配戴與配戴後每6個月定期追蹤的方式，為期2年，分別量測他們的視力、眼軸長度與角膜厚度之數據，再利用敘述統計、重複量測變異數分析等統計方法產生實證結果。
研究結果為學童配戴角膜塑型片加點低濃度長效型散瞳劑眼藥水者其眼軸長的增長量顯著較小；配戴角膜塑型片後會讓角膜厚度顯著變薄，但加點散瞳劑與否與角膜變薄程度無關；兩種近視控制方法，學童矯正後的視力均可達0.9以上，矯正成效在視力的比較上沒有顯著差異。本研究認為學童配戴角膜塑型片加點低濃度長效型散瞳劑眼藥水會有較佳之近視控制成效。此結果可以提供給各相關醫療院所、家長、研究人員及其他關係人作為學童近視控制方式之參考。


關鍵詞:近視控制、角膜塑型片、低濃度長效散瞳劑、近視學童

Discussion on the effect of low concentration long-acting mydriatics on myopia control of school children in orthokeratology

Student：Shun-Huan Wang Advisor：Che-Yang Lin, Ph. D.

Graduate Institute of Business Administration
Yuan-pei University of Medical Technology
Abstract
The prevalence of nearsightedness among schoolchildren in Taiwan is extremely high and rising; the proportion of people who suffer from the high myopia is also increasing, which poses a great threat to the health of national visual acuity. The most effective method of myopia control is currently recognized as corneal casts. However, this study is to investigate whether the use of orthokeratology double with a low concentration of long-acting mydriatics for myopia treatment is more effective than the traditional use of corneal surgery alone. The safety and efficacy of myopic treatment using mydriatic agents or wearing orthokeratology are retrospectively reviewed, too.
In this study, 45 children who met the eligibility criteria were collected in the Liming Eye clinic of Zhubei City. Among them, 19 children were treated with orthokeratology and a low concentration long-acting mydriatic eye drops with or below a concentration 0.125% ; another 26 children were only treated with orthokeratology. The data of the degree of myopia, visual acuity and axial length of the school children were measured by the method of two-year regular tracking every six months after the first wearing. The statistical methods such as narrative statistics and repeated measurement variation analysis were used to produce empirical results.
The results of the study showed that the growth of the axial length of the children with the orthokeratology plus the low-concentration long-acting mydriatic was significantly smaller. The corneal thickness was significantly thinner after wearing the orthokeratology, but adding the mydriatic agent was not related to the degree of corneal thinning. Two methods of myopia control, the visual acuity of the corrected children were able to reach 0.9 or more, and the correction effect had no significant difference in visual acuity comparison. The study found that school children wearing orthokeratology plus low concentration of long-acting mydriatics would have better myopia control results. This result can be provided to all relevant hospitals, parents, researchers and other related persons as a reference for the schoolchild's control of myopia.


Keywords: myopia control, orthokeratology, low concentration long-acting mydriatics, myopic schoolchildren

目 錄
頁次
口試委員審定書 ............................................... I
誌謝 .........................................................II
中文摘要 ....................................................III
英文摘要 .....................................................IV
目錄 ........................................................VI
圖目錄 .....................................................VIII
表目錄........................................................IX
第一章前言.....................................................1
1.1研究背景與動機..............................................1
1.2研究目的....................................................3
1.3研究架構....................................................4
1.4研究內容....................................................4
第二章 文獻探討................................................5
2.1近視成因與分類..............................................5
2.2高度近視的併發症............................................7
2.3近視的治療.................................................8
2.3.1近視的治療方式-眼鏡......................................8
2.3.2近視的治療方式-眼藥水....................................9
2.3.3近視的治療方式-角膜塑型術................................9
2.4低濃度長效散瞳劑在控制近視中的應用...........................9
2.5角膜塑型術在控制近視中的應用................................14
第三章 研究方法...............................................22
3.1研究對象..................................................22
3.2治療方式..................................................23
3.3所需藥品或醫療器材.........................................23
3.4評估方式..................................................24
3.5材料與方法................................................26
第四章研究結果................................................27
4.1學齡孩童於受試前之基本資料分析..............................27
4.2學齡孩童於受試後之眼軸長度分析..............................28
4.3 學齡孩童於受試後之角膜厚度分析.........................32
4.4學齡孩童於受試後之視力分析..............................35
第五章 結論..................................................38
5.1角膜塑型片與角膜塑型片加點低濃度長效散瞳劑近視控制相關文獻討論..........................................................38
5.1.1角膜塑型片軸長變化相關文獻討論.............................39
5.1.2角膜塑型片加點低濃度散瞳劑軸長變化相關文獻討論...............39
5.2長效散瞳劑控制方法影響性.................................39
5.3角膜塑型片控制方法影響性.................................40
5.4 結論..................................................41
5.4.1角膜塑型片和角膜塑型片加點低濃度長效散瞳劑眼軸長度控制成
效.................................................41
5.4.2 研究限制.............................................42
參考文獻.....................................................43
 
圖 目 錄

圖1-1: 台灣地區6至18歲近視盛行率（1986-2010年）..................1
圖3-1:試片組..................................................24
圖3-2:視力表..................................................24
圖3-3:電腦自動驗光機 NIDEK NT-530 Tonometer....................25
圖3-4:全功能眼球量測儀(Lenstar LS 900).........................25
圖3-5:光學式眼軸長測量儀(AL-Scan) ..............................25
圖3-6:角膜地圖儀(Corneal topography )..........................26
圖4-1:實驗組與對照組受試者各時間之眼軸長度比較....................29
圖4-2:實驗組與對照組受試者各時間之眼軸長度增長量比較...............30
圖4-3: 實驗組與對照組受試者各時間之角膜平均厚度比較................33
圖4-4: 實驗組與對照組受試者接受視力矯正後各時間之平均視力比較.......36
圖5-1:眼軸生長變化量...........................................41
 
表 目 錄
表1-1:2000年左右各國孩童6-7歲近視盛行率..........................2
表4-1:實驗組與對照組受試者性別分布情形...........................27
表4-2:實驗組與對照組受試者年齡分布情形...........................28
表4-3:實驗組與對照組受試者年齡初始值比較.........................28
表4-4:實驗組與對照組受試者眼軸長初始值比較.......................29
表4-5:實驗組與對照組受試者各時間之眼軸長度比較....................30
表4-6:實驗組與對照組受試者各時間之眼軸長度增長量比較...............31
表4-7:實驗組與對照組受試者各時間之眼軸長度增長量球型假設檢定結果...........................................................31
表4-8:實驗組與對照組受試者各時間之眼軸長度增長量模型檢定結果........32
表4-9:實驗組與對照組受試者各時間之眼軸長度增長量多重比較...........32
表4-10:實驗組與對照組受試者各時間之眼軸長度增長量球型假設檢定結
果......................................................33
表4-11: 實驗組與對照組受試者各時間之角膜厚度模型檢定結果...........34
表4-12:各時間之受試者角膜厚度平均值之Bonferroni信賴區間的多重比
較..................................................34
表4-13:驗組與對照組受試者各時間之角膜厚度多重比較..................35
表4-14: 實驗組與對照組受試者各時間之平均視力比較..................35
表4-15: 實驗組與對照組受試者視力矯正後各時間之視力球型假設檢定結
果.......................................................36
表4-16:實驗組與對照組受試者各時間之角膜厚度模型檢定結果............37
表4-17:實驗組與對照組受試者各時間之矯正後視力的多重比較............37
表5-1:角膜塑型片軸長變化相關文獻.................................38
表5-2:角膜塑型片加點低濃度散瞳劑軸長變化相關文獻...................39

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二、中文部分
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2.國立台灣大學醫學院眼科，國內外屈光問題相關研究文獻探討- 近視流行病學及防治篩檢文獻回顧計畫，民國93年9月1日-民國94年2月28日。
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