不同光學設計多焦點軟式隱形眼鏡相對周邊離焦與視覺品質之研究

目的 近視相關議題在近年來一直是全球視力保健熱烈討論與關注的項目之一。 隨著基礎與臨床研究專家的努力，在近視控制的效果上逐漸看到了成效，而隱形眼鏡在近視控制效果上又以多 ( 雙 ) 焦光學設計最為顯著。本研究探討不同設計之軟式多焦點隱形眼鏡在周邊離焦與視覺品質表現之關聯性。方法 本研究的受試者為35人，排除有硬式隱形眼鏡配戴經驗、眼睛曾經歷手術與不適合配戴隱形眼鏡相關疾病者，研究共計收納12位男性與23位女性，年齡介於19~27歲，屈光狀態均未達近視-6.00D與散光度數-1.00D，遠方與近方的單眼個別最佳矯正視力皆在0.8以上。本研究在非散瞳下以Shin-Nippon開放視野型電腦屈光儀器進行水平視野中央、鼻側顳側各10°, 20°, 25°, 30°的周邊屈光與周邊離焦量測；周邊屈光量測分為雙眼視覺正常與異常兩組，周邊離焦測量則包括了四種軟式隱形眼鏡。戴鏡視覺品質的量測包括了遠近距離視力、立體視、調節幅度、調節狀態、球面像差與水平彗星像差。研究結果以SPSS V22.0進行統計分析，本研究遵從赫爾辛基宣言規範並通過中山醫學大學附設醫院第二人體實驗委員會審查（許可案號：CS2-20089）。結果 雙眼視覺正常與異常組的相對周邊屈光狀態並無明顯差異；在雙眼視覺正常組配戴不同隱形眼鏡所量測之相對近視性周邊離焦，無論是在M、J0或J45，均以亞瑟魔視鏡片（lens2）最為明顯，其次為酷柏邁視兒鏡片（lens4）；視覺品質分析在調節幅度與球面像差這兩個項目呈現出較明顯差異，配戴酷柏邁視兒鏡片（lens4）的調節幅度顯著較基線值低，在球面像差部分，亞瑟魔視鏡片（lens2）則呈現了顯著的正球面像差。結論 本研究主要探討周邊屈光、周邊離焦與視覺品質的變化，在臺灣目前近視率高居不下的時期，如何讓發展中的近視穩定下來成為相當重要的議題，研究中的三款中心看遠型多 ( 雙 ) 焦隱形眼鏡有著不同的周邊離焦能力，如何在不影響視覺品質情況下，長期配戴具有控制近視效果之離焦鏡片為本研究最重要的結果。不同光學設計在配戴時所呈現的周邊離焦型態與視覺品質將產生完全相異的結果，需加入更多相關近視控制的隱形眼鏡參與研究比較。

Purpose: The myopia-related issue has been heatedly discussed and paid attention to in global vision care in recent years. With the efforts of basic and clinical research experts, the progress of myopia control has gradually been achieved, and the contact lens with multifocal (bifocal) optical design has proven to be one of the most effective methods. This research explores the correlation between peripheral defocus and visual quality performance of soft multifocal contact lenses of different designs.Methods: Thirty-five subjects participated in this study, excluding those with experience in hard contact lenses wear, eye surgery, and ocular diseases contraindicated to contact lens wearing. The study included a total of 12 males and 23 females, aged between 19 and 27, whose refractive status is below myopia -6.00D and astigmatism -1.00D, and the respective best-corrected visual acuity of the distant and near vision is above 0.8. A Shin-Nippon open-field autorefractor was used to measure the peripheral refractive errors, and peripheral defocus of 10°, 20°, 25°, and 30° in the central, nasal, and temporal side of the horizontal field of view under the non-mydriatic pupil. The measurement of peripheral refraction was divided into two groups: normal and abnormal binocular vision. The peripheral defocus group includes four types of soft contact lenses. The visual quality measurement with lenses includes far distance VA, near distance VA, stereopsis, the amplitude of accommodation, accommodative posture, spherical aberration, and horizontal coma aberration. SPSS V22.0 statistically analyzed the results of the study. This study complied with the Declaration of Helsinki and passed the review by the Second Human Experiment Committee of the Hospital of Chung Shan Medical University (license number: CS2-20089). Results: There is no significant difference in the relative peripheral refraction between the normal and abnormal binocular vision groups. The relative myopic peripheral defocus measured by wearing different contact lenses in the normal binocular vision group, whether in M, J0, or J45, the ArtMost lens (lens 2) has the most obvious result, followed by Cooper Vision MiSight lens (lens 4). The visual quality analysis shows a significant difference in the amplitude of accommodation and spherical aberration. The amplitude of accommodation in the Cooper Vision MiSight lens (lens 4) is significantly lower than the baseline value. In spherical aberration, the ArtMost lens (lens 2) presents a significant positive spherical aberration.Conclusion:This study mainly discusses the changes in peripheral refraction, peripheral defocus, and quality of vision. The rate of myopia in Taiwan has remained high in recent years, how to slow down the progression of myopia has become a crucial public topic. In this study, the three types of central distance design multifocal (bifocal) contact lenses all have different peripheral defocusing capabilities. Wearing defocusing lenses designed to control myopia for a long time without affecting the quality of vision is the most important result of this research. The peripheral defocus and quality of vision presented by different optical designs will generate completely different results. More contact lenses designed for myopia control will be needed to participate in the research for comparison in the future.