新型冠狀病毒肺炎對臺灣青壯年眼生理與雙眼視覺之影響

目的 COVID-19大流行從2020年開始爆發，這場悲劇壟罩全球三年。隨著疫情發展，各國對於該病毒的特徵及症狀都有了初步認識，卻鮮少探討該疾病對於眼生理及雙眼視覺的長期影響，特別是在年輕的族群中。考量到臺灣民眾特殊的用眼環境及不同性別、年紀或是不同屈光程度之間的差異性，本研究的目的為新型冠狀病毒肺炎對於臺灣20~35歲青壯年的眼生理與雙眼視覺之影響。方法實驗分為兩個階段。第一階段為大規模問卷調查，透過線上問卷進行大規模發放調查，調查內容包含基本資料、確診時的症狀、康復後的症狀……等變項，總計招募525份問卷；第二階段則進行眼相關的檢查，主要招募第一階段調查中表達意願的受試者，年齡皆為20~35歲的臺灣青壯年，最終有效樣本共94人，健康組共27人；COVID-19確診組共67人。第二階段測量項目包含：乾眼OSDI問卷、BIVSS問卷、CISS問卷、遠近視力、對比敏感度、瞳孔大小、立體視、色彩測試、雙眼視功能（眼位、調節幅度、聚合近點、調節與聚合靈敏度）測試、角膜內皮細胞健康狀況、淚液測試、眼表淚膜分析視網膜斷層掃描以及眼底照相。最後將所有研究對象的檢測結果及問卷內容以 IBM SPSS Statistic v22 統計軟體分析。結果 第一階段的問卷結果表明，女性與青少年族群在確診期間具有較多的症狀，當中較常被回報的眼症狀大多與眼表或視覺品質有相關，這一現象呼應了具有眼疾病或屈光狀況為高度近視的填答者的反應。而第二階段則顯示COVID-19對於瞳孔、淚膜、對比敏感度以及主觀視覺品質有關。確診組的瞳孔縮放較少、淚膜較不穩定、中低頻率的對比敏感度表現較差、調節幅度有減少的趨勢以及主觀視覺品質較差的現象。結論感染COVID-19後可能存在對於淚膜以及瞳孔反應的功能影響，進而導致調節、對比敏感度、以及主觀視覺品質下降。考量到臺灣特殊的用眼環境及為了因應未來疫情流感化所導致的調節力不足可能出現年輕化的現象，評估COVID-19患者在感染後的視覺功能以及照護的提供有其必要性。此外，仍需要進一步進行生活上的衛教及建議，以避免眼表症狀或閱讀不適惡化的現象。

PurposeThe COVID-19 pandemic broke out in 2020 and cast a shadow over the world for three years. As the pandemic has progressed, countries have begun to understand the characteristics and signs of the virus. Still, there has been little research on the long-term effects of the disease on ocular physiology and binocular vision, especially in young populations. Given the unique ocular habits of the Taiwanese population and the differences among genders, ages, or refractive errors, this study aims to investigate the effects of COVID-19 on ocular physiology and binocular vision in Taiwanese adults aged 20-35 years.MethodThe experiment consisted of two phases. The first phase consists of a large online survey covering basic information, symptoms at diagnosis, symptoms after recovery, and other variables. A total of 525 responses were received. The second phase involves optometric examinations; all participants are Taiwanese young adults aged 20-35 years. 94 subjects were obtained, with 27 in the healthy group and 67 in the COVID-19 group. Measurements in the second phase included questionnaires (OSDI, BIVSS, and CISS), distance and near visual acuity, contrast sensitivity, pupil size, stereopsis, color vision test, binocular visual function test (phoria, amplitude of accommodation, near point of convergence, accommodation and vergence facility), corneal endothelial cell health, Schirmer tests, tear film analysis, retinal optical coherence tomography (OCT) and fundus photography. Statistical analysis was performed using IBM SPSS Statistics 22 software.ResultIn the first phase, the questionnaire showed that females and adolescents had more symptoms during each COVID-19 stage. Ocular symptoms were frequently reported as mostly related to the ocular surface or visual quality, which is consistent with the responses of participants with eye disease or high myopia. In the second phase, COVID-19 is associated with changes in pupil response, tear film stability, contrast sensitivity, and subjective visual quality.　compared to the healthy group, the COVID-19 group exhibited less pupil constriction, lower tear film stability, poorer performance in mid-to-low spatial frequency contrast sensitivity, reduced accommodation amplitude, and poorer subjective visual quality. Discussion and ConclusionAfter COVID-19 infection, functional impacts on tear film and pupil response, may leading to binocular visual function and visual quality decreased. Considering Taiwan's unique ocular habits and the possibility of a future pandemic leading to an early onset of accommodative insufficiency. It is necessary to evaluate the visual function of COVID-19 patients after infection, and provide health education and recommendations in daily life to avoid worsening of ocular symptoms or reading discomfort.