透過眼動儀量測配戴軟式散光隱形眼鏡之 閱讀與視覺表現

目的探討習慣性配戴隱形眼鏡之中低度散光年輕族群使用散光隱形眼鏡以及等價球面隱形眼鏡後，視覺功能、閱讀表現、眼球表面客觀參數以及主觀問卷結果之差異性與相關性。方法本研究為隨機和單盲交叉試驗，共納入 28 名受試者，招募年齡介於 18 至 35 歲之間、眼表疾病指數量表分數低於 22 分且散光 - 0.75 至 – 2.00 DC 之中低度散光受試者。隨機配戴散光以及球面軟式隱形眼鏡，而球面組是以等價球面度數作為處方。在初始值及回訪中，主要評估受試者配戴兩種隱形眼鏡一週後之結果。使用 Snellen 視標及 ETDRS 視標分別測量遠距離及中近距離視力值，並使用 Pelli-Pobson 視標及近距離成人對比測驗測量遠近距離對比敏感度。採用開放式全視野電腦驗光儀進行他覺式屈光檢查。角膜地圖儀用來評估眼球表面相關指標，包含角膜弧度、亮暗室瞳孔大小、非侵入式淚液破裂時間、眼表保護指數與眨眼間隔時間等項目。閱讀表現使用發展性眼球運動測試以及藉由眼動儀以近年大學入學測國文閱讀測驗考題文章作為視標量測閱讀速度、眨眼、注視、躍視和回視等閱讀相關參數。藉由近距離活動視覺問卷及視覺類比量表分別評估每種矯正類型之主觀近距離視覺品質以及舒適度與乾澀度。統計方法包含Wilcoxon符號等級檢定分析兩組隱形眼鏡之視力表現、視覺功能與閱讀表現比較與Spearman檢定分析相關性。結果共 28 名受測者完成研究 ( 平均年齡 23.05 ± 3.69 歲，71.4 %為女性 )。在中距離 66 公分視力值，相比球面組 ( -0.07 ± 0.08 logMAR )，散光組表現顯著較佳 ( -0.11 ± 0.07 logMAR, p = 0.044 )。多項閱讀表現指標亦顯示散光組優於球面組。閱讀表現多項指標亦顯示散光組優於球面組。閱讀速度方面，配戴散光鏡片時平均為 345.37 ± 122.41 字/分鐘 ( wpm )，顯著快於球面組的 322.49 ± 130.65 wpm ( p = 0.032 )。總注視時間在散光組顯著較短 ( 1011.97 ± 370.68 秒 vs. 1251.86 ± 422.46 秒，p < 0.001 )；平均每字注視次數也顯著較少 ( 0.73 ± 0.26 次 vs. 0.82 ± 0.27 次，p = 0.020 )，總注視次數同樣顯著較低 ( 226.36 ± 76.52 次 vs. 291.21 ± 95.33 次，p < 0.001 )。相較於球面組 ( 4.64 ± 1.16 度，p = 0.030 )，躍視幅度於散光組略小 ( 4.43 ± 1.01 度 )，躍視次數也顯著較少 ( 225.61 ± 76.42 次 vs. 290.61 ± 95.24 次，p < 0.001 )。回視次數方面，散光組的回視進入次數明顯下降 ( 19.04 ± 7.30 次 vs. 27.93 ± 12.66 次，p = 0.002 )，regression-out 也顯著減少 ( 9.36 ± 4.45 次 vs. 12.11 ± 6.66 次，p = 0.041 )。回視進入次數與遠中視力值呈現顯著中度正相關 ( DVA : r = 0.342, p = 0.01；IVA at 80cm : r = 0.380, p = 0.004 )，總注視時間與中距離視力值呈顯著低度正相關 ( r = 0.280, p = 0.036 )。比起散光隱形眼鏡，配戴等價球面隱形眼鏡在主觀問卷結果產生顯著較佳，分別為整天舒適度 ( p = 0.001 )、直至取出舒適度 ( p = 0.002 ) 和整體舒適度 ( p = 0.001 )。結論與等價隱形眼鏡相比，中低度散光受試者在配戴散光隱形眼鏡後，在中距離視力值與眼動相關參數上表現較佳，且使用眼動儀分析評估閱讀表現可能可以提供功能性視覺的可靠結果。未來可以將不同程度之散光屈光不正納入考量，以更全面性探討散光屈光不正對於日常生活視覺表現之影響。

PurposeThis study aimed to investigate the differences and correlations in visual function, reading performance, ocular surface parameters, and subjective questionnaire outcomes after wearing toric contact lenses and spherical equivalent contact lenses in young adults with low to moderate astigmatism.MethodsThis randomized, single-masked, crossover study recruited 28 participants aged 18 to 35 years with low to moderate astigmatism ( -0.75 to -2.00 DC ). and an Ocular Surface Disease Index ( OSDI ) score below 22. Participants were randomly assigned to wear either toric or spherical soft contact lenses, with the prescriptions based on spherical equivalent power. All assessments were conducted at baseline and after one week of wear for each lens type. Distance, intermediate, and near visual acuity were measured using Snellen and ETDRS charts, respectively. Contrast sensitivity at distance and near was evaluated using the Pelli-Robson chart and the Near Contrast Sensitivity Test for adults. Objective refraction was measured using an open-field autorefractor. Corneal topography was used to evaluate ocular surface parameters, including corneal curvature, photopic and mesopic pupil size, non-invasive tear breakup time ( NIBUT ), ocular protection index ( OPI ), and interblink interval ( IBI ). Reading performance was assessed using the Developmental Eye Movement ( DEM ) and EyeLink 1000 Plus with passages adapted from the national university entrance exam ( Chinese reading section ) used as stimuli. Reading speed, blink rate, fixation duration, fixation count, saccade amplitude, saccade count, and number of regressions were collected by Eyelink 1000 Plus. Subjective outcomes was evaluated through the Near Activity Visual Questionnaire ( NAVQ ) and a visual analog scale ( VAS ) for comfort, dryness, and visual quality. Statistical analyses included between-group comparisons using Wilcoxon sign-rank test and correlation analyses with Spearman rank correlation analysis.ResultsAll 28 participants completed the study ( mean age: 23.05 ± 3.69 years; 71.4% female ). Intermediate visual acuity at 66 cm showed significantly better ( p = 0.044 ) in toric group ( -0.11 ± 0.07 logMAR ) compared with spherical group ( -0.07 ± 0.08 logMAR ). Multiple parameters in reading performance also showed better in toric group. Reading speed in toric group was 345.37 ± 122.41 words per minute ( wpm ) and 322.49 ± 130.65 wpm in spherical group, showed significant faster in reading speed while wearing toric lenses ( p = 0.032 ). Total fixation duration was shorter in toric group ( 1011.97 ± 370.68 s vs. 1251.86 ± 422.46 s, p < 0.001). Fixation per word was significantly reduced with toric lenses ( 0.73 ± 0.26 vs. 0.82 ± 0.27, p = 0.020 ), and fixation count was also lower ( 226.36 ± 76.52 vs. 291.21 ± 95.33, p < 0.001 ). Saccade amplitude was smaller in the toric group ( 4.43 ± 1.01 degree ) compared to the spherical group ( 4.64 ± 1.16 degree, p = 0.030 ), while saccade count was significantly lower ( 225.61 ± 76.42 vs. 290.61 ± 95.24, p < 0.001 ). Number of regression in decreased significantly with toric lenses ( 19.04 ± 7.30 vs. 27.93 ± 12.66, p = 0.002 ), as did number of regression out ( 9.36 ± 4.45 vs. 12.11 ± 6.66, p = 0.041 ). Number of regression in was moderately positively correlated with distance and intermediate visual acuity ( DVA: r = 0.342, p = 0.01; IVA at 80 cm: r = 0.380, p = 0.004 ). Total fixation duration showed a low positive correlation with intermediate visual acuity ( r = 0.280, p = 0.036 ). Number of regression in showed a significant moderate positive correlation with distance and intermediate VA ( DVA : r = 0.342, p = 0.01；IVA at 80 cm : r = 0.380, p = 0.004 ), and total duration demonstrated a significant low positive correlation with intermediate VA ( r = 0.280, p = 0.036 ). In contrast, participants reported significantly higher subjective comfort when wearing spherical equivalent lenses, including all-day comfort ( p = 0.001 ), end-of-day comfort ( p = 0.002 ), and overall comfort ( p = 0.001 ).ConclusionCompared with spherical equivalent lenses, toric contact lenses provided better intermediate visual acuity and reading performance in young adults with low-to-moderate astigmatism. Eye-tracking–based analysis of reading behavior may offer a reliable method for assessing functional vision. Future studies should consider including subjects with broader range of astigmatism to more comprehensively evaluate the impact of astigmatic refractive error on daily visual performance.