探討雙面鏡系統延伸視距對兒童調節反應與瞳孔尺寸的影響

目的：探討使用雙面鏡系統改變目標的成像距離，對學童注視時的調節反應與瞳孔尺寸造成之影響。方法：本研究共納入57位年齡介於7到12歲之受試者，並將實驗分為兩個階段進行，第一階段為問診、屈光狀態及視覺功能檢查，第二階段則使用Grand Seiko, WAM-5500的開放式自動電腦驗光機(Open field autorefractor)，測量受試者以單眼分別於實際觀察距離的2.285公尺、0.4公尺以及使用雙面鏡系統(Double - mirror system, DMS)注視目標時，眼睛的調節反應與瞳孔尺寸。結果：統計結果發現學童的調節反應在使用雙面鏡系統時(0.37 ± 0.31D)，與觀察距離為2.285公尺(0.36 ± 0.30D)注視目標時沒有明顯差異(p > 0.05)，但在觀察距離為0.4公尺(1.34 ± 0.43D)注視目標時的調節反應，與其他兩者均有顯著差異(all p < 0.001)。另外學童的瞳孔尺寸不論在使用雙面鏡時(6.59 ± 0.91mm)或觀察距離為2.285公尺(6.60 ± 0.75mm)、0.4公尺(6.46 ± 0.67mm)注視目標時，在統計結果中皆無顯著差異(all p > 0.05)，這可能與單眼注視有關。結論：本研究中，學童的調節反應與瞳孔尺寸在使用雙面鏡系統與觀看遠方2.285公尺的目標有非常相似的結果，證明雙面鏡系統能使視距延伸達到調節放鬆的效果，這項研究結果也可能對近視控制有潛在的作用。

Purpose: To investigate the effects of remote image formed by double - mirror system (DMS) in schoolchildren’s accommodative response and pupil size.Method: Fifty-seven subjects aged between 7 and 12 years old were included in this study. The experiment was divided into two stages. The first stage consisted of case history inquiry, refraction state and visual function examination. In the second stage, the subjects gaze the target at 2.285m, 0.4m, and gaze the image through DMS respectively, the accommodative response and pupil size were measured using the Grand Seiko WAM-5500 open field autorefractor.Results: There was no significant difference between the subjects gaze the target at 2.285m (0.36 ± 0.30D, p > 0.05) and gaze the image through DMS (0.37 ± 0.31D) in the children's accommodative response. However, the accommodative response presented significantly difference between (1) the subjects gaze the target at 0.4m and 2.285m, and (2) the subjects gaze the target at 0.4m and gaze the image through DMS. Comparing the three different viewing conditions, i.e., the subjects gaze the target at 0.4m (6.46 ± 0.67mm, all p > 0.05), 2.285m (6.60 ± 0.75mm) and the subjects gaze the image through the DMS (6.59 ± 0.91mm), there was no significant difference in children's pupil size, and it was attributed to the monocular fixation. Conclusion: In this study, the results of the accommodative response and pupil size measured at 2.285m or through DMS were very similar. The viewing distance can be extended by DMS, and resulted in the accommodative relaxation. This results may have the potential in myopia control.