雙眼視覺功能與學齡前兒童氣質表現之相關

驗光師臨床上發現，雙眼視覺的好壞可能與兒童的行為或表現（可統稱氣質）有關，但到目前為止，國內外卻缺乏可以參考的驗證，因此本研究的目的在調查學齡前兒童的氣質和雙眼視覺，並探討兩者之間的關係。本研究共有32名5〜6歲的學齡前健康兒童參與，其中還包括家長和學校教師。雙眼視覺檢查內容包括單、雙眼的屈光檢查，遠方和近方慣用視力、利眼（慣用眼）、眼斜視斜位狀態、瞳孔反應、眼動能力（固定、追踪、掃視）、雙眼立體視覺、色彩視覺、調節近點與視¬動整合能力(The Beert-Buktenica Developmental Test of Visual-motor Integration, VMI)等項目 ；此外，研究亦設計一份整合兒童氣質量表（TABC）與兒童健康、營養、教養、睡眠時間、休閒活動、電視和手機或iPAD使用情形的調查問卷，要求家長和學校老師在雙眼檢查前完成兒童氣質量表的內容。32名兒童當中，男生14人（43.8％）、女生18人（56.3％）；平均身體BMI指數偏低（n = 28，87.5％），過敏體質者比例偏高（n = 18，56.3％），夜間睡眠呈現睡眠不足比例也較多（n = 23，在8-9小時內占71.9％）。在研究對象中，大多數兒童是該家庭中的長子／女（25人，78.1％），其中10人（31.3％）為獨生子女。在兒童氣質表現方面，受試兒童們為「高度適應性」，「堅持度」為次強，「活動量」、「注意力分散度」、「情緒本質」、與「趨避性」則為中低度表現。雙眼視覺檢查結果顯示，在所有受試兒童當中，有40.6％（n=13）為近視，37.5％（n=12）為遠視，84.4％（n=27）有散光。值得注意的是，有8位兒童的遠方視力和10位兒童的近方視力不佳，但卻只有一個孩子有配戴矯正鏡片。慣用眼為右利眼占59.4％（n = 19），左利眼占40.6％（n = 13）。兒童的瞳孔反應、色彩視覺、追視、固視、掃視能力都正常，但雙眼立體視和眼位狀態則明顯較差。 兒童檢測到的眼位狀態非正位有18位，其中外斜位（exo n = 15，46.9％）的兒童明顯比內斜位（eso n = 3，9.4％）的比例來得高。線性回歸分析的VIF值顯示每個變量都是一個獨立因子，因此可進行後續的逐步線性回歸分析。和兒童「活動量」相關的變項有加工食品（r=0.657, p=0.000）、性別（r=-0.496, p=0.004）; 與兒童「適應性」相關的變項有慣用利眼（r=0.467, p=0.007）和近方視力，兩者合併可解釋變異量可達28.1%；兒童「趨避性」與慣用利眼（r=0.397, p=0.024）及水果（r=-0.381, p=0.032）有顯著相關；「情緒本質」則與兒童是否為過敏體質（r=0.420, p=0.017）、夜間睡眠時數（r=-0.411, p=0.019）、加工食品（r=0.514, p=0.030）有關，過敏跟加工食品兩者合併可解釋變異量達31.3%；與兒童「注意力分散度」相關的變項包括性別（r=-0.397, p=0.024）、使用手機時數（r=-0.389, p=0.028）和夜間睡眠時數，三者合併的可解釋變異量達21.3%；此外，近視（r=0.528, p=0.002）、瞳孔反應、眼位（內斜位和外斜位）三者合併對兒童「注意力分散度」的可解釋變異量高達51%；而「堅持度」與加工食物（r=-0.397, p=0.024）有關。本研究探討兒童氣質與雙眼視覺的橫斷面模式可能是臺灣的第一項相關的研究，在雙眼視覺功能中，特別是兒童的屈光狀態、近方視力、眼位（內斜位和外斜位）、以及調節能力，都有可能在兒童氣質的教養中扮演主要的角色，更有可能進一步影響未來的學習和社交技能。

Purpose: Many clinical optometrists have indicated that binocular vision might be influence on children’s behavior or performance, but is short of references for verifing. The purpose of this study was to investigate the relationship between temperament and binocular vision for kindergarten children. Methods: There were totally 32 healthy children age from 5 to 6 participanted in the study, parents and school teachers were also included. Binocular examination included refracive errors, habitual distance and near visual acuity, dextrocularity or sinistrocularity, cover-uncover test, pupillary response, fixation, pursuit, saccades, stereoacuity, color vision, near point of accommodation, and Visual-motor Integration (The Beert-Buktenica Developmental Test of Visual-motor Integration, VMI). In addition, an questionnaire about children’s health, nutrition, upbringing, sleep hours, leisure activities, TV and mobile or iPAD use; attaching Temperament assessment battery for children(TABC) were all ask to finish by parents and school teachers before binocular examination. Results: There were 14 boys (43.8%) and 18 girls (56.3%), participants showed lower BMI index (n=28, 87.5%), high percent of irritable the physique(n=18, 56.3%) and sleep inadequate (n=23, 71.9% under 8-9 hour). Most children were the eldest child in their families(n=25, 78.1%) and 10 of them(31.3%) were singleton. Binocular examinations indicated all participants had more or less refractive errors, 40.6%(n=13) children were myopic, 37.5%(n=12) were hyperopic, 84.4%(n=27) were astigmastic, and 31.3% (n=10) were anisometropia. It was astonished that 8 (Distance VA) to 10 (Near VA) children had poor visual acuity, but only one child had been prescribed corrective lenses. 59.4% children were dextrocularity(n=19) and 40.6% were sinistrocularity(n=13). Most children had normal pupillary response(n=31, 96.9%), normal color vision(n=31, 96.9%), normal pursuit(n=32, 100%), fixation (n=30, 93.8%), and scaccades(n=31, 96.9%), but showed poor stereoacuity (n=5, 15.6%) and poor accommdation(n=13, 40.6%). Moreover, cover-uncover test detected above helf children were phoria(eso n=3, 9.4%; exo n=15, 46.9%). Additionally, VIF (Variance Inflation Factor) values of linear regression analysis indicated that each variable is an independent factor. Processed foods and gender stood out as the main factor for modulating children’s Activity Level; the modulating factors about children’s Adaptability included habitual eye and near visual acuity (adjusted X2=0.281); Approach included habitual eye and fruit; Quality of mood included processed foods, irritable the physique and sleep (adjusted X2= 0.213); Distractibility included myopia, pupil response and phoria (adjusted X2= 0.51); Persistence was associated with Processed foods. Conclusions: The cross-sectional pattern of molding children’s temperament might be the first study in Taiwan. It is still unknown if this pattern reflects a longitudinal effect, as environment is generally diversified and complex. Some of these modulators may be due to the part of the learning process that requires attention or adaptability. It should be mentioned that binocular vision, especially habtiual eye, near visual acuity, phoria(exo and exo), and accommodation might play the leading role in children’s temperament cultivation, and might have influence on their learning and social skill in the future.