評估早期老花眼患者配戴軟式漸進多焦點隱形眼鏡的像差與視覺功能表現

目的評估30~45歲的成年人(老花眼前期)配戴漸進多焦點軟式隱形眼鏡與單焦點隱形眼鏡的視覺功能與視力品質的差異，並受測者配戴主觀感受度進行分析。方法20名受測者（13位女性；7位男性，平均年齡37.15 ± 4.45歲）配戴一款單焦點日拋隱形眼鏡與兩款多焦點日拋隱形眼鏡。受測者配戴研究鏡片(每天至少配戴6小時，在配戴鏡片之間至少有1天的清除期)，測量配戴時遠距離視力、中距離視力、近距離視力、低對比度遠距離視力與近距離視力、雙眼視覺檢查(近點內聚力、近點調節力、調節幅度)、高階像差、工作距離測量以及配戴主觀感受問卷。結果單焦點日拋隱形眼鏡與多焦點日拋隱形眼鏡Ｂ在遠距離視力有顯著差異（左眼：P = 0.004；雙眼：P = 0.010）。單焦點隱形眼鏡與多焦點隱形眼鏡Ａ的高階像差有顯著差異(左眼水平彗星像差：p＜0.001；右眼水平彗星像差：p＜0.001；右眼垂直彗星像差：p＝0.001；右眼第四階球面像差：p=0.035)；單焦點日拋隱形眼鏡與多焦點日拋隱形眼鏡Ｂ的像差有顯著差異（右眼水平彗星像差：p＜0.001；左眼水平彗星像差：p＜0.001；右眼第四階球面像差：p=0.007）。主觀感受問卷是配戴多焦點日拋隱形眼鏡Ｂ在眼睛感到乾澀(p=0.028)、眼睛感覺到有刺痛感或是異物感(p=0.044)中統計上顯著的比配戴單焦點日拋隱形眼鏡多；而對於遠距離視力(p=0.004)、中距離(電腦)視力(p=0.033)、夜間開車或騎車(p=0.035)、轉頭或是水平移動(p=0.030)、整體感覺(p=0.006)中統計上顯著的比配戴單焦點日拋隱形眼鏡差。配戴多焦點日拋隱形眼鏡B在眼睛感覺到有刺痛感或是異物感(p=0.008)、視力感到模糊(p=0.045)、眼睛會過度眨眼(p=0.018)中統計上顯著的比配戴多焦點日拋隱形眼鏡A多；而遠距離視力(p=0.026)、中距離(電腦)視力(p=0.033)、整體感覺(p=0.009)中顯著的差於配戴多焦點日拋隱形眼鏡A。對比敏感度視力檢查、雙眼視覺功能檢查與工作距離測量在三款鏡片中並沒有顯著差異。結論單焦點日拋隱形眼鏡與多焦點日拋隱形眼鏡相比，有更好的遠視力、更少的高階像差與主觀感受度的分數也較高。但兩款多焦點隱形眼鏡和單焦點隱形眼鏡相比，多焦點日拋隱形眼鏡比單焦點日拋隱形眼鏡有更好的中近距離視力。主觀感受度上，在中近距離視力，受測者更偏好選擇配戴多焦點日拋隱形眼鏡。

PurposeThis study aims to evaluate the visual function and visual performance in 30- to 45-year-old subjects (early presbyopes) wearing one single focus and two multifocal soft contact lenses (MFSCLs) to compare the differences. MethodsTwenty adult (13 females, 7 males; mean age, 37.15 ± 4.45-year-old) wore one single vision contact lens (SVCL) and two multifocal contact lenses (MFCLs).The participants wore lenses at least 6 hours a day and a one day wash-out period was allowed for each lens trial between the total four measurements (baseline exam and three follow-up visits). The methodology included distance and near visual acuity (100% contrast), contrast sensitivity visual acuity (100% to 10%), binocular function (near point on convergence, near point on accommodation and amplitude of accommodation), high order aberrations, work distance data and subjective questionnaires.ResultsDistance VA was significantly higher in SVCL than MFCL B (p=0.004 in OS; p=0.010 in OU). For a 5-mm pupil, a significantly high order aberration was found in the subjects fitting with MFCL A than in those with SVCL (p＜0.001 in OS horizontal coma; p＜0.001 in OD; horizontal trefoil; p＝0.001 in OD vertical coma; p=0.035 in OD SA 4th). With NFCL B, more high order aberrations were found comparing with SVCL (p＜0.001 in OD horizontal coma; p＜0.001 in OS horizontal coma; p=0.007 in OD SA 4th). For subjective investigation, dry eyes (p=0.028), eye pain or foreign body sensation (p=0.044) in the subjects with MFCL B was significantly greater than SVCL; and with MFCL B in distance VA (p=0.004), intermediate clarity distance VA (p=0.033), driving at night (p=0.035), head rotation or horizontal move (p=0.030), total sensation (p=0.003) were worse than SVCL. For MFCL B in eye pain or foreign body sensation (p=0.008), blur vision (p=0.045), blink rate increased (p=0.018) was significantly greater than MFCL A; and with MFCL B in distance VA (p=0.015), intermediate clarity distance VA (p=0.033), total sensation (p=0.009) were worse than MFCL A. Finally, no significant differences in stereopsis and contrast sensitivity, binocular function and work distance were found in MFSCLs compared to SVSCLs. ConclusionsSingle vision contact lenses provide a better distance visual acuity, less high order aberration. No significant differences were found in accommodative amplitude, near point of convergence, stereopsis and accommodative facility between single vision and multifocal soft contact lens wearing. The participants with MFCL wearing had a greater subjective sensation and a better intermediate and near visual acuity than those wearing SVCL.