不同光學設計之隱形眼鏡對雙眼視覺異常成人視覺功能之影響

目的隱形眼鏡的研發技術日新月益，針對不同設計與不同目的（如近視控制、老花眼、乾眼症狀以及整體視覺品質）的產品愈來愈多，本研究以臺灣目前已上市的離焦隱形眼鏡進行臨床驗證性研究，研究欲探討配戴不同光學設計之隱形眼鏡對雙眼視覺異常成人視覺功能之影響。本研究所使用的隱形眼鏡並無診斷與治療的功能，僅針對視覺功能與視覺品質進行探究。方法本研究分為兩個部分，第一部份為問卷調查，收納20至30歲之成年人共257名，受試者填寫聚合不足綜合症問卷（CISS）以及視力發展生活品質問卷（QOL COVD-19）。第二部分研究為隨機雙盲之臨床試驗，納入第一階段分數達標（CISS 21分以上；COVD 20分以上）的受試者共35名進行研究，配戴順序以隨機輪流的方式，配戴三種不同光學設計之隱形眼鏡（水平正離焦鏡片、水平負離焦鏡片、環狀正離焦鏡片），並測量受試者每次配戴鏡片前後的雙眼視覺，檢查項目包含：視力、調節幅度、交叉圓柱鏡、正負相對調節反應、對比敏感度、雙眼近點聚合能力、立體視、近遠距離之眼位、注視偏差、調節靈敏度、聚散靈敏度、周邊意識等測量項目。本研究使用IBM SPSS Statistic v.22統計軟體進行資料之分析。結果研究結果顯示，（一）CISS與QOL COVD-19問卷對於雙眼視覺異常的篩選具敏感度與特異性，本研究受試者有內聚不足、外斜眼位、調節不足、固視偏差等四種類型；（二）在配戴不同光學設計的隱形眼鏡後，正離焦鏡片使大多數的受試者在配戴後表現出較差的調節靈敏度、較差的正相對調節與負相對調節，但卻連動出較好的調節幅度與周邊反應以及向外的眼位；負離焦鏡片受試者在配戴後表現出較差的調節靈敏度、較差的調節幅度、調節遲滯、較差的正相對調節與負相對調節，僅聚散靈敏度與周邊反應較佳，且眼位有向內移動的趨勢。兩種水平離焦鏡片對立體視與視力的影響不大，環狀離焦鏡片在這兩個項目則有較差的表現；在對比敏感度方面，只有環狀正離焦鏡片在空間高頻時對比敏感度有較好的表現；固視偏差的部份則無顯著的影響。（三）依照雙眼視覺異常項目進行個別分析，發現有外斜眼位者適合配戴負離焦鏡片；PRA值低適合配戴正離焦鏡片；調節幅度較低、NRA值較低、FCC較低與聚散靈敏度較低者適合配戴水平離焦鏡片。結論 由結果可以得知，配戴不同光學設計之隱形眼鏡後確實會改變一些雙眼視覺的相關數據，不同雙眼視覺異常類型所需要不同的離焦設計鏡片，但仍需更多研究佐證相關的結果。

PurposeThe development of contact lens design is advancing rapidly, with an increasing number of products serving for various purposes such as myopia control, presbyopic, dry eye symptoms, and improving visual quality. This study serves to clinically validate correction currently available defocus-designed contact lenses in Taiwan. It aims to investigate the effects of different optical designs of contact lenses on the visual functions of adults with binocular vision anomalies. The contact lenses used in this study are not intended for diagnosis or treatment but rather to explore their impact on visual function and quality.MethodsThis study consists of two parts. The first part involved a questionnaire survey of 257 adults aged 20–30, who completed the Convergence Insufficiency Symptom Survey (CISS) and the College of Optometrist in Vision Development Quality of Life (QOL COVD-19). The second part was a randomized, double-blind clinical trial including 35 participants from the first phase who met the inclusive criteria (CISS ≥ 21; COVD ≥ 20). The wearing sequence involved randomly alternating among three different optical designs of contact lenses: horizontal positive defocus lenses, horizontal negative defocus lenses, and annular positive defocus lenses. Before and after wearing each lens, vision functions included visual acuity, amplitude of accommodation, fused cross cylinder test, positive and negative relative accommodation (NRA/PRA), contrast sensitivity, near point of convergence, stereopsis, phoria at near and distance, fixation disparity, accommodative facility, vergence facility, peripheral awareness were evaluated. Data analysis was conducted using IBM SPSS Statistics v.22.ResultsThe findings showed that, first, the CISS and QOL COVD-19 questionnaires demonstrated sensitivity and specificity in screening for binocular vision anomalies. Participants were categorized into four types: convergence insufficiency, high exophoria at near, accommodative insufficiency, and large of fixation disparity.Second, after wearing contact lenses with different optical designs, the positive defocus lenses led to poorer accommodative facility and NRA/PRA performance but improved amplitude of accommodation and peripheral awareness, and a shift toward exophoria. The negative defocus lenses resulted in poorer accommodative facility, low amplitude of accommodation, accommodation lag, and worse NRA/PRA, but showed better vergence facility and enhance peripheral awareness, and with a trend toward esophoria. Both horizontal defocus lenses had little effect on stereopsis and visual acuity, whereas the annular defocus lenses showed poorer overall performance. In contrast sensitivity, only the annular positive defocus lens performed better at high spatial frequencies at central visual acuity. In fixation disparity, three types of lenes showed no significant effects.Third, individual analysis based on binocular vision anomaly types suggested that those with exophoria may benefit from negative defocus lenses. And those who with low PRA may benefit from plus defocus lenes. Individuals with low NRA, low accommodation amplitude, lag accommodation, or poor vergence facility may benefit from plus and minus horizontal defocus lenses.ConclusionThe results indicate that wearing contact lenses with different optical designs can indeed alter various binocular vision metrics. Different types of binocular vision anomalies may require different defocus lens designs. However, further research is needed to support these findings.