學童近視管理暨定期追蹤與家長近 視風險認知衛教成效評估

研究背景:近年來台灣學童近視盛行率持續上升，已成為重要的公共衛生議 題。許多研究指出早期介入與家長參與對近視控制效果具有正向影響。然而， 過去較少探討家長對近視控制知識的認知程度，是否與其子女的各項視覺健康 狀況有關，像是等效屈光、眼軸長以及視覺功能，亦缺乏衛教介入對家長認知 改變的成效評估。研究目的:本研究旨在以橫斷型與縱貫型研究方法，探討家長近視控制知識之 認知程度，與學童視覺參數(屈光度、眼軸長)之間的關聯性，並進一步分析 衛教介入前後家長知識改變情形及其與子女近視進展的情形間關係。研究方法:本研究共納入 69 對親子作為有效樣本。家長需填寫近視認知問 卷，並於衛教介入前後分別進行近視認知前後測;學童經詳細完整檢查後記錄 下其屈光度(SER)、眼軸長(AL)與調節遲緩(accommodative lag)等視覺參 數，並進行 6 個月和 12 個月的回診追蹤。依據問卷前測總分將家長分為高分 組、中等與不及格三組，比較其子女視覺參數之差異;另依後測得分中位數將 樣本分為高分組與低分組，共 31 位學童完成追蹤，分析其 12 個月學童近視變 化量。統計分析方法包括 Shapiro–Wilk 常態性檢定、Kruskal–Wallis H 檢定、Bonferroni 校正、Spearman 等級相關分析與 McNemar 檢定，統計顯著水準設 定為 p < 0.05。研究結果:橫斷研究結果顯示，家長前測得分與學童的屈光度呈顯著負相關 (Spearman’s r = –0.44，p = 0.014)，與眼軸長則呈正相關(r = 0.43，p = 0.015)。數據分析顯示，認知測驗(家長)高分組之學童期平均屈光度為 –3.00 ± 1.80 D，顯著低於中間組(–2.07 ± 1.57 D)與不及格組(–1.51 ± 1.62 D)(p = 0.01);眼軸長亦呈顯著差異，高分組為 24.95 ± 0.77 mm，顯著長於中間組 (24.40 ± 0.79 mm)與不及格組(24.20 ± 0.81 mm)(p = 0.042)。而其中前後測 分數在 McNemar 檢定下達統計顯著(p < 0.05)，顯示家長對近視控制知識顯 著提升。在歷時 12 個月追蹤後(縱貫型研究)，眼軸長變化量高分組為 0.28 ± 0.18 mm，低分組為 0.37 ± 0.24 mm，差異未達統計顯著(p = 0.278)。家長認知於 衛教介入後後測總分與 12 個月的 SER 變化量呈現正相關(r = 0.44，p = 0.014)。研究結論:本研究發現家長的近視控制認知程度與其學童之近視狀況呈顯著相 關性，學童的近視越嚴重，家長的近視認知越高，完成追蹤後的學童等效屈光 變化量也隨著家長後測分數越高增加越少。經過衛教介入後家長知識在短期成 效上有立即提升認知(前後測)，顯示衛教策略具有實質成效; 在長期成效上則需要更多樣本數或者更長近視監控期，未來應持續強化家長端之視覺健康教育，作為延緩學童近視惡化的補助介入方式。

Background:AbstractThe prevalence of myopia among schoolchildren in Taiwan has been steadily increasing in recent years, posing a significant public health concern. Previous studies have shown that early intervention and parental involvement have a positive impact on myopia control. However, few studies have investigated the relationship between parental knowledge of myopia control and their children's visual health status, and there is a lack of evaluation regarding the effectiveness of educational interventions in improving parental awareness.Purpose:This study aimed to explore the association between parental knowledge of myopia control and children’s visual parameters (spherical equivalent refraction and axial length), as well as to assess changes in parental knowledge before and after health education and its potential relationship with myopia progression in their children.Methods:A total of 69 parent-child pairs who received myopia control consultation and treatment at a vision clinic were included. Parents completed a myopia awareness questionnaire before and after a structured educational intervention. Children's visual parameters, including spherical equivalent refraction (SER), axial length (AL), and accommodation lag, were recorded at baseline and after a one-year follow-up. Parents were grouped into high, medium, and low categories based on pre-test scores to compare their children's baseline visual status. Post-intervention scores were divided by median split into high and low groups, with 31 children completing the one-year follow-up. Statistical analyses included the Shapiro–Wilk test for normality, Kruskal– Wallis H test, Bonferroni correction for post hoc comparisons, Spearman’s rank correlation, and the McNemar test. The significance level was set at p < 0.05.Results:Parental pre-test scores were significantly negatively correlated with children’s SER (Spearman’s r = –0.44, p = 0.014) and positively correlated with axial length (r = 0.43, p = 0.015). At baseline, children in the high-score group had a mean SER of – 3.00 ± 1.80 D, significantly higher in myopia compared to the medium group (–2.07 ± 1.57 D) and the low group (–1.51 ± 1.62 D) (p = 0.01). Axial length was also significantly longer in the high group (24.95 ± 0.77 mm) than in the medium (24.40 ± 0.79 mm) and low (24.20 ± 0.81 mm) groups (p = 0.042). Parental questionnaire scores significantly improved after the intervention, with items showing statistical significance in McNemar’s test (p < 0.05).At the one-year follow-up, the mean axial length change was 0.28 ± 0.18 mm in the high-score group and 0.37 ± 0.24 mm in the low-score group, though the difference was not statistically significant (p = 0.278). Post-intervention total scores were positively correlated with 12-month SER change (r = 0.44, p = 0.014).Conclusion:The findings suggest that parental knowledge of myopia control is associated with their children's myopic status. Consistent trends were observed across both baseline comparisons and follow-up outcomes. Health education interventions significantly enhanced parental awareness, indicating their practical value. Strengthening parent- targeted myopia education may serve as a supplementary strategy to slow myopia progression in children.