調查學童近距離工作時配戴近用閱讀眼鏡對其近視進展的影響

目的：探討學童在從事近距離視覺活動時配戴閱讀眼鏡對其視覺功能之改善，及在近視進展所造成之影響。利用周邊離焦原理達成有效控制近視之目標，並決定個人化近用加入度。方法：本研究共招募了55位學童參與計畫，年齡介於6歲至12歲，期初收案時有1位受測者因自行停藥造成屈光度數變化而遭排除，期中收案時則有1位受測者因未持續配戴眼鏡而排除，期末收案則有7位學童因未確實點藥而排除，完成一年收案者共計46名。點用Atropine者24人，未點用者22人。受測者皆使用寬式型驗光機於33公分處測量其屈光及調節狀態(包含裸視、遠距離矯正及近距離矯正三種狀態)，眼軸長度及眼前房深度則使用IOL Master測量。周邊屈光則測量看近時的鼻側20度至顳側20度的周邊屈光(N20, N10, Central, T10 and T20)，過程中蒐集之屈光度數皆以等價球面進行分析。結果：Atropine組與控制組一年後的等價球面屈光度數變化分別為-0.17±0.45D及-0.52±0.45D(p<0.001)，眼軸長變化分別為0.15±0.12mm及0.27±0.15mm(p<0.001)。一年後Atropine組在全部位置都出現遠視偏移，控制組則在T10及N10出現遠視偏移，但兩組別一年內的變化量皆無顯著統計差異。結論：一年平均等價球面變化在Atropine組比控制組要少(p<0.001)，眼軸長變化也是Atropine組較少(p<0.001)，且在配戴眼鏡一年後，兩組別周邊屈光變化不大，與先前文獻比較兩組皆有良好的控制效果。研究結果表示閱讀眼鏡對近視控制是有幫助的，同時可以讓點用Atropine的學童產生近視控制的加乘效果，並提供藥物對於其調節功能造成下降之輔助矯正。

Purpose: To investigate myopia progression in the children with reading glasses during their near work. And the role of the change in peripheral refraction for one-year follow-up. Methods: 55 children were enrolled from the elementary schools in Taichung city, Taiwan. 34 were females (61.8%) and 21 (38.2%) were males, with the range of the age from 6 to 12 years old. Nine children were excluded due to poor compliance. Forty-six children accomplished the measurements and were divided into the atropine group (n=24) and the control group (n=22). The accommodation and refraction were measured for the both eyes of each subject using an open-field autorefractor (SHIN-NIPPON NVISION-K 5001). The axial length and anterior chamber depth were measured by an IOL Master. The addition power were determined with the spherical equivalent refraction ≦- 3.00D at 33cm. Peripheral refractions were collected from 0° to 20° for nasal and temporal retinas. Spherical equivalents in peripheral refraction were used for data analysis.Results: After one-year follow-up of reading glasses wearing, the 1-year change in SER of atropine group and control group were -0.17±0.45D and -0.52±0.45D (p<0.001). A significant difference was found in 1-year change in AL between the atropine group and control group (0.15±0.12mm vs 0.27±0.15mm; p<0.001). After wearing reading glasses for one year, atropine group showed hyperopic shifts at all positions and the control group showed hyperopic shifts only at T10 and N10, but no statistically significant differences in 1-year change in peripheral refraction was found in both groups.Conclusions: The 1-year change in SER and AL of the atropine group was less than the control group (p<0.001). Our research confirmed that there is a greater effect of myopia control in both groups compared to the previous studies. The results suggested that reading glasses plus atropine can provide a greater beneficial effect and obtain a better myopia control. Also, the accommodative functions of the children with atropine treatment were benefited using addition lenses.