不同光學設計隱形眼鏡對青年人雙眼視覺功能及視覺行為表現之影響

目的配戴隱形眼鏡會改變眼睛的調節和聚散需求，調節和聚散能力影響雙眼視覺的表現，當調節與聚散能力受隱形眼鏡介入而有所改變時，是否影響雙眼視覺功能與視覺行為表現，本研究之目的為探討配戴不同光學設計之隱形眼鏡對青年人雙眼視覺功能及視覺行為表現的影響。方法本研究採單盲之實驗研究法，藉由視覺行為表現問卷進行初步篩選，招募問卷得分達9分以上者為研究對象，總計納入19位20至26歲之受試者，完成眼表疾病指數量表後進行自覺式驗光及雙眼視覺功能檢測，作為基線期數值，測量項目包括主力眼、遠、近聚散能力、調節能力、注視偏差、水平眼位、立體視與調製傳遞函數等。在建立基線期後將所有受試者隨機分為三組並確定三組人的所有基線能力值均未達顯著差異後進行實驗，受試者分別配戴單焦點、漸進離焦非球面與雙焦點之不同光學設計隱形眼鏡，於鏡片初始配戴後、配戴隱形眼鏡的第2週與第4週進行追蹤測量，並在最後一次測量完成後填寫視覺行為表現問卷後測與視覺品質問卷。結果研究結果顯示，配戴單焦點隱形眼鏡增加調節遲滯量，影響負相對調節力及遠近聚散能力，改善聚散靈敏度及調節靈敏度，並使眼位向內斜偏移，同時提升視覺行為表現中的舒適度與肢體平衡。配戴漸進離焦隱形眼鏡使調節遲滯量降低，影響近方聚合能力及改善聚散靈敏度與調節靈敏度，並降低調製傳遞函數，說明對比敏感度下降，同時提升整體視覺行為表現，改善近距離工作、知覺行為、與肢體平衡等主觀感受。配戴雙焦點隱形眼鏡影響正負相對調節，改善聚散靈敏度、調節靈敏度與立體視，同時也對整體視覺行為表現有所改善，分別在近距離工作與肢體平衡的主觀感受特別明顯。以視覺品質而言，單焦點隱形眼鏡具有最佳的舒適度，漸進離焦隱形眼鏡較容易產生夜間光暈的困擾，而雙焦點隱形眼鏡則反應較常有重影或複視，且漸進離焦與雙焦點隱形眼鏡的遠距離視覺清晰度與穩定度較低，鏡片總體滿意度以單焦點隱形眼鏡最佳，其次為漸進離焦隱形眼鏡，雙焦點隱形眼鏡居後。結論相較於單焦點隱形眼鏡，漸進離焦與雙焦點隱形眼鏡能夠幫助調節放鬆，降低調節遲滯量，且對聚散能力造成影響；依據受試者之主觀感受，整體視覺行為表現亦有所改善，說明光學設計隱形眼鏡對雙眼視覺功能及視覺行為表現的影響性。

PurposeTheoretically, accommodation and vergence demands of the eyes will change with the wearing of contact lenses, and it will also affect the binocular vision immediately. The purpose of this study is to investigate the influence of different optical design contact lenses on binocular vision and visual behavior of young adults.MethodsThe study was a randomized, single-blind experimental research. The visual behavioral performance questionnaire (CSMU-VBP) was used for preliminary screening, subjects were included who score equal or more than 9 points. Nineteen myopic subjects aged from 20 to 26 years of age (21.59 ± 1.40 years) participated in this study. After completing the Ocular Surface Disease Index (OSDI), subjective refraction and the examination of binocular vision were performed as the baseline value, including dominant eye, distance and near vergence, accommodation, fixation disparity, heterophoria, stereopsis and Modulation Transfer Function (MTF). All the subjects were randomly grouped under the same condition, respectively wearing contact lenses with different optical designs of single-vision (Lens1), aspherical (Len2) and bifocal (Lens3) lenses. Eye examinations were performed in the first wearing day, 2nd week and 4th week. In addition, subjects filled out the CSMU-VBP visual quality questionnaire in the end of the examination.ResultsLens1 induced accommodative lag, negative relative accommodation, distance and near vergence; however, vergence sensitivity, accommodative sensitivity, heterophoria, and the comfort and balance dimensions in visual behavioral performance were improved. Lens2 reduced the lag of accommodation, and near vergence, vergence and accommodative sensitivity were improved, but contrast sensitivity was badly affected. Lens3 affected negative and positive relative accommodation, but vergence sensitivity, accommodative sensitivity and stereopsis were progressed. Furthermore, both Lens2 and Len3 enhance overall visual behavioral performance.In terms of visual quality, Lens1 was most comfortable, Lens2 had more complain about halo at night, and Lens3 was more likely to have double vision. While aspherical and bifocal contact lenses reduce distance visual acuity and stability. The order of satisfaction was Lens1, Lens2, and Lens3.ConclusionComparing with single-vision contact lens, aspherical and bifocal contact lens relax accommodation, reduce lag of accommodation, and also showed improvement of visual behavioral performance. Although vergence function showed significant change, it did not show the indeed development trends by wearing contact lenses. Different optical design contact lenses have grate influence on binocular vision and visual behavioral performance.