| Abstract: | 本研究之目的在了解國小學童長效型睫狀肌麻痺劑的點用情形與在視力、雙眼視覺機能及視覺反應異常的風險評估。研究設計分為兩部分，問卷及視覺相關檢查，使用的統計方法為描述統計（descriptive statistical）與風險評估（Odds Ratio），最後利用χ2 pearson 分析視力、雙眼視覺機能及視覺反應三者的相關。
參與的學童共1067位，問卷回答從未點用者佔多數，過去長期點用的學童約佔兩成，目前正在點用的也佔一成五。點用的學童在性別變項上無顯著差異，但都市化高的學童點用比例也顯著較高，且五、六年級學童與高度近視的學童之點用比例亦顯著偏高。比較值得注意的問題是，不論是過去長期點用或目前正在點用睫狀肌麻痺劑，都有四成至六成的學童未接受屈光矯正。
研究進一步將學童的點用狀況以及學童的瞳孔反應交集分組進行風險評估，在近距離慣用視力與最佳矯正視力未達0.8方面，點用組的風險皆為未點用組的2~3倍。而在雙眼視覺機能異常方面，點用組在調節近點、調節靈巧度、遮蓋測試、近方斜位、調節與內聚比值、聚合近點之回復點、躍視及立體視等項目，功能異常的風險皆較未點用組顯著來得高（Odds= 1.838~11.000），未達顯著差異的只有聚合近點之破裂點一項。
此外，由學童在戶外活動、室內看遠、室內看近及室內中近距離使用3C產品等四種情境的視覺反應結果來看，點用組於戶外時較易覺得陽光刺眼無法睜開眼睛（Odds= 6.575），雖然未配戴太陽眼鏡或變色鏡片的風險比未點用組低（Odds= .312），但仍有超過八成不常配戴。另外室內三種情境的視覺反應當中，點用組看不清楚、頭部歪歪的、以及斜眼看的風險皆明顯高於未點用組；而較為嚴重的副作用如頭痛、眼睛疼痛或流眼淚在兩組之間的風險差異則不顯著。其他點用組在室內看遠與室內看近時出現眼睛痠澀疲勞想睡的反應比例偏高，在室內看近時出現雙重影像與常分心需較長時間完成功課的風險亦較未點用組來得高。
有鑑於國內學童點用atropine的普遍，建議對於對於睫狀肌麻痺劑的使用須更加謹慎小心，包括點用對象的篩選、點用過程的注意事項、點用學童的反應、點用期間的視覺檢查與屈光矯正及停藥之後的後續追蹤等等，皆有賴學童家長與專業人士的共同參與，以降低點用副作用之風險。
Purpose: Using topical cycloplegics for the control of school myopia has a long history in Taiwan. While the physiological side-effects of cycloplegia, such as poor near vision and photophobia, are well-recognized, the impact on subjective visual complaints and binocular functions is much less understood. Since the subjective complaints can also interfere with academic learning, they are addressed in the present study.
Methods: 1,067 students of ages ranging from 6 to 12 years old with no eye diseases and otherwise healthy participated in the study. General ocular examination included testing of visual acuity, pupillary response to light, objective and subjective refraction, and binocular functions. For the purpose of the present study, the completion by participating students and their parents of a questionnaire on visual complaints adopted from CISS and COVD-QOL was done after the eye examination. Data were then analyzed for Odds Ratio (OR) as well as with χ2 Pearson by using the SPSS 18 package.
Results: 63.8% never used cycloplegics whereas 21.4% were long-term past users and 14.7% present users. The highest usage was seen in Grades 5 (20.5%), Grades 6 (17.8%), and Grades 2 (17.1%). Among the cycloplegic users, results showed an increase of 34.3% in the high myopia group and 22.4% in the low myopia group. A lag in optical correction was also noted: while 33.3% of the current cycloplegic users wore prescription spectacles, 57.7% had no optical correction at all.
Comparing to the non-users, cycloplegic users had more photophobia complaints during outdoor activities (OR=6.575, CI=3.699~11.687), worse habitual near visual acuity and worse best corrected visual acuity (OR=2.618~2.955), and higher risks in declining visual functions such as near point of accommodation (OR=7.379, CI=4.218~12.971), accommodation facility (OR=11.000, CI=2.996~40.386), cover test (OR=2.335, CI=1.122~4.857), near phoria (OR=1.838, CI=1.075~3.143), AC/A ratio (OR=2.698, CI=1.308~5.565), near point of convergence recovery (OR=1.958, CI=1.096~3.498), saccades (OR=2.710, CI=1.561~4.707), and stereopsis (OR=5.715, CI=3.118~10.473).
In addition, cycloplegic users were at higher risk in several categories: (1) Blurred vision, head tilting when viewing distance (OR=11.599, OR=7.482) and near (OR=14.052, OR=4.205), and also when using digital devices (OR=4.711, OR=6.485). (2) Sore eye or eye fatigue when viewing distance (OR=6.485) and near (OR=2.928); although no statistically significant difference was noted when using digital devices (OR=1.704). (3) Double vision (OR=7.448) and difficulty completing assignment on time that required near work (OR=1.929). In addition, cycloplegic therapy was accompanied by a lack of timely optical correction (Chi-Square Pearson R=0.096~0.266, p=.000~.035 ).
Discussion: Our results showed that while cycloplegic therapy appears somewhat effective, the visual functions were clearly altered which was accompanied by a lack of timely optical correction, little or no active protection against photophobia, and inadequate near vision care.
Early detection and remedial action of visual complaints is important owing to the impact on academic learning and the quality of life. Government-mandated public education for parents and teachers may be imperative if cycloplegic therapy for controlling school myopia is to be widely applied. |
