| 摘要: | 研究目的:
視光領域臨床檢查經常引用的傳統雙眼視覺Morgan標準值（1944年）與Scheiman標準值（1994年），OEP期望值距今已久，隨著時代演進與科技的發展，用眼的習慣與需求已經有很大的改變，臺灣的臨床判定標準可審視其適用性。
研究方法:
本研究以調查研究法進行，調查年齡為15至24歲的臺灣青年，主要收案的對象為中山醫學大學、亞洲大學、康寧大學、及馬偕醫護專科學校四間學校的視光學系(科)學生為主，進行第一部分視覺行為表現量表之問卷調查及第二部分為24項的雙眼視覺機能檢測。問卷分成（一）近距離工作、（二）知覺、（三）舒適度、（四）肢體平衡四大向度。研究者依受測者視覺行為表現問卷的填寫結果將受測者分為「無明顯症狀」與「有症狀」兩組，並將四個向度的分組結果做ROC曲線分析，企圖建構臺灣青年雙眼視覺功能之標準值。
研究結果:
本研究總計招募308名15-24歲的健康青年人，平均年齡為18.7 ± 1.7歲；83名男性、225名女性。調節及聚散異常之發生頻率為15%（46位），其中又以調節過度（13人, 4.2%）及內聚過度（12人, 3.9%）最為常見。
根據問卷結果分析，受測者當中有43人（14%）的被歸類為有症狀，其餘265人（86%）為無明顯症狀；46位雙眼視覺機能異常的受測者中，有接近78%（36人）表示無明顯症狀。統計結果發現，有症狀組的最佳矯正視力及雙眼調節靈敏度數值皆顯著低於無明顯症狀組。
研究受測者雙眼視覺機能大多數與傳統標準值皆有統計上之顯著差異，僅雙眼調節靈敏度未達顯著差異。而達顯著差異之檢查項目，除了遠方基底朝內稜鏡至破裂點、回復點及調節幅度高於傳統標準值，其餘皆低於傳統標準值。
以屈光度、性別、聚合近點、調節幅度與雙眼調節靈敏度為分組的依據，分別進行組間的差異考驗，高度近視組在調節幅度及雙眼調節靈敏度方面顯著高於輕中度近視及遠視組；女性的聚合幅度顯著高於男性；符合聚合近點、調節幅度與調節靈敏度標準者之最佳矯正球面度之平均近視度數、內聚能力及調節幅度皆顯著高於未符標準者；視覺行為量表與雙眼視覺機能之線性回歸分析表可發現，總量表及近距離工作、知覺向度之分數會隨著雙眼調節靈敏度的表現呈負相關；舒適度向度的分數會隨著遠方基礎眼位的表現呈負相關，而肢體平衡向度的分數會隨著近方注視偏差量的表現呈正相關。研究最後利用ROC曲線分析企圖找出不同向度臺灣青年雙眼視覺之鑑定標準值(切節點)。
結論與建議:
臺灣青年人的雙眼視覺平均值表現差於傳統期望值，且運用傳統雙眼視覺機能異常分類標準，診斷為雙眼視覺異常的受測者中有接近八成表示無明顯症狀。隨著時代變遷及人種差異，用眼習慣與需求大大增加，建構屬於臺灣的雙眼視覺功能之標準值勢在必行。此外，因為雙眼調節靈敏度能預測多數的視覺行為表現，建議將雙眼調節靈敏度的檢查納入常規的驗光檢查中，對患者視覺行為表現及困擾的判斷很有效益。
Purpose
Traditional normative values of binocular vision known as Morgan’s, Scheiman’s and OEP expected findings have been used for a long time in clinical optometric examination. However, with the advancement of technology,visual habits and demands of have also changed, therefore, clinical assessment could examine those applicability against Taiwan.
Methods
This study surveyed.Participants between 15-24 years old recruited from Chung Shan Medical University, Asia University, University of Kang Ning and MacKay Junior College of Medicine, Nursing and Management. First part of study was filled out the Visual Behavioral Performance questionnaire （CSMU-VBP） and second part was a 24-steps examination. The questionnaire was divided into four parts （1） near work,（2）visual perception,（3）comfort and（4）balance of body. Participants were separated into symptomatic or non-sx.group based on the questionnaire.Data were analyzed with receiver operating characteristic curve (ROC curve) to establish normative value for Taiwan young adults.
Results
Total participants were 308 healthy Taiwanese young adults (83 males and 225 females); the mean age of the participants was 18.7 ± 1.7 years and prevalence of accommodation or vergence anomalies was 15% (46 participants). Most common dysfunctions in this sample population were accommodative excess (13 participants, 4.2%) and convergence excess (12 participants, 3.9%). Based on the questionnaire 43 participants were identified as symptomatic.Of the46 participants who were tested as having binocular visual anomalies,nearly 78% were asymptomatic indicated no significant symptom based on the questionnaire. Both of best corrected visual acuity and binocular accommodative facility in the symptomatic group were less than the asymptomatic group.
Most binocular visual functions in this study showed significant difference from the traditional normative value. Amplitude of accommodation、 base-in prism to break and recovery points at distancewere higher than the traditional normative values.While others were lower. Furthermore, participants were divided into each groups by refraction, gender, near point of convergence, amplitude of accommodation and binocular accommodative facility. Amplitude of accommodation and binocular accommdative facility in high myopic group are significantly higher than moderate myopic, low myopic and hyperopic group.Nevertheless, amplitude of convergence in females was higher than males.
The simple regression of CSMU-VBP and binocular visual functions showed that the overall questionnaire, near work and visual perception were negatively correlated with binocular accommodative facility; comfort was negatively correlated with basic phoria at distance; category of balance of body was positively correlated with associated phoria at near. Finally, we identified the normative values of binocular visual in Taiwanese young adults using ROC curve analysis.
Conclusion and Suggestion
According to the results, mean values of binocular vision funtions in Taiwanese young adults were less than traditional normative values. There were about 80% of subjects identified with binocular vision anomalies diagnosed with traditional normative values,but had no visual complaints. Moreover, with the change of times, race difference and greater VIS. Needs it is essential to establish binocular visual normative values for Taiwanese young adults. This study also showed that binocular accommodative facility could predict most of the visual behavioral performance. We suggest performing binocular accommodative facility as part of the routine eye examination. |
