散光成像及鐘面圖30法則原理

散光為屈光不正的一種，與近視及遠視的不同在於其網膜上的像不成為一個焦點，而是兩條焦線。

在規則性散光當中，眼屈光系統的兩條主徑線分別在網膜附近成為兩條互相垂直的焦線。

依兩條主徑線的屈光強度而決定其前後

• 屈光力較強主徑線成像在前
• 屈光力較弱主徑線成像在後

以矯正鏡片的負柱鏡矯正屈光力較強的主徑線
定義屈光力較弱的主徑線為散光的軸度

多數人眼睛的垂直方向的屈光力較強，因此稱為順規散光

如上圖右

• 90度屈光力強，形成180度焦線在網膜之前
• 180度屈光力弱，形成90度焦線在視網膜之上，為散光軸

因此多數人在近視且順散，未矯正情形之下，會覺得垂直方向的線條較清楚。

也就是患者覺得清楚的方向與其處方軸度方向相差90度。

所以可以利用此原理，請患者陳述覺得最清楚的方向，判斷其散光軸度。

最簡單而普遍的方式就是鐘面圖，在霧視的情況下，讓患者觀看時鐘狀的圖形，描述其所見最清楚的線條，最清楚的鐘點數x30即為其散光軸度。

如上圖，患者覺得6-12最清楚，在時鐘上及視網膜上皆為90度方向，因此其散光軸度為與90垂直的180度。6x30=180

如上圖，患者覺得3-9最清楚，在時鐘上及視網膜上皆為180度方向，因此其散光軸度為與180垂直的90度。3x30=90

但到這邊卻無法解釋其餘角度，例如1-7清楚為散光軸度1x30，但在患者所見時鐘上卻是60度清楚(以三點鐘為座標0度)，而與60度垂直的是150度，並不是30度。

這是因為患者所見方向與檢查者所見試鏡架上的方向是左右相反的。

如上圖，3-9清楚時，雖然同樣為180度，但患者所見0度在時鐘的3點鐘(耳側)方向，而在試鏡架上耳側方向卻是180度。

如上圖，患者所見1點鐘為時鐘的60度方向，而實際上在患者的試鏡架上卻是120度。

如上圖，因此患者覺得清楚的方向在眼內為120度，模糊的是30度，因此其散光軸度為30度。

依此類推2-8方向清楚為散光軸度60度，最模糊焦線為60度，最清楚焦線為150度。

光線強度、藍光與近視

http://wechat.fingerdaily.com/thread-107470-1-1.html

以上是google查到的圖-犯了那些錯誤呢?

沒時間的就直接看結論與建議! 有部分可能跟您所想的不同!

結論

1. 實驗顯示，在低光照時，眼睛會對於影像劣化較為敏感，長時間低亮度近距離工作，會導致近視容易增加。
2. 從統計數據來看，學童每天於戶外明亮環境活動能有效對抗近視發展。
3. 在成長階段，短波長的光(接近藍光的波長)似乎對眼球的生長有一定的調節作用，且較能抑制近視的發生。

建議

1. 每天要有一段時間於戶外明亮光線下活動。
2. 近距閱讀工作，要有明亮且舒適的白光照明。
3. 不要為了趕潮流長時間(包括室內)配戴太陽眼鏡。
4. 不建議成長中的學童配戴抗藍光鏡片，無益於近視控制。
5. 關於藍光的傷害-不管何種波長，只要能量過強，都會傷害視網膜。

有興趣的就看看以下相關的研究結論及參考文獻~

一、關於光亮度與近視的研究文獻

1. 學校兒童夏季的近視增加較慢。
2. 雞近視實驗--高亮度環境飼養雞未近視，低亮度環境卻製造近視；高亮度環境飼養雞其中一眼戴太陽眼鏡，帶鏡眼近視。高亮度的環境，不管陽光或人工燈光，皆能阻止雞近視形成
3. 光亮度阻止近視可能與dopamine(一種神經傳導物質，經研究與近視的形成有關)有相關性，實驗雞注射dopamine拮抗劑能消除光的保護作用。
4. 猴實驗類似，且發現連續5小時以上高光照才有效。
5. 也能解釋戶外活動對近視防治的效果。
6. 對眼的影像品質--亮光-瞳孔縮小能增加焦深，使網膜上影像清晰。暗-瞳孔放大-球面像差增加(近視者像差較正視者大)。
7. 低亮度對雙眼視覺也有負向作用，若有內斜問題者情況會惡化。

二、關於光波長與近視，目前的實驗及研究

色光--  紅橙黃綠藍紫

波長--   較長--- 較短

1. 光具有色散現象-過濾藍光鏡片會表現出輕微近視。
2. 此色散現象是否會影響人眼偵測網膜影像焦點的正確性及正視化的進行仍有爭議。
3. 近讀時選擇性地消除長波長，明顯降低調節刺激約0.50D，顯示視覺系統近讀時主要使用長波長光，在分子生物研究中也得到類似的結論。
4. 豬近視實驗--長波長燈光環境下飼養的豬較易近視及有較深玻璃體腔深度(眼軸長)。
5. 戶外活動較能減少近視增加，可能由於戶外光線波長較室內燈光短。
6. 帶著藍色鏡片於戶外活動，眼球生長較慢。
7. 藍光可能有益於人體中央神經系統的dopamine調整。
8. 鼠近視實驗--相對於正常白光，養於中波長環境的豬，發展出近視；而飼養於短波長環境的豬，發展出遠視。
9. 鼠近視實驗--即使用負鏡片誘發近視的豬，藍光都能抑制眼軸生長。
10. 雞近視實驗--紅光誘發近視，藍光誘發遠視。
11. 猴近視實驗--長波長光是近視的危險因子。

本文主要翻譯於Dr. rer. nat. Klaus Schmid, Physicist所著之

Myopia Manual Edition January 2015，P133-142。個人有所增刪。作者此部分章節所引用的參考文獻如下。

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Woung LC, Lue YF, Shih YF, Accommodation and pupillary response in early-onset myopia among 

schoolchildren, Optom Vis Sci 1998 Aug; 75(8): 611-6    

Charman WN, Radhakrishnan H. Accommodation, pupil diameter and myopia. Ophthalmic Physiol Opt. 2009 Jan;29(1):72-9    

Young, Francis A, The effect of nearwork illumination level on monkey refraction, Am J Optom and Arch Am Acad Optom 1969; 46(9), referenced in referenced in The prevention of acquired myopia, 

http://members.aol.com/myopiaprev/page2.htm    

Lang G, Augenheilkunde, Georg Thieme Verlag Stuttgart New York, 2000, p. 228 

Schaeffel F, Presseerklärung im Rahmen der 96. Tagung der Deutschen Ophthalmologischen Gesellschaft, 19. – 22. September 1998, Berlin    

 Feldkaemper M, Schaeffel F. Are retinal image brightness and spatial frequency distribution independently processed during deprivation myopia development? Investigative Ophthalmology and Visual Science 37: 1497(1996)    

 Ashby R, Ohlendorf A, Schaeffel F. The Effect of Ambient Illuminance on the Development of Deprivation Myopia in Chicks. Invest Ophthalmol Vis Sci. 2009 Jun 10.   

 Ashby RS, Schaeffel F. The effect of bright light on lens compensation in chicks. Invest Ophthalmol Vis Sci. 2010 Oct;51(10):5247-53. Epub 2010 May 5.    

 Optom Vis Sci. 2011 Vol. 88, No. 3; 13th International Myopia Conference Symposium Summaries, Symposium 5, Paper 2 by Ashby R and Morgan I    

 Moore, S. E., Irving, E. L., Sivak, J. G., Callender, M. G.: Decreased light levels affect the emmetropization process in chickens. In: Vision Science and its Applications. OSA Technical Digest Series, Vol. l (Optical Society of America, Washington DC), S. 202-205 (1998)    

 Schmid KL et al. The effect of common reductions in letter size and contrast on accommodation responses in young adult myopes and emmetropes. Optom Vis Sci. 2005 Jul;82(7):602-11    

 Cohen Y et al. Dependency between light intensity and refractive development under light-dark cycles. Exp Eye Res. 2010 Nov 3    

 Smith EL 3rd et al. Protective effects of high ambient lighting on the development of form-deprivation myopia in rhesus monkeys. Invest Ophthalmol Vis Sci. 2011 Dec 14  

Backhouse S, Collins AV, Phillips JR. Influence of periodic vs continuous daily bright light exposure on development of experimental myopia in the chick. Ophthalmic Physiol Opt. 2013 Sep;33(5):563-72   

Lan W, Feldkaemper M, Schaeffel F. Intermittent episodes of bright light suppress myopia in the chicken more than continuous bright light. PLoS One. 2014 Oct 31;9(10):e110906.   

 Roberts JE, Visible light induced changes in the immune response through an eye-brain mechanism 

(photoneuroimmunology), I Photochem Photobiol B 1995 Jul; 29(1): 3-15    

Norton TT1, Siegwart JT Jr. Light levels, refractive development, and myopia--a speculative review. Exp Eye Res. 2013 Sep;114:48-57.  

 Atchison DA, Smith G, Efron N, The effect of pupil size on visual acuity in uncorrected and corrected myopia, Am J Optom Physiol Opt 1979 May; 56(5): 315-23    

 Paquin MP, Hamam H, Simonet P, Objective measurement of optical aberaations in myopic eyes. Optom Vis Sci 2002 May;79(5):285-91    

 Owens, Liebowitz, Accommodation, convergence, and distance perceprtion in low illumination. Am J Optom Physiol Opt 1980 Sep;57(9):540-50   7    REFERENCES 341

 Kersten D, Legge GE, Convergence accommodation. J Opt Soc Am 1983 Mar;73(3):332-8    

 Vannas AE, et al. Myopia and natural lighting extremas: risk factors in Finnish army conscripts. Acta Ophthalmol Scand. 2003 Dec;81(6):588-95    

Lan W1, Feldkaemper M, Schaeffel F. Bright light induces choroidal thickening in chickens. Optom Vis Sci. 2013 Nov;90(11):1199-206.   

 Illuminance – Recommended Light Levels http://www.engineeringtoolbox.com/light-level-rooms-d_708.html    

 Millodot M, Stevenson RW, Electrophysiological evidence of adaptation to colored filters. Am J Optom Physiol Opt 1982 Jun;59(6):507-10    

 Schmid KL, Wildsoet CF. Contrast and spatial-frequency requirements for emmetropization in chicks. Vision res 1997 Aug;37(15):2011-21   

 Kroger RH, Binder S. Use of paper selectively absorbing long wavelengths to reduce the impact of educational near work on human refractive development. Br J Ophthalmol 2000 Aug;84(8):890-3    

 Kubena T, Kubena K, Galatik A, Neumann P. Effect of infrared rays on the eye in progressive myopia. Cesk Slov Oftalmol 1999 May;55(3):155-9    

 Long Q et al. Illumination with monochromatic long-wavelength light promotes myopic shift and ocular elongation in newborn pigmented guinea pigs. Cutan Ocul Toxicol. 2009;28(4):176-80.    

 Optom Vis Sci. 2011 Vol. 88, No. 3; 13th International Myopia Conference Symposium Summaries, Kexnote Lecture 3 by Neitz J and Neitz N.    

 Long Q et al. llumination with monochromatic long-wavelength light promotes myopic shift and ocular elongation in newborn pigmented guinea pigs. Cutan Ocul Toxicol. 2009;28(4):176-80.    

 Hathaway WE. Effects of School Lighting on Physical Development and School Performance The Journal of Educational Research Volume 88, Issue 4, 1995    

 Cowan RL et al. Differential effects of D-amphetamine on red and blue light-induced photic activation: A novel BOLD fMRI assay of human dopamine function. Synapse. 2008 Apr;62(4):268-72. doi: 10.1002/syn.20491.    

 Quian YF et al. Transfer from blue light or green light to white light partially reverses changes in ocular refraction and anatomy of developing guinea pigs. J Vis. 2013 Sep 26;13(11)    

Jiang L et al. Interactions of chromatic and lens-induced defocus during visual control of eye growth in guinea pigs (Cavia porcellus). Vision Res. 2014 Jan;94:24-32   

Foulds WS, Barathi VA, Luu CD. Progressive myopia or hyperopia can be induced in chicks and reversed by 

manipulation of the chromaticity of ambient light. Invest Ophthalmol Vis Sci. 2013 Dec 9;54(13):8004-12   

 Shang YM et al. White Light-Emitting Diodes (LEDs) at Domestic Lighting Levels and Retinal Injury in a Rat Model. Environ Health Perspect. 2014 Mar;122(3):269-76    

 Igor Kanin, Personal communication   a570 

 Liberman J, Light: Medicine of the future, Bear & Co, 1992 

關於兒童近視控制所使用之散瞳劑濃度你應該要知道的事

簡單的說

1.長效型散瞳劑(睫狀肌麻痺劑)-阿托品，濃度越高，控制近視的效果越好，但副作用也隨之越強，停藥之後的近視反彈現象也越嚴重，各項視覺功能的恢復期也越長。

2.不同學童對於相同濃度藥物的副作用反應並不完全相同，真正適合的藥物濃度需要經過詳細檢查評估(瞳孔、調節、遠近視力甚至雙眼視覺功能等等...)才能確定。

---------------------------------------------------------------------------------

近視率高居世界之首的台灣，國內推估曾點用散瞳劑之學童約在四成左右。

但許多學童及家長並不完全清楚所點用之藥物種類、濃度、使用方式、注意事項及副作用等。

這是相當危險的事情!!

在Ophthalmology 2012期刊當中，ATOM計畫(Atropine for the Treatment of Childhood Myopia study)回顧過去所做的研究 

發現點用Atropine 1.0%兩年的期間，控制近視的效果可達80%
當濃度下降後，0.5% 可達75%，0.1%可達70%
即使低至0.01%，仍有60%的近視控制效果。

但在停藥一年之後，1.0%點用組的近視快速的增加，幾乎將兩年點用期間所控制的近視，全數奉還。共三年的實驗結果，與點用安慰劑組的結果幾乎相同(點用組-1.37 vs 安慰劑組-1.56)。

而這樣的近視回彈現象，隨著濃度的下降，也漸趨輕微，到0.01%時，已未有明顯的回彈現象。

比較0.5%、0.1%及0.01%點用期間與停藥之後的視覺功能
遠距最佳矯正視力在三組之間無明顯差異
近距視力與瞳孔大小在停用兩個月之後逐漸恢復
調節幅度則需要較長時間恢復，且三組在停藥一年之後仍有顯著差異
以上視覺功能在低濃度組皆有較快的恢復時間

三組當中，0.01%的atropine有較低的近視反彈，因此能有持續的控制效果，且有最低的瞳孔放大與調節損失，停藥後的恢復也較快。似乎對於學童控制近視在藥效與安全性之間有最佳的平衡。

另也有研究者將Atropine的副作用訂出3項目標毒性標準
分別1.為調節小於5D、2.瞳孔放大超過3mm及3.近距離視力無法看清楚J1。

以此標準實驗不同濃度的作用，結果發現當濃度高於0.05%時，皆完全無法通過此標準。
一直要低至0.012%的濃度才勉強通過

但即使是0.012%的濃度，三位受測者當中仍有一位瞳孔放大了3mm，調節幅度僅剩3.60D，且抱怨在戶外時有畏光的現象。

網路上也曾有網友自行稀釋Atropine至0.003125%的經驗分享


參考資料


Chia, A., Chua, W. H., Cheung, Y. B., Wong, W. L., Lingham, A., Fong, A., & Tan, D. (2012). Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2). Ophthalmology, 119(2), 347-354. doi: 10.1016/j.ophtha.2011.07.031

Chia, A., Chua, W. H., Wen, L., Fong, A., Goon, Y. Y., & Tan, D. (2013). Atropine for the Treatment of Childhood Myopia: Changes after Stopping Atropine 0.01%, 0.1% and 0.5%. Am J Ophthalmol. doi: 10.1016/j.ajo.2013.09.020

Chua, W. H., Balakrishnan, V., Chan, Y. H., Tong, L., Ling, Y., Quah, B. L., & Tan, D. (2006). Atropine for the treatment of childhood myopia. Ophthalmology, 113(12), 2285-2291. doi: 10.1016/j.ophtha.2006.05.062

Tong, L., Huang, X. L., Koh, A. L., Zhang, X., Tan, D. T., & Chua, W. H. (2009). Atropine for the treatment of childhood myopia: effect on myopia progression after cessation of atropine. Ophthalmology, 116(3), 572-579. doi: 10.1016/j.ophtha.2008.10.020

COOPER, J. et al. Maximum Atropine Dose Without Clinical Signs or Symptoms. Optom Vis Sci, Sep 26 2013. ISSN 1040-5488.

新型漸進多焦(兒控)鏡片用於近視控制的兩年實驗

視光界最權威的期刊IOVS 2014最新的文章

結果再次證實了兒控鏡片控制近視的效果只有約20%

近用時減少調節的使用對於控制近視效果真的有限，就算加上周邊屈光差也沒有改善。

還不如單獨使用周邊屈光差設計的控制近視鏡片

顯示控制近視還是要從視覺影像著手，眼球的機械性力量(調節、內聚等等)的調整，改善程度有限。


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一種新型的漸進多焦鏡片，兩年、多中心、隨機、對照控制的近視控制實驗。

此種新型漸進多焦鏡片採用新設計的周邊正非球面設計

可以同時減少調節與視網膜周邊的遠視性離焦

197位6~12歲兒童參與實驗，等值球面近視在-1.00D ~ -4.50D
隨機分為三組，單焦組，多焦加入度+1.00D，多焦加入度+1.50D

兩年後的結果
單焦組 增加 -1.39 ± 0.09 D

多焦加入度+1.50D比單焦組減少0.27 ± 0.11 D

也就是控制近視效果約20%，統計上達顯著程度。

多焦加入度+1.00D則不具顯著控制近視效果。


Invest. Ophthalmol. Vis. Sci., 2014

Myopia Control with Positively Aspherised Progressive Addition Lenses: A two-year, Multicenter, Randomized, Controlled Trial.

Hasebe, S; Jun, J; Varnas, SR

PURPOSE: To evaluate the effect of newly-designed positively aspherised progressive addition lenses (PA-PALs), which reduce both lag of accommodation and hyperopic defocus on the peripheral retina, on progression of early-onset myopia.
METHODS: PA-PALs have a near addition and a high positive distance zone aspherisation comparable to the addition power. One hundred and ninety-seven children were enrolled, 6 to 12 years of age, with spherical equivalent refraction from -1.00 to -4.50 D. The children were randomized to receive one of three lenses: single vision lenses (SVLs), PA-PALs with +1.0 D addition, or PA-PALs with +1.5 D addition. Follow-up visits occurred every 6 months for two years. The primary outcome is myopia progression evaluated by cycloplegic autorefraction.
RESULTS: One hundred and sixty-nine (86%) children completed the follow-up. Statistical analysis of adjusted progression rates showed a mean (±SE) progression of -1.39 ± 0.09 D in the control group wearing SVLs at the 24-month visit. Statistically significant (p = 0.017) retardation of SER (0.27 ± 0.11 D over 24 months or reduction ratio of 20%) by +1.5 D add PA-PALs relative to the SVLs was found, which was within the range of the percentage efficacy of myopia retardation by the conventional PALs in earlier trials over the same follow-up period. Nearly all retardation occurred in the first 12 months with no significant efficacy in the second year. PA-PALs with +1.0 D addition showed negligible efficacy.
CONCLUSION: The high positive aspherisation of the distance zone added to PALs apparently does not enhance their therapeutic efficacy in slowing myopia progression.
Copyright © 2014 by Association for Research in Vision and Ophthalmology.

PMID: 25270192
URL  - http://www.ncbi.nlm.nih.gov/pubmed/25270192?dopt=Citation

針灸可能是弱視治療的一種選擇

針灸可能是弱視治療的一種選擇，紐西蘭的研究顯示，針灸對

弱視的治療效果甚至優於一天遮眼治療2小時，約七成的弱視

孩童能提高兩行的視力。雖然樣本數不高，且進步幅度不大，

不過值得更進一步研究。

http://www.moneycontrol.com/news/health/acupuncture-could-be-option-to-treatlazy-eye-study_505066.html

Acupuncture could be option to treat 'lazy eye': Study

Published on Tue, Dec 14, 2010 at 13:02 | Updated at Tue, Dec 14, 2010 at 16:08 | Source : Reuters

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Acupuncture could be an alternative to eye patches or eye drops for older children with amblyopia, a common childhood vision problem more commonly known as "lazy eye," according to a study.

The problem, in which one eye is less farsighted or nearsighted than the other, can be corrected with glasses or contact lenses if caught at an early age. But both are less effective for children beyond about the age of 7, who traditionally have been treated by patching the stronger eye.

But Robert Ritch of the New York Eye and Ear Infirmary and Chinese colleagues found that children treated by a certified acupuncturist had similar improvement in their affected eyes as those who wore a patch for a couple of hours each day.

Both advanced two lines or more on an eye chart over the course of the study, which was published in the Archives of Opthalmology.

"Acupuncture has been used for a lot of things in Chinese medicine. And it's being used more and more in the West," Ritch told Reuters Health.

"But evidence-based medicine to see what it actually does is relatively lacking."

Ritch and Chinese colleagues studied 88 children in China between the ages of 7 and 12 who suffered from amblyopia and had already been wearing glasses for at least 16 weeks.

They randomly assigned the children to wear a patch over the good eye for two hours every day, or to attend five acupuncture sessions weekly. The acupuncture needles were inserted at sites on the body associated with vision in traditional Chinese medicine.

All the children were also given new glasses to wear and asked to perform an hour of daily near-vision activities.

By the end of the 25 week study, sight in the affected eye had improved by at least two lines on an eye chart for 28 children in the patched group, or 66.7%, and 31 in the acupuncture group, or 75.6%.

More than twice as many children who received acupuncture overcame the condition compared to those who wore an eye patch, 42% against 17%.

Some experts were sceptical, noting the small size of the study and the fact that there was no untreated group to use to see if doing nothing, or simply wearing glasses and doing daily exercises, would work just as well.

Matthew Gearinger at the University of Rochester in New York, who was not involved in the study, told Reuters Health it was encouraging to hear of alternate treatment methods.

"Patching can be annoying for kids. It can be socially tough to wear a patch at school, and wearing a patch at home can interfere with homework."

But he too noted the small size of the study and questioned whether the treatment option was practical, given that there are few acupuncturists in the United States with experience treating amblyopia.

Ritch and his team are following up with more studies.

"Don't knock Chinese medicine. It's been around for more than 3,000 years and there's a lot we don't understand yet," he said.

度數配不足對於近視惡化的影響

小朋友近視了!

常見的問題之一就是，度數要配足嗎?  

啊不是要減一點? 不然會頭暈而且度數增加很快喔~

事實上，配不足才會讓度數增加較快!

1.美國一位私人的視光診所回顧性的研究，近視的惡化速度正相關於未配足度數
，也就是度數配得越不足，近視增加越快。

J Optom. 2014 Jul-Sep;7(3):147-52. doi: 10.1016/j.optom.2013.12.007. Epub 2014 May 10.

Under-correction of human myopia - Is it myopigenic?: A retrospective analysis of clinical refraction data.

Vasudevan B1, Esposito C2, Peterson C2, Coronado C2, Ciuffreda KJ3.

2.前瞻性的研究，配不足75度(0.75D)與全矯正相比，近視惡化速度一年多23度(0.23D)

一年近視增加度數--矯正不足組：-1.00D vs 全矯正組：-0.77D

Vision Res. 2002 Oct;42(22):2555-9.

Undercorrection of myopia enhances rather than inhibits myopia progression.

Chung K1, Mohidin N, O'Leary DJ.

3.同樣是前瞻性的研究，配不足50度(0.50D)與全矯正相比，近視惡化速度一年多17度(0.17D)
一年近視增加度數--矯正不足組：-0.99D vs 全矯正組：-0.82D

Clin Exp Optom. 2006 Sep;89(5):315-21.

The possible effect of undercorrection on myopic progression in children.

Adler D1, Millodot M.

視網膜影像清晰程度會嚴重影響近視的進展，度數配不足對於調節的幫助不大，但卻犧牲影像品質，反而使近視增加較快。

2000年到2007台灣學童點用Atropine的調查報告

    

圖片來源http://pics7.this-pic.com/key/Images%20for%20Images%20for%20pictures%20of%20pink%20eye%20in%20infants

    

    簡單說，在這段期間兒童點用Atropine的比例增加了，主要在低濃度部分。原因也許跟教育部的視力篩檢計畫有關。9~12歲、住在大都市及父母社經地位較高的兒童有較高的點用機會。長期點用的副作用及13-18歲兒童點用的研究需要被進一步進行。

------------------------------------------------------

    近視是一嚴重的世界性健康問題，而在台灣，近視的高比例及嚴重程度更是居於全球領先地位。控制近視增加的方法有很多，其中Atropine在台灣地區是眼科醫師日常處置近視兒童的一種方式，但這在其他國家並不常見。

    

    作者分析2000年到2007年全民健康保險局的資料庫，試圖呈現台灣4到18歲兒童及青少年點用Atropine的情況。

    

    結果顯示，兒童求診眼科的比例，在這期間增加了68.3%，而被診斷為近視的兒童中，處方Atropine的比例也提升了34%，處方高濃度(0.5% & 1%)的比例下降，而處方低濃度(0.3%、0.25% & 0.1%)的比例則明顯提高。

    

    進一步分析發現，眼科求診的人數增加，也許是跟教育部的健康促進實施計畫的視力篩檢有關。另外點用Atropine的兒童年齡以9~12歲的比例最高，城鄉的部分以大都市點用機會較高，社經地位以高收入者點用機會較高。

    

    作者最後提出，有關長期點用的副作用及13-18歲兒童點用的研究需要被進一步進行。

原文如下

http://www.nature.com/eye/journal/v27/n3/full/eye2012279a.html

Eye (Lond). 2013 Mar;27(3):418-24. doi: 10.1038/eye.2012.279. Epub 2013 Jan 4.

Prescription of atropine eye drops among children diagnosed with myopia in Taiwan from 2000 to 2007: anationwide study.

Fang YT, Chou YJ, Pu C, Lin PJ, Liu TL, Huang N, Chou P.

Source

Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan.

Abstract

PURPOSE:

This study was conducted to examine the atropine eye drop prescription trend for children diagnosed with myopia, and to determine the factors associated with the prescription of atropine eye drops.

DESIGN:

This was a population-based cross-sectional study.

METHODS:

This study was conducted using a national representative sample from the National Health Insurance (NHI) claims data. All school childrenbetween 4 and 18 years of age who had visited an ophthalmologist and were diagnosed with myopia between 2000 and 2007 were included herein. The main outcome measure was the proportion of subjects who were prescribed atropine eye drops in each year. Logistic regression was used to identify the factors associated with atropine eye drops being prescribed.

RESULTS:

The prescription of atropine eye drops for children diagnosed with myopia increased significantly from the school years 2000 (36.9%) to 2007(49.5%). There was also a shift from prescribing high concentrations (0.5 and 1%) of atropine eye drops to lower concentration ones (0.3, 0.25, and 0.1%) within this period. Atropine eye drops were more frequently prescribed to 9-12-year-old children (OR=1.26-1.42, compared with those 7-8 years old), and tochildren from families with a high socioeconomic status (OR=1.19-1.25); however, they were less prescribed to those living in mid to low urbanized areas (OR=0.65-0.84).

CONCLUSIONS:

This study revealed an increasing trend of atropine eye drop prescription for children with myopia in Taiwan. Our study provides eye-care professionals worldwide a reference for the potential integration of atropine eye drops into their clinical practice toward children with myopia.

PMID:

 

23288141

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC3597881

 [Available on 2014/3/1]

MeSH Terms, Substances