소아에서의 조절마비굴절검사의 유용성
Availability of Cycloplegic Refraction in Children and Adolescents
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목적: 소아 청소년에서 연령에 따른 조절마비검사의 필요성에 대해 알아보고자 하였다. 대상과 방법: 2015년 9월부터 2017년 12월까지 내원한 환자를 대상으로 조절마비 전후 굴절값을 Ocucyclo®, Mydrin P®을 이용하여 자동굴절검사기로 시행하였다. 4세 이하(1군), 4-6세(2군), 6-8세(3군), 8-10세(4군), 20세 미만(5군)으로 나누었다. 결과: 대상은 총 203명으로, 조절마비 전후 구면대응치의 값은 전 연령에서 1.26 ± 1.02디옵터로 통계적으로 유의하게 차이가 있었다(p<0.05). 연령 증가에 따라 그 차이가 감소하는 상관관계를 보였으나(r=0.207, p<0.05), 10세 이상 군에서도 조절마비 전후 값의 차이가 2디옵터 이상인 경우가 약 9% 정도 나타났다. 난시도수 및 난시축 변화 값은 유의한 차이가 없었다(p=0.071). 6세 이상 원시안 및 8세 이하 근시안에서 조절마비 전후 값 차이가 통계적으로 유의하게 증가하였다(p<0.05). 현성굴절검사상 굴절부등으로 판정된 비율은 22.6%, 조절마비 후 그중 32.6%는 굴절부등이 없는 것으로 판정되어 조절마비 후에는 전체의 7.39%가 굴절부등이 있었다(p>0.05). 결론: 전 연령에서 조절마비 후 원시로의 유의한 이동이 있었으며, 10세 이상의 연령에서 통계적으로 유의하진 않았지만 양안 부등시 및 가성근시 여전히 남아있었다. 따라서 조절마비검사를 청소년 및 성인연령에서 굴절측정의 오류 및 과교정을 예방하기 위해 시행하는 것이 바람직하다.
Abstract
Purpose: To compare non-cycloplegic and cycloplegic refractive errors and evaluate the utility of cycloplegia in Korean children and young adolescents. Methods: An anterospective study including 406 outpatients was conducted from September 2015 to December 2017. Pre and post-cycloplegic refractive errors for both eyes were measured using Ocucyclo® and Mydrin P® with an auto-refractor. Patients were divided into different groups according to age: group 1 (< 4 years), group 2 (4-6 years), group 3 (6-8 years), group 4 (8-10 years) and group 5 (< 20 years). Results: A total of 203 patients were studied. Standard deviation (sphere post-pre) was 1.26 ± 1.02 diopters significant in all age groups (p < 0.05). The mean difference decreased with increasing age (r = 0.207, p < 0.05), however, 9% of group with age greater than 10 years old still had manifest refraction-cycloplegic refraction (MR-CR) difference greater than 2 diopters. There were no significant cylindrical or axial component value difference before and after cycloplegia (p = 0.071). Significantly greater MR-CR differences were observed in hypermetropes ≥ 6 years old and myopes ≤8 years old (p < 0.05). The prevalence of pre-cycloplegic eyes with anisometria was 22.6% and 32.6%, a total of 7.39% regressed after cycloplegia (p > 0.05). Conclusions: After CR hyperopic shift was observed in all age groups. In patients with age greater than 10 years old, although statistically not significant, anisometropia and pseudomyopia still existed. Thus cycloplegic refraction should be performed in young adolescent to precisely measure and correct refractive error and avoid overcorrection.
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