안경착용 후 굴절이상의 장기변화
Long-term Changes in Refractive Error after Spectacle Use
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초록
목적: 굴절이상 환자에서 안경 착용 후에 굴절이상의 변화 양상을 장기간 추적 관찰하여 분석하고자 한다. 대상과 방법: 사시나 약시를 동반하지 않은 굴절이상 환아 중 최소 3년 이상 최대 12년까지 정기적으로 추적 관찰이 가능했던 103명을 대상으로 하였다. 안경 착용 시작 연령, 안경 착용 시작 시 구면렌즈대응치, 그리고 난시에 따라 군을 나눈 후 굴절력 변화를 분석하였다. 결과: 대상자들의 평균 관찰 기간은 9.1 ± 1.6년이었다. 안경 착용 시작 연령과 무관하게 시간에 따라 유의하게 구면렌즈대응치가 근시화되고(p<0.001) 난시가 증가하였다(p<0.001). 근시군에서 원시군보다 근시화가 더 빠르게 진행되고(p<0.001), 난시 값도 더 많이 증가하는 경향을 보였다(p=0.02). 경도와 중등도 난시군에서 시간에 따라 통계적으로 유의하게 난시 값이 증가한 반면(p<0.001), 중증난시군에서는 난시 값이 일정하게 유지되었다(p=0.866). 결론: 굴절이상 소아 환자는 연령 증가에 따라 근시화되고 난시가 점차 증가하는 경향을 보이며 이는 안경 착용을 시작한 나이와 무관하였다. 안경 착용 시작 시 근시군에서 근시화가 빠르게 진행하였고 난시 값도 많이 증가하였다. 안경 착용 시작 시 난시 정도가 작은 군일수록 난시가 유의하게 많이 증가하였다.
Abstract
Purpose: To evaluate the long-term changes in spherical equivalent (SE) refractive error and astigmatism in patients after spectacle use. Methods: A total of 103 patients with refractive error without strabismus and amblyopia who received at least 3 years of follow-up after using spectacles were included in this study. Patients were divided into groups according to the age at which spectacles were used (<4 years, ≥4 to <7 years, ≥7 years), the initial degree of SE refractive error (<-0.50 diopter [D], -0.50 to +0.75 D, >+0.75 D), and the initial degree of astigmatism (<1.00 D, 1.00 to 3.00 D, ≥ 3.00 D). Changes in the SE refractive error and astigmatism were compared between these groups using mixed linear models. Results: Patients were followed up for a mean of 9.1 ± 1.6 years. An overall negative shift in SE refractive error and an increasing tendency in astigmatism during follow-up were noted regardless of the age at which spectacles were used (p < 0.001). The myopic group showed the largest negative shift in SE and the largest increase in astigmatism (p < 0.001, p = 0.02 respectively). The low and moderate astigmatism groups were more likely to have significant increases in astigmatism (p < 0.001). Conclusions: Patients with refractive error showed a negative shift in SE and an increasing tendency in astigmatism regardless of the age at which spectacles were used. Changes in SE and astigmatism may be influenced by the initial degree of SE, and the initial degree of astigmatism may influence changes in astigmatism.
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