한 눈 약시 환아에서 원거리 시력과 근거리 시력의 호전속도 비교
Comparison of Improvement Rates between Distance and Near Visual Acuity in Children with Unilateral Amblyopia
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목적: 한 눈 약시 환아에서 약시안의 원거리 시력과 근거리 시력의 호전속도를 비교하고자 하였다. 대상과 방법: 한 눈 약시로 진단 받고 가림치료를 시행하여 약시치료에 성공한 환아를 대상으로 2달마다 측정한 원거리 시력(4 m)과근거리 시력(33 cm)을 조사하여, 각각의 치료기간과 호전속도를 비교하고 약시 종류와 정도, 나이에 따른 차이가 있는지 살펴보았다. 약시안과 정상안의 시력이 한 줄 이내의 차이를 보이는 경우를 약시치료 성공으로 정의하였다. 결과: 굴절부등이나 사시로 인한 약시였던 76명은 평균 5.8세에 약시치료를 시작하였고, 평균 16.4개월 동안 추적관찰되었다. 치료시작 시기에 52명(68.4%)은 근거리 시력, 4명(5.3%)은 원거리 시력이 더 좋았다. 두 눈의 시력이 같아지는 데 원거리 시력은 평균5.4개월, 근거리 시력은 평균 3.9개월 걸렸으나, 시력호전량을 고려한 호전속도는 원거리 시력은 한 달에 0.11 logMAR 시력, 근거리시력은 0.08 logMAR 시력이 호전되어 원거리 시력이 빨랐다(p=0.016). 약시 종류나 나이에 따른 시력호전속도의 원근 차이는 없었으나, 경도 약시일수록 원거리 시력의 호전속도가 근거리 시력보다 빨랐다. 또한 초기 근거리 시력이 좋을수록 원거리 시력의 호전속도가 빨랐다. 결론: 한 눈 약시 환아에서 초기 근거리 시력이 원거리 시력보다 좋은 경우가 많았지만, 시력호전속도는 원거리 시력이 빨랐다. 또한초기 근거리 시력이 좋을수록 원거리 시력의 빠른 호전을 기대할 수 있었다.
Abstract
Purpose: To compare the improvement rates of distance visual acuity (VA) with that of near VA in amblyopic eyes of children with unilateral amblyopia. Methods: The medical records of children with unilateral amblyopia successfully treated with patching were reviewed. During subsequent visits for amblyopia treatment, subjects had best-corrected VA measured at 4 meters and 1/3 meters every 2 months. Duration of treatment to achieve equal VA between both eyes and improvement rates were compared between distance and near, and analyzed according to the cause and severity of amblyopia, or age. Results: A total of 76 children with amblyopia due to anisometropia and/or strabismus started amblyopia treatment at a mean age of 5.8 years and were followed up during a mean period of 16.4 months. Baseline VA was better at near than at distance in 52 children (68.4%), and better at distance than at near in 4 (5.3%). The mean duration of treatment was 5.4 months at distance and 3.9 months at near. However, the improvement rate considering the amount of improvement of VA was faster at distance; 0.11 log MAR/month at distance, and 0.08 log MAR/month at near (p = 0.016). The improvement rate differences between distance and near did not differ based on the cause of amblyopia, or age, whereas in mild amblyopia the improvement rate of distance VA was significantly faster than near. Additionally, children with better initial near VA tended to have a faster improvement rate of distance VA. Conclusions: Although baseline VA was better at near than at distance in more patients, the improvement rate was faster at distance than at near. Children with better initial near VA appeared to have a faster improvement rate of distance VA.
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