가장자리 각막난시를 가진 근시 환자에서 난시 각막굴절교정 렌즈의 효과
Effect of Toric Orthokeratology Lenses in Patients with Limbus to Limbus Corneal Astigmatism
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
목적: 가장자리 각막난시를 가진 근시 환자에서 난시 각막굴절교정 렌즈의 효과를 알아보고자 하였다. 대상과 방법: 난시는 1.5 D 이내이지만 가장자리 각막난시로 인해 구면 각막굴절교정 렌즈 처방이 불가능하였거나 실패한 환자에서난시 각막굴절교정 렌즈를 처방 받아 최소 6개월 이상 착용하였던 16명 23안을 대상으로 하였다. 착용 전후 나안시력, 굴절이상값, 그리고 각막변화를 분석하였으며, 처방된 렌즈 난시도와의 상관관계를 알아보았다. 결과: 렌즈 착용 후 나안시력(logarithm of the minimum angle of resolution, logMAR)은 0.61 ± 0.22에서 0.05 ± 0.08로 의미 있게호전되었다(p＜0.001). 구면굴절 이상값(p＜0.001) 및 구면 대응값(p＜0.001) 역시 유의한 감소를 보였다. Simulated K (Sim K) 값은모두 유의하게 편평해진 변화를 보이고(p＜0.001), 편심률은 유의하게 감소되었으나(p＜0.001), 각막(p=0.330) 및 굴절(p=0.124) 난시는 렌즈 착용 전후 통계적으로 유의한 차이를 보이지 않았다. 렌즈 착용 전 각막난시(r=0.244, p=0.300) 및 굴절난시(r=-0.051, p=0.832) 정도는 처방된 렌즈의 난시도와 유의한 상관관계를 보이지 않았다. 렌즈의 중심이탈 및 이로 인한 시력저하와 불편감으로렌즈 처방이 불가능하였거나 실패한 환자는 없었다. 결론: 각막 난시의 양이 적더라도 구면 각막굴절교정렌즈 처방에 실패한 환자에서는 반드시 각막지형도를 확인하여 가장자리 각막난시 여부를 확인해 보는 것이 중요하며, 난시 각막굴절교정 렌즈는 가장자리 각막난시를 가진 환자에서 효과적인 치료 방법으로 생각된다.
Abstract
Purpose: To report the efficacy of toric orthokeratology lenses in patients with astigmatism within 1.5 D having difficulty in wearing spherical orthokeratology lenses due to the limbus-to-limbus corneal astigmatism. Methods: Twenty-three eyes of 16 patients with limbus-to-limbus corneal astigmatism who had been wearing toric orthokeratology lenses for more than 6 months were recruited. The uncorrected visual acuity (UCVA), refractive error, and keratometric changes including eccentricity before and after wearing lenses were compared, and the correlations between corneal astigmatism as well as refractive astigmatism and lens toricity were assessed. Results: After wearing the lens, UCVA (log MAR) significantly improved from 0.61 ± 0.22 to 0.05 ± 0.08 (p < 0.001). Myopia and spherical equivalent were also reduced significantly (p < 0.001 and p < 0.001, respectively). While Simulated K (Sim K) tended to be more flattened (p < 0.001) and the eccentricity showed significant decrease (p < 0.001), corneal and refractive astigmatism were not changed significantly (p = 0.330 and p = 0.124, respectively). Correlations between corneal and refractive astigmatism and lens toricity were not statistically significant (r = 0.244, p = 0.300; r = -0.051, p = 0.832). No patients showed lens decentration or visual discomfort. Conclusions: Corneal topography was essential in patients who had difficulty in wearing spherical orthokeratology lenses due to the limbus-to-limbus corneal astigmatism. Toric orthokeratology lenses may be an effective treatment option in patients with limbus- to-limbus corneal astigmatism.
참고문헌 (23)
- Grosvenor T., "Houston Myopia Control Study : a randomized clinical trial. Part II. Final report by the patient care team", Am J Optom Physiol Opt, 64, pp.482~498 (1987)
- Chung K., "Undercorrection of myopia enhances rather than inhibits myopia progression", Vision Res, 42, pp.2555~2559 (2002)
- Grosvenor T., "Use of siliconeacrylate contact lenses for the control of myopia : results after two years of lens wear", Optom Vis Sci, 66, pp.41~47 (1989)
- Chua WH., "Atropine for the treatment of childhood myopia", Ophthalmology, 113, pp.2285~2291 (2006)
- Cho P., "Retardation of Myopia in Orthokeratology(ROMIO)Study : a 2-year randomized clinical trial", Invest Ophthalmol Vis Sci, 53, pp.7077~7085 (2012)
- Cheung SW., "Subjective and objective assessments of the effect of orthokeratology-a cross-sectional study", Curr Eye Res, 28, pp.121~127 (2004)
- Chan B., "Orthokeratology practice in children in a university clinic in Hong Kong", Clin Exp Optom, 91, pp.453~460 (2008)
- Cheung SW., "Astigmatic changes in orthokeratology", Optom Vis Sci, 86, pp.1352~1358 (2009)
- 박영기, "난시 각막굴절교정학 렌즈를 이용한 가장자리 각막난시 교정", 대한안과학회지, 54(3), pp.502~507 (2013), 대한안과학회
- Pauné J., "Toric double tear reservoir contact lens in orthokeratology for astigmatism", Eye Contact Lens, 38, pp.245~251 (2012)
- 최정훈, "역기하렌즈 착용 후 시력, 굴절이상 그리고 각막 난시의 상관성 분석", 대한안과학회지, 47(8), pp.1266~1273 (2006), 대한안과학회
- Kawamorita T., "Repeatability, reproducibility, and agreement characteristics of rotating Scheimpflug photography and scanning-slit corneal topography for corneal power measurement", J Cataract Refract Surg, 35, pp.127~133 (2009)
- Jain R., "Repeatability of corneal parameters with Pentacam after laser in situ keratomileusis", Indian J Ophthalmol, 55, pp.341~347 (2007)
- Kleinstein RN., "Refractive error and ethnicity in children", Arch Ophthalmol, 121, pp.1141~1147 (2003)
- Bourne RR., "Prevalence of refractive error in Bangladeshi adults : results of the National Blindness and Low Vision Survey of Bangladesh", Ophthalmology, 111, pp.1150~1160 (2004)
- Cho P., "The longitudinal orthokeratology research in children(LORIC)in Hong Kong : a pilot study on refractive changes and myopic control", Curr Eye Res, 30, pp.71~80 (2005)
- Mountford J., "An analysis of the changes in corneal shape and refractive error induced by accelerated orthokeratology", Int Contact Lens Clin, 24, pp.128~144 (1997)
- Soni PS., "Clinical contact lens practice", pp.1~7 (1993), Lippincott
- Joe JJ., "The relationship between corneal eccentricity and improvement in visual acuity with orthokeratoloy", J Am Optom Assoc, 67, pp.87~97 (1996)
- 윤여민, "중등도 이하 근시 환자에서 역기하렌즈 착용중지 후 각막 변화 관찰", 대한안과학회지, 46(9), pp.1478~1485 (2005), 대한안과학회
- Chen C., "Toric orthokeratology for high myopic and astigmatic subjects for myopic control", Clin Exp Optom, 95, pp.103~108 (2012)
- Chen CC., "Toric orthokeratology for highly astigmatic children", Optom Vis Sci, 89, pp.849~855 (2012)
- Sanders DR., "An atlas of corneal topography", pp.5563~ (1993), Slack Incorporated