안과종합검진의 유용성

임수현(Soo Hyun Lim),김국영(Kook Young Kim),정재근(Jae Keun Chung)한재욱(Jae Wook Han),김응수(Ungsoo Samuel Kim) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.2

Purpose: To investigate the efficacy and detection rate of disease in the customized eye examination program. Methods: We reviewed the medical charts of 122 patients who have conducted the customized eye examination program from January 2018 to January 2019 in Kim’s Eye Hospital retrospectively. The customized eye examination program consisted of visual acuity test, intraocular pressure measurement, color vision test, slit-lamp examination, visual field tests, fundus photography, spectral domain optical coherence tomography (Cirrus HD-OCT, Zeiss), Optical Quality Analysis System (OQAS, Visiometrics, Terrassa, Spain), and dry eye test (LipiView II TearScience, Morrisville, NC, USA). The rate of newly diagnosed diseases and vision-threatening disorders including glaucoma and retinal disorders were calculated. Results: A total of 122 patients (46 males and 76 females, mean age; 47.8 ± 14.0 years old, from 22 to 85 years) were included. Nine patients (14 eyes) had a poor vision of less than 0.8. Newly detected diseases were found in 17 patients (13.9%), and among them, 10 glaucoma (8.2%) and retinal disorders (5.7%) were included. When it comes to glaucoma, 7 patients were diagnosed with definite glaucoma with visual field loss, and 3 patients had preperimetric glaucoma. Retinal disorders were composed of 5 epiretinal membranes, 1 diabetic retinopathy, and 1 central serous chorioretinopathy. Conclusions: Various diseases were identified by the customized eye examination program, and vision-threatening diseases such as glaucoma and retinal disorders were found. Therefore, a regular eye examination is needed to detect the serious ocular diseases in the early stage.

직업군별 채용신체검사에서 안과규정에 대한 조사

김응수(Ungsoo Samuel Kim) 대한안과학회 2021 대한안과학회지 Vol.62 No.10

목적: 직업군별 채용신체검사에서 안과와 관련된 규정을 알아보고자 하였다. 대상과 방법: 신체검사가 규정된 9개의 직업군(군인, 육군장교, 공군장교, 해군장교, 철도공무원, 소방공무원, 경찰공무원, 일반공무원, 항공조종사) 및 운전면허취득 기준을 조사하였으며 각 군의 신체검사 규정을 비교 분석하였다. 시기능장애는 시력장애, 시야장애, 굴절이상, 색각이상, 사시 및 기타 질환으로 구분하였고, 각 직업군에서 제시하는 추가적인 제한 사항에 대해 조사하였다. 결과: 직업군별로 다양한 기준을 제시하고 있다. 시력장애는 공군사관학교에서 1.0의 가장 높은 기준을 제시하였다. 육군사관학교와 해군사관학교는 0.6 이상, 소방공무원, 경찰공무원은 0.8 이상의 시력을 갖고 있어야 하나 일반공무원신체검사규정에서는 시력 기준이 없다. 시야장애는 소방공무원과 철도운전사만 1/3 이하로 명시되어 있고 다른 직종에서는 뚜렷한 기준이 없다. 색각장애도 직종별로 차이를 보였으며 항공관련과 철도운전사는 색각장애가 있으면 지원할 수 없다. 굴절이상 및 사시에 대해서는 각 직종별로 기준에 차이를 보였다. 결론: 각 직종별로 안과신체검사에 대한 기준이 매우 상이하므로 이에 대한 의사 및 환자의 이해가 필요하며, 기준 마련에 대한 과학적 근거에 대한 논의가 필요할 것으로 생각된다. Purpose: To investigate physical ophthalmological parameters relevant to job choice. Methods: I analyzed the ophthalmological demands imposed on those engaged in military service and on applicants for army officer, air force officer, naval officer, railroad officer, firefighting officer, police officer, state public officer, and pilot positions; the visual requirements for a driver’s license were also examined. Visual dysfunction was classified into loss of visual acuity, visual field defects, refractive errors, color vision disorders, strabismus, and other disorders. Additional restrictions imposed by each occupation were investigated. Results: Various standards were imposed on the occupational groups. Applicants to the Air Force Academy required 1.0 visual acuity; the visual acuity for applicants to the military and naval academies were ≥0.6, and those for fire and police personnel ≥0.8. The general public official regulations do not mention visual acuity. In terms of visual field defects, such defects must be <33% for firefighters and railroad drivers; no clear standard was set for other occupations. The importance of color vision differed by job type; pilots and railroad drivers must have full color vision. In terms of refractive error and strabismus, the standards differed among occupations. Conclusions: As the ophthalmological standards vary extensively by occupation, both ophthalmologists and clients must be aware of this information. The scientific basis of the various standards requires attention. J Korean Ophthalmol Soc 2021;62(10):1415-1419

근시의 약물치료

김응수(Ungsoo Samuel Kim) 대한검안학회 2018 Annals of optometry and contact lens Vol.17 No.1

The prevalence of myopia is up to 80% in young Korean population. The myopia can develop serious complications such as choroidal neovascularization, retinal detachment and glaucoma. As a result, several studies to prevent progression of myopia have been conducted. Among them, muscarinic antagonists are the more effective at slowing progression than other methods including orthokeratology and designed glasses. Recent studies have reported that low-dose atropine is also effective to slow progression of the myopia and it has fewer complications than high-dose atropine. However, long term side effect has not been clarified, and the commercial low-dose atropine is not available currently in Korea. Thus, in-depth studies about low-dose atropine should be considered.

눈떨림의 수술적치료

김응수(Ungsoo Samuel Kim) 대한검안학회 2017 Annals of optometry and contact lens Vol.16 No.2

Surgery is the one of the option of treatment of nystagmus. When it comes to the patients with abnormal head posture including head turn, chin-up, chin-down and head tilt, we could consider the repositioning of the extraocular muscles into null point. In the patients without abnormal head posture, four-muscle recession or tenotomy could be considered. The surgical treatment of nystagmus may not only reduce the amplitude of nystagmus but also improve visual acuity.

다양한 독서 매체를 통해 느껴지는 눈의 피로도와 각 매체의 특징에 관한 연구

장윤수,김응수,백승희,김용란,공상묵.Yoon Soo Jang. MD. Ungsoo Samuel Kim. MD. Seung-Hee Baek. MD. PhD.Yong Ran Kim. MD. Sang Mook Gong. MD. PhD 대한안과학회 2012 대한안과학회지 Vol.53 No.5

Purpose: The aim of the present study was to evaluate the different features of such instruments and how they cause ocular fatigability. Methods: Under the same settings and circumstances, 75 participants were asked to read the novel, “You without me?” in different formats including paper book, E-book (biscuit?, Interpark Inc., LG INNOTECK LTD, Korea) and LCD reader (iPad?, Apple Inc., United States). For every 10 minutes of reading, 10 minutes of rest was provided. After finishing the novel, the participants were asked to complete a questionnaire, and the data obtained were statistically analyzed using univariate analysis. Results: Compared to paper book readers (1.93), LCD readers (2.40) complained of insufficient lubrication in the eye (p = 0.038), and experience more letter-floating illusions (1.92) than did paper book readers (1.49) (p = 0.043). Moreover, compared to the other formats including the E-book (20%) and paper book (8%), LCD readers (72%) experienced more significant glare symptoms (n = 23) and could read at a faster rate than the other groups of readers (n = 26). Conclusions: In the present study, the I-Pad caused ocular fatigability more easily than the other formats examined. No statistical significance of ocular discomfort or fatigability was observed among the different format groups. Further investigation with a greater number of age-controlled participants should be conducted prior to designing a study to determine the best format for reading. J Korean Ophthalmol Soc 2012;53(5):689-693

간헐외사시 수술 후의 장기 성적: 운동기능과 감각기능 성과에 영향을 미친 인자의 분석

백지선,조명진,김응수,김용란,공상묵,백승희,Ji Sun Baek,Myung Jin Cho,Ungsoo Samuel Kim,Yong Ran Kim,Sang Mook Kong,Seung Hee Baek 대한안과학회 2014 대한안과학회지 Vol.55 No.7

<b>Purpose:</b> To evaluate the long-term surgical success rate (>3 years) and contributing success factors considering motor and sensory criteria for patients with intermittent exotropia. <b>Methods:</b> Fifty-four patients who received surgery for intermittent exotropia and were followed-up for a minimum of 3 years, including reoperation, were retrospectively evaluated. The first procedure was unilateral recession and resection in 50 patients and bilateral lateral rectus recession in 4 patients. Patients were classified as achieving a good, fair or poor outcome based on motor and sensory criteria. Success rate and associated factors such as postoperative alignment, exotropia type, first surgical procedure, and proportion of patients receiving reoperations were analyzed. <b>Results:</b> The mean follow-up period after the first surgery was 4.81 ± 1.30 years. The good outcome was achieved in 32 patients (59.3%), fair in 14 patients (25.9%), and poor in 8 patients (14.8%) considering motor criteria only. The good outcome was achieved in 29 patients (51.9%), fair in 12 patients (22.2%), and poor in 14 patients (25.9%) when considering combined motor/ sensory (functional) criteria. No patient who received bilateral lateral rectus recession as the first procedure belonged to the good outcome group (<em>p</em> = 0.03 by motor criteria and <em>p</em> = 0.044 by functional criteria). Patients who received reoperation were significantly more likely to be in the good and fair groups (<em>p</em> = 0.009 by motor criteria and <em>p</em> = 0.02 by functional criteria). <b>Conclusions:</b> Long-term surgical results of intermittent exotropia in this Korean population revealed 85.2% motor success rate and 74.1% functional success rate. Early postoperative overcorrection was not associated with long-term success. Recession and resection procedure and reoperations were significantly associated with better outcome based on motor and functional criteria. Diligent reoperations after the first surgery could possibly contribute to good long-term functional outcome in intermittent exotropia patients. J Korean Ophthalmol Soc 2014;55(7):1064-1070

안과병원으로 내원한 굴절부등약시 환자의 굴절이상 분포와 임상양상 분석

조수연(Soo-Yeon Cho),김대희(Dae Hee Kim),김응수(Ungsoo Samuel Kim),백승희(Seung-Hee Baek) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.1

Purpose: To investigate clinical characteristics and visual prognosis of anisometropic amblyopia patients in a secondary referral eye hospital in Seoul, South Korea. Methods: Medical records of 561 patients with anisometropic amblyopia between 3 and 12 years of age were retrospectively reviewed and 450 patients who followed up ≥ 2 times were included for comprehensive analysis. Amblyopia was defined as best corrected visual acuity difference of ≥ 0.2 logarithm of the minimum angle of resolution (logMAR) between the sound and amblyopic eyes. Anisometropia was defined by ≥ 1 diopter (D) difference in spherical equivalents (SE), or ≥ 1.5 D difference of cylindrical error in any meridian between the eyes. Baseline clinical characteristics, best corrected visual acuity and cycloplegic refraction of both eyes at the first visit were collected. According to the SE of amblyopic eyes, patients were categorized into hyperopia (SE ≥ 1 D), emmetropia (-1 < SE < +1) and myopia groups (SE ≤ -1 D). Treatment success was defined as achieving interocular logMAR visual acuity difference < 0.2. Treatment success rates and time to reach treatment success were compared among the SE groups. Results: Median age of patients was 5.0 years. Median follow-up period was 25.8 months. The proportions of hyperopia, emmetropia and myopia groups were 68.9%, 14.4%, and 16.7%, respectively. Emmetropia group showed anisometropia mostly due to cylindrical error difference between the eyes, rather than SE difference. Treatment success rates were the highest in emmetropia group (95.4%), followed by hyperopia group (85.8%) and then myopia group (77.3%, p = 0.010). Among the patients who fulfilled the success criteria, median time to reach treatment success was the shortest in emmetropia group (3.0 months) followed by hyperopia group (3.6 months) and then myopia group (4.0 months, p < 0.001). Conclusions: Hyperopia was the most common refractive error of the amblyopic eyes in anisometropic amblyopia patients who presented to an eye hospital in Seoul. Treatment success rate was the best in emmetropia group, followed by hyperopia group, and then by myopia group. Time to reach treatment success was the shortest in emmetropia group.

대한민국의 안과 취약 지역 실태에 대한 연구

이행진(Haeng-Jin Lee),김현아(Hyuna Kim),김응수(Ungsoo Samuel Kim) 대한안과학회 2022 대한안과학회지 Vol.63 No.11

목적: 대한민국 전체 의료 기관의 약 90%가 도시에 분포하여 도시와 농촌 간 의료 자원 분포가 심한 불균형을 보이고 있다. 형평성있는 보건의료제도를 확립하기 위해서는 의료 기관 분포와 진료 현황을 파악하고 의료기관 접근 가능성을 살펴보는 것이 필요하다. 본 연구에서는 안과 보건 정책의 토대를 만들고자 안과 의료 기관의 실태를 파악하고자 하였다. 대상과 방법: 각 지역별 안과의원, 보건소와 보건지소의 안과 공중보건의, 군의료시설에서 안과 전문의의 유무를 파악하였다. 취약지역에서 안과 진료가 가능한 지역으로의 이동 시간 및 취약 지역의 인구 현황에 대해 알아보았다. 결과: 우리나라 안과의원 수는 2021년 2/4분기 기준으로 1,658개였으며 지역별로는 서울, 경기, 부산, 대구 순으로 분포하였다. 안과전문의는 3,610명이었고 서울, 경기, 부산, 대구 순으로 분포하였다. 전국 250개 시군구 중 안과의원이 없는 시군구는 20개, 안과전문의가 없는 시군구는 13개였다. 안검진을 위해 인근 지역으로 이동하는 데 걸리는 평균 소요 시간은 자차로 48.0 ± 38.1분, 대중교통으로는 75.1 ± 40.0분이었다. 해당 안과 진료의 빈곤 지역 내에서 총 인구는 558,336명이었으며 취약한 10세 이하의 소아는28,358명이었다. 결론: 안과 진료에 대한 취약 지역 현황을 바탕으로 지리적 접근성, 형평성과 효율성을 제고할 수 있는 보건의료체계 확립이 필요하다고 생각한다. 또한 영유아와 노인 안질환에 대한 검진의 중요성을 감안하고 이를 보완해 나갈 중장기적인 대책 수립과 적극적인 개선이 필요하겠다. Purpose: Approximately 90% of the medical institutions in Korea are located in cities, so there is a disparity in medical resource distribution between urban and rural areas. In order to establish an equal healthcare system, it is necessary to understand the distribution and treatments offered by medical institutions and to investigate access to these facilities. In the present study, we investigated medical institutions offering ophthalmic examinations for children in Korea. Methods: The presence or absence of regional eye clinics and ophthalmologists in public health centers, public health offices, and military medical facilities were investigated in different cities and counties. In addition, the population status and ophthalmic facilities in vulnerable areas were investigated. Results: In the second quarter of 2021, there were 1,658 regional eye clinics in Korea located in Seoul, Gyeonggi, Busan, and Daegu, respectively. There were a total of 3,610 ophthalmologists in Seoul, Gyeonggi, Busan, and Daegu, respectively. Among the 250 counties, 20 did not have eye clinics while 13 did not have an ophthalmologist. The average time required to reach the closest eye examination center was 48.0 ± 38.1 minutes by car and 75.1 ± 40.0 minutes by public transportation. The total population in vulnerable areas was 558,336, including 28,358 children under the age of 10 years. Conclusions: The present study identified vulnerable areas for eye examinations. Based on the findings, it is necessary to establish a healthcare system with improved accessibility, equity, and efficiency considering the importance of ophthalmic examinations in children and the elderly.

조기 발병 근시를 가진 환아에서 약시 발생의 위험인자

이관복(Kwan Bok Lee),최세랑(Se Rang Choi),김응수(Ungsoo Samuel Kim) 대한검안학회 2016 Annals of optometry and contact lens Vol.15 No.2

Purpose: To investigate the prognosis and risk factors for amblyopia in myopic children under four years of age. Methods: Forty-eight children with cycloplegic refractive error of ≥ 5.00 diopters (spherical equivalent) in each eye. Age < 4 years old at the time of the first visit, and follow-up until the patient was > 8 years old were enrolled. Best-corrected visual acuity (BCVA) and refractive errors were evaluated serially over 8 years old. The presence of strabismus was identified through use of the alternating cover test and examination of duction and version test. The children were divided into 2 groups according to BCVA at 8 years. A BCVA worse than 20/25 in either eye was considered as the presence of amblyopia. Results: Amblyopia was detected in 20 out of 48 (41.7%) patients. In amblyopia group had a high rate of male children. The refractive error was similar in amblyopic and non-amblyopic children at both 4 and 8 years of age. Strabismus (exotropia and esotropia) was more common in the amblyopia group. A significant correlation was found between refractive errors at 4 years of age and BCVA at 8 years of age (Spearman rho=0.417, p=0.009). BCVA at 4 years of age was also strongly correlated with BCVA at 8 years of age (Spearman rho=0.517, p=0.001). Conclusions: Early onset myopic children who have strabismus or early onset myopic boys may develop amblyopia.