저시력 재활의료서비스 개선방안 마련을 위한 관련 전문가 의견 조사

김경우(Kyoung Woo Kim),문남주(Nam Ju Moon) 대한검안학회 2013 Annals of optometry and contact lens Vol.13 No.1

목적: 체계적인 저시력 재활의료서비스를 제공하는 방안을 마련함으로써 저시력 시각장애인의 재활의료서비스 전달체계를 제시하고 자 하였다. 대상과 방법: 저시력 재활의료서비스에 대한 전문가인 안과 전문의를 조사대상으로 선정하여, 총 10명의 전문가에게 설문지를 보내 의견 조사를 시행하였다. 결과: 전체 시각장애인 중 저시력 재활의료서비스를 필요로 하는 저시력 시각장애인의 분율은 평균 30.6 ± 5.9%이었다. 각 저시력 클리닉의 저시력 환자수는 주당 평균 2.7 ± 1.16명이고 진료시간은 1회당 평균 1.0 ± 0.41시간이었다. 저시력 진료의 수요에 비해 실제 제공받는 환자의 수가 적은 이유는 저시력 진료에 대한 보험수가가 낮기 때문이라고 나타났다. 더불어 저시력 재활전문병 ․ 의원 지정을 위한 적정설비 및 시설, 인력기준, 보장구 적정수가 및 급여화 필요 항목, 그리고 저시력 재활의료서비스 수가지급 방식 개선 방안에 대해서도 조사하였다. 결론: 저시력 재활의료서비스의 적정 수요에 따른 시설 및 장비를 갖춘 저시력 재활전문병 ․ 의원을 지정하고 저시력 환자에 대한 경제적 지원 및 재활의료서비스 수가 지급 방식을 개선한다면 효율적인 저시력 재활의료서비스 제공이 이루어질 것이다. Purpose: To establish the delivery system of rehabilitation health care service for low vision patients by arranging the methods for providing well-organized rehabilitation health care. Methods: We surveyed of 10 ophthalmologists who give medical treatment for low vision patients with sending a questionnaire by e-mail. Results: A proportion of low vision patients requiring visual rehabilitation care among the whole visually disabled was 30.6 ± 5.9%. A weekly average number of low vision patients per one low vision clinic was 2.7 ± 1.16, and an average treatment time per one visit was 1.0 ± 0.41 hours. The reason of low number of patients who treated in the low vision clinic compared to the demands was estimated to be the low insurance costs for low vision treatment. In addition, optimal standards of equipments and facilities, human resources for assigning the special hospital for low vision rehabilitation as well as reasonable costs of assisting devices, items to be benefited, and methods of improving the cost-providing system were surveyed. Conclusions: If with the special facilities based on the relevant demand, and with both economic support and improvement of cost-providing system, the efficient low vision rehabilitation care will be supplied to low vision patients.

의인성 안구건조증에서 신경펩티드의 변화와 가능한 역할

A-Young Lee,Seok Jae Lee,Sang-Mok Lee 대한검안학회 2022 Annals of optometry and contact lens Vol.21 No.1

최근 안구건조증의 발병기전에 각막신경의 역할이 부각되고 있다. 신경펩티드가 신경계와 면역계의 중요한 매개체로 알려져 있다는점을 고려하면, 신경 말단에서 분비되는 신경펩티드가 유발하고 조절하는 신경성염증은 안구건조증의 발병기전에도 관여할 것으로기대된다. 최근에 눈 수술 및 콘택트렌즈 사용 후에 발생하는 안구건조증에 대한 관심이 증가하면서, 의인성 안구건조증은 안구건조증의 중요한 분야로 각광을 받고 있다. 이 논문에서는 안구건조증의 발병기전과 관련하여 신경펩티드의 역할에 대한 최근 연구 결과들을 간단히 살펴보고, 특히 의인성 안구건조증에서 신경펩티드의 변화 및 가능한 역할에 대한 기존 연구 결과들을 정리하고자 한다.

한국인의 장기기증 인식 실태와 매스컴의 영향

김은철(Eun Chul Kim),김만수(Man Soo Kim) 대한검안학회 2012 Annals of optometry and contact lens Vol.11 No.1

목적: 장기기증 캠페인이 국민 기증의식과 각막기증에 미치는 영향을 파악하고자 한다. 대상과 방법: 장기기증 캠페인 전후의 인식변환을 전국의 만 20세 이상 1,036명을 대상으로 전화설문을 하였고, 2005년 각막이식 현황과 2004년도 비교는 25병원에 설문지를 발송해서 회답을 받은 18병원의 자료를 보고하였다. 결과: 응답자 중 94.8%가 장기기증에 대해 인지하고 있고 그 중 86.9%가 대중매체를 통해 인지하였다. 장기기증에 대한 찬성은 80.8%였고 장기기증의사가 있다는 응답은 81.3%였다. <눈을 떠요> 프로그램 시청 후 장기기증의 필요성을 느꼈다는 응답이 94.9%였으며 운전면허 취득 시 장기기증의사를 묻는 법률의 필요성은 66.2%가 있다고 대답했다. 전체 각막이식 건수는 전년도(503안)보다 2005년도(665안)에 32.4% 증가하였고 그 중 국내각막(51.5% 증가)이 수입각막(19.9% 증가)보다 큰 증가율을 나타냈으며, 국내안구 기증자는 50세 이하가 62명(46%)으로 많은 분포를 보였다. 결론: 장기기증 캠페인의 결과로 국민들의 장기기증에 대한 인식이 변화되었으나, 향후 지속적인 장기기증에 대한 홍보와 제도적 장치가 필요한 상태이다. Purpose: To evaluate the Korean s recognition of organ donation and the effect of mass media to people s thought & organ donation or transplantation. Methods: We evaluate the change of people’s thought after cornea donation campaign by means of surveying 1036 peoples above 20 years old with telephone and compare 2005 corneal transplantation to 2004 by distributing questionnaires to 25 hospitals and received it by 18 hospitals. Results: 94% of the survey respondents by telephone were aware of organ transplantation and 86.9% of respondents knew through mass media. 80.8% of respondents agreed to organ transplantation and 81.3% of respondents wanted to donate their organ. After watching <open your eyes> program, 94.9% of the survey respondents realized the requirement of organ transplantation and 66.2% of respondents consent the establishment of law which asking one’s mind to donate organ when acquire driving license. Number of total corneal transplantation is increased in 2005 than in 2004. Portion of domestic corneal transportation is more increased than imported one. Under 50 years is most abundant in corneal donor proportion. Conclusions: As result of organ donation campaign, people’s thought of organ donation is changed. However organ donation should be given continuously publicity and be established as well organized system.

유리체절제술 후 발생한 눈물막 및 안구표면장애에 대한 0.15% 히알루론산나트륨 점안액의 효과

최지호(Ji-Ho Choi),박영명(Young-Myoung Park),정진구(Jin-gu Jeong),조남천(Nam-Chun Cho),유인천(In-Cheon You) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.1

Purpose: To confirm the effect of 0.15% sodium hyaluronate on tear film and ocular surface disorders after vitrectomy surgery. Methods: The control group 19 patients and the test group 20 patients who underwent vitrectomy were enrolled. The control group took only antibiotics and steroids eye drops after surgery for 1 month, and the test group used 0.15% sodium hyaluronate eye drops for 2 months additionally. Ocular surface disease index (OSDI), tear film break-up time, Schirmer test, corneoconjunctival staining and meibomian gland seretion test were evaluated before surgery (baseline), 1 day, 1 week, 1 month, and 2 months after surgery. Results: There was significant difference between the control and trial group at 1 week in Schirmer test (p = 0.038). In OSDI, the score significantly increased until 2 months after vitrectomy in the control group (p = 0.021). However, the test group recovered at 2 month after surgery. In control group, TBUT showed significant decrease at 1 month (p = 0.022) and Schirmer test showed significant decrease at 2 months (p = 0.048) compared to the baseline, but there was no difference in the test group. Corneoconjunctival staining showed early increase and then progressive decreasing tendency at postoperative period in both groups, but there was a significant decrease of corneal staining at 2 months (p = 0.007) compared to the baseline only in the test group. Conclusions: Tear film and ocular surface disorders that occurred after vitrectomy worsen after surgery and then mostly recover. Postoperative 0.15% sodium hyaluronate instillation can alleviate the dry eye symptoms and is thought to contribute to early improvement of clinical findings.

미숙아망막병증 진단과 치료의 최신 지견

허 환(Hwan Heo) 대한검안학회 2018 Annals of optometry and contact lens Vol.17 No.4

Retinopathy of prematurity is still the leading cause of blindness in children. It is on the rise due to the development of postnatal care technology in developing and developed countries. However, due to the lack of experts, appropriate diagnosis and treatment are often not available. Therefore, it is necessary to develop technologies such as telemedicine and diagnostic automation technology for retinopathy of prematurity. Experts should know that the difference of timing and nature of recurrence between intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection and laser treatment. And, after verifying safety dose and systemic complication, guidelines for safe use of intravitreal anti-VEGF injection should be developed.

원자 폭탄 피해자의 후손에서 발생한 색소성 건피증과 각막 편평상피세포암 1예

이동초(Dong Cho Lee),최웅산(Woong San Choi),안정현(Jung Hyun Ahn) 대한검안학회 2007 Annals of optometry and contact lens Vol.6 No.1

목적: 원자폭탄 피해자의 후손에서 발생한 색소성 건피증 환자에서 각막 종양이 동반된 예를 경험하였기에 이를 보고하는 바이다. 대상과 방법: 15세경 색소성 건피증 진단을 받은 과거력이 있는 45세 남자 환자가 좌안의 시력 저하를 주소로 내원하였다. 가족력상 부친이 일본 히로시마에서 원자폭탄 피폭의 병력이 있었으며, 친형도 환자와 같은 색소성 건피증을 앓았다고 하며, 환자는 색소성 건피증과 더불어 안면부에 다발성 편평상피세포암이 동반되어 타 병원에서 수차례 수술을 받은 과거력이 있었다. 좌안 시력은 0.3이었고, 좌안 각막 이측에 3×6 mm 크기의 백색의 종괴와 내측 각막 주변부의 혼탁이 관찰되었으며 내측과 외측 결막에 익상편과 유사한 결막 증식과 결막 충혈을 보였으며 각막 종괴를 제거하였고, 증식된 결막을 절제한 후 양막이식술을 시행하였다. 결과: 각막 종괴의 조직 병리소견상 편평상피세포암으로 확인되었다. 술 후 1년 뒤에도 결막 및 각막에 종양 조직의 재발 없이 치유되었으며 환자의 시력은 0.6으로 호전되었다. Purpose: To report a case of corneal squamous cell carcinoma and Xeroderma pigmentosum in the offspring of atomic bomb survivor. Methods: A 45-year old male diagnosed with Xeroderma Pigmentosum at the age of 15 years presented with decreased visual acuity of his left eye. His brother also had Xeroderma Pigmentosum. His father was atomic bomb survivor in Hiroshima. Multiple squamous cell carcinoma affected right eye which was developed on his face starting from the age of 15 years, and were treated by local excision and exentration at other hospital. On his first visit to our hospital, his left visual acuity was 0.3. The left eye revealed 3×6 mm sized, whitish mass on temporal cornea, and corneal opacity on nasal cornea with pterygium-like growth. The excision of the pterygium-like lesion and corneal mass was done. Amniotic membrane was sutured with 10-0 nylon to cover the bare sclera fully. Results: The pathologic result was consistent with the diagnosis of squamous cell carcinoma in situ. During the one year follow-up, neither recurrence nor any postoperative complication. We found postoperative best corrected visual acuity improved from 0.3 to 0.6 after one year.

경사대 척삭종에 의한 작은 각의 한눈 가돌림신경마비

최영아(Yeong A Choi),서영범(Youngbeom Seo),김원제(Won Jae Kim) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.1

Purpose: To report a unilateral abducens nerve palsy caused by clival chordoma presenting with small angle of esotropia. Case summary: A 66-year-old male visited our clinic with a complain of suddenly developed horizontal diplopia for 4 days. He did not report the presence of any other systemic disease. The visual acuity was 20/40 in both eyes. There was no proptosis and abnormal lid problem in either eye. The pupils showed normal response to both light and near stimulation. Extraocular examination revealed 6 prism diopters (PD) esotropia at primary gaze without definitive abduction limitation. The esotropia increased to 12 PD at the right gaze and orthotropia at the left gaze. There were no other systemic neurologic or ocular symptoms. The brain magnetic resonance imaging revealed the mass arising from the clivus compressing the pontine area and the right abducens nerve. He was consulted to neurosurgery department for surgical treatment of mass. The removal of tumor using endoscopic endonasal transclival approach was performed. The pathologic report confirmed the chordoma. At 1 month after the surgery, there was no diplopia. He showed orthotropia at primary and both lateral gaze. Conclusions: The small angle of esotropia can be only presenting sign of abducens nerve palsy caused by clival chordoma. The strabismus and diplopia can be improved with surgical treatment.

건강검진 안저검사에서 이상 소견을 보여 안과에 내원한 환자의 임상양상 분석

이승민(Seung Min Lee),문지영(Ji Young Moon),전루민(Roo Min Jun),최규룡(Kyu-Ryong Choi),김현진(Hyun Jin Kim) 대한검안학회 2021 Annals of optometry and contact lens Vol.20 No.1

Purpose: To analyze the actual diagnosis and clinical features of patients who visited the eye clinic due to abnormal findings on the fundus photograph taken for screening purposes at the health screening. Methods: From February 2014 to July 2019, the medical records of patients whose fundus photography were suspect to be abnormal in the mass screening test were analyzed. Results: The average age of the patients was 53.6 ± 12.0 years (range, 22-81 years), and the average period to visit the eye clinic after screening was 41.3 days. The most frequent findings were identified as glaucoma suspect (n = 235), followed by retinal lesion (n = 212), media opacity (n = 49), and others (n = 48). The most common abnormalities in retinal abnormalities were drusen (n = 49, 20.5%), epiretinal membrane (n = 42, 17.6%), vascular disease (n = 29, 12.1%) and macular degeneration (n = 24, 10%). Of the patients who were suspicious of glaucoma, 42 patients (16.8%) were diagnosed as glaucoma after thorough ophthalmic examination. Among the patients with media opacity, 43 patients (78.2%) were diagnosed with cataract. Of the 544 patients, 450 patients (82.7%) were in condition requiring treatment or periodic ophthalmic examination. Conclusions: For rapid diagnosis and treatment, taking fundus photography at health screening is highly recommended. We found that detailed ophthalmic examination would be helpful for patients who visited the ophthalmology clinic with fundus abnormalities after health screening.

심한 백내장에서 초음파와 파장가변 빛간섭단층촬영의 안구생체계측 비교

오혜영(Hea Young Oh),최정훈(Jeong Hoon Choi),정영권(Young Kwon Chung) 대한검안학회 2020 Annals of optometry and contact lens Vol.19 No.1

Purpose: To compare the ocular biometry and prediction of postoperative refractive outcomes using IOL Master??700 (Carl Zeiss Meditec AG, Jena, Germany) and A-scan (Aviso??, Quantel Medical, Cournon-d Auvergne, France) in severe cataract. Methods: Seventy nine eyes with severe cataract under visual acuity of 1.7 logMAR were scheduled for cataract surgery. Axial length and anterior chamber depth were measured preoperatively with IOL Master?? 700 and A-scan. Mean absolute error was obtained with the difference between preoperative predictive refraction and postoperative refraction outcome using autorefraction. Results: Forty three cases received phacoemulsification and 36 received extracapsular cataract extraction. The mean absolute error between IOL Master??700 and A-scan in 20 eyes received phacoemulsification and 11 eyes received extracapsular cataract extraction (ECCE) was not significant (p < 0.001 and p < 0.001, respectively). IOL Master??700 measured mean axial lengths and anterior chamber depths longer than A-scan in phacoemulsification group (p < 0.001 and p < 0.001, respectively). However, there was no significant difference in mean axial length of ECCE group between two devices (p = 0.350). Conclusions: There was no significant difference between IOL Master??700 and A-scan in prediction of refractive outcomes after surgery of severe cataract under visual acuity of 1.7 logMAR. If available, IOL Master??700 can be considered as reliable method for prediction of postoperative refractive outcomes in cases of severe cataract.

한국인에서 빛간섭단층촬영기로 측정한 시신경 유두주위 망막신경섬유층 두께의 연령에 따른 변화

권용대(Yong Dae Kwon),강신희(Shin Hee Kang) 대한검안학회 2012 Annals of optometry and contact lens Vol.11 No.1

목적: 정상 한국인에서 빛간섭단층촬영기로 측정한 시신경 유두주위 망막신경섬유층 두께의 연령과 위치에 따른 변화를 알아보고자 하였다. 대상과 방법: 13세에서 82세까지의 정상인 자원자 237명 470안을 대상으로 빛간섭단층촬영기를 이용하여 시신경 유두주위 망막신경섬유층 두께를 측정하고, 측정 지점 각각에서의 연령 변화에 따른 두께의 변화를 분석하였다. 결과: 평균연령은 43.0세이고, 전체 대상의 망막신경섬유층의 평균 두께는 106.5±10.5μm였으며, 연령이 증가함에 따라 유의하게 감소하였다. 측정 위치별로 하이측에 해당하는 226∼246 지점이 연령증가와 가장 큰 음의 상관관계를 보였고, 연령대별 망막신경섬유층 두께의 감소는 30대의 8시 방향에서 가장 급격하게 감소하였다. 결론: 빛간섭단층촬영기로 측정한 한국인의 망막신경섬유층의 두께는 연령증가에 따라 하이측에서 상이측보다 급격한 감소를 보였고, 30대 연령대에서 가장 빠르게 망막신경섬유층의 두께가 감소되어, 녹내장을 포함하는 시신경 질환을 진단하거나 진행여부를 판단할 때 연령증가와 위치에 따른 의한 망막신경섬유층의 감소를 고려하여야 할 것으로 판단된다. Purpose: To investigate the relationship between peripapillary retinal nerve fiber layer (RNFL) thickness measurements by time domain optical coherence tomography (TD-OCT) in a normal Korean population and aging. Methods: 470 eyes of 237 healthy Korean volunteers (age range 13∼82 years, mean age 43.0 years old) were enrolled in this clininical cross-sectional study. The peripapillary RNFL was measured by TD-OCT (Stratus OCT). The thickness of the peripallary RNFL was obtained at the 256 points of circular edge around the optic disc with diameter 3.4 mm. The relationship between peripapillary RNFL thickness and age was analyzed. Results: The mean age was 42.95 years. The mean RNFL thickness of the healthy Korean people was 106.5±10.5μm. There was a significant negative correlation in average RNFL thickness with increasing age. In the nasal quadrant, there was no significant negative correlation with increasing age. At the scan points from 226 to 246 (8 o clock direction), the RNFL thickness was decreased with age significantly. Among age groups, thirties group was disclosed most decreasing rate at 8 o clock direction. Conclusions: The RNFL thickness of normal Korean population appeared to decrease with increasing age especially in the inferotemporal and superotemporal portions. The property of RNFL thickness with a decreasing tendency of different degrees according to the area over time should be considered in diagnosis and follow up of glaucoma patient.