다운증후군 아동청소년의 이중초점안경 교정효과 = The Effect of Bifocal Glasses on Childhood and Adolescent with Down Syndrome

다국어 초록 (Multilingual Abstract)

Purpose: The purpose of this study is to examine the effect that can be gained by prescribing bifocal glasses to childhood and adolescent with Down syndrome having under-accommodation.
Methods: This study, targeting 23 childhood and adolescent (11 males, 12 females), aged between 7 and 18, with Down syndrome having under-accommodation, before and after wearing bifocal glasses, and 11 (5 males, 6 females), after six months and one year, tested distance visual acuity and near visual acuity (LogMAR), performed objective refraction by using Mohindra retinoscopy, and conducted accommodative response test by using dynamic retinoscopy in the condition of 4D, 6D, and 10D accommodative stimuli, and evaluated the developmental status of their visual perception by using Korean Developmental Test of Visual Perception (K-DTVP-2).
Result: For subjects with Down syndrome (n=23), near visual acuity, accommodative response measured in the condition of 4D, 6D, 10D, and two out of three scales of Korean Developmental Test of Visual Perception significantly increased (p<0.05) after wearing bifocal glasses, and for those wearing bifocal glasses for one year (n=11), 11 of them (100%) showed increased accommodative response and 6 of them (55%) showed normally developed accommodative response, which indicates that their near vision could be improved without near vision correction.
Conclusion: Prescribing bifocal glasses to childhood and adolescent with Down syndrome having under-accommodation can be considered to be an efficient method in that it could temporarily improve near visual acuity, accommodative response, and some part of visual perception development, and in the long term, it could enable near visual acuity development by treating accommodative response.

국문 초록 (Abstract)

목 적: 조절력이 저하된 다운증후군 아동청소년에게 이중초점안경의 처방효과를 알아보고자 하였다.
방 법: 7~18세 사이의 조절력이 저하된 다운증후군 아동청소년 23명(남자 11명, 여자 12명)을 대상으로 이중초점렌즈 착용 전과 후 그리고 11명(남자 5명, 여자 6명)을 대상으로 6개월 및 1년 후 원거리시력과 근거리시력(LogMAR), Mohindra 검영법을 이용한 타각식굴절검사, 4D와 6D 및 10D 조절자극 상태에서 동적검영법을 이용한 조절반응검사를 실시하였고, 한국판 시지각발달검사(K-DTVP-2: Korean developmental test of visual Perception)를 이용하여 시지각 발달상태를 평가하였다.
결 과: 이중초점안경을 착용한 23명의 근거리 시력, 조절반응(조절자극 4D, 6D 및 10D) 및 시지각발달검사의 종합척도 3가지 중 2가지가 유의하게 높아졌으며(p<0.05), 1년 동안 장기적으로 이중초점안경을 착용한 대상자 11명 모두 조절반응이 증가되었고, 6명(55%)은 조절반응이 정상수준으로 발달하여 미교정 근거리 시력이 향상되었다.
결 론: 조절력이 저하된 다운증후군 아동청소년에게 이중초점안경을 처방하면 일시적으로 근거리 시력과 조절반응 및 일부 시지각능력이 향상되고 장기적으로 조절반응이 개선되어, 근거리시력을 발달시킬 수 있는 효과적인 교정방법이라고 생각한다.

참고문헌 (Reference)

1 임현성, "양안시 이상 환자에서 우세안과 주시안의 관계 분석" 대한시과학회 12 (12): 173-179, 2010

2 전인철, "안정피로 개선을 위한 조절이완장치의 임상성능 분석" 대한시과학회 13 (13): 280-293, 2011

3 이현주, "대전지역 취학 전 어린이와 부모의 시력검사 행동양식 조사" 대한시과학회 13 (13): 249-259, 2011

4 류동규, "다운증후군 아동 청소년의 굴절상태, 조절반응 및 시지각발달 상태의 분석" 대한시과학회 16 (16): 59-71, 2014

5 Hayden A, "The multidisciplinary preschool program for Down’s syndrome children at the University of Washington Model Preschool Center" 3 : 193-221, 1975

6 Woodhouse JM, "The effect of age, size of target, and cognitive factors on accommodative responses of children with Down syndrome" 41 (41): 2479-2485, 2000

7 Woodhouse JM, "Refractive errors in young children with Down syndrome" 74 (74): 844-851, 1997

8 Haugen OH, "Refractive development in children with Down’s syndrome: a population based, longitudinal study" 85 (85): 714-719, 2001

9 Woodhouse JM, "Reduced accommodation in children with Down syndrome" 34 (34): 2382-2387, 1993

10 Byrne A, "Reading, language and memory skills: a comparative longitudinal study of children with Down syndrome and their mainstream peers" 72 (72): 513-529, 2002

11 Catalano RA, "Ophthalmologic concerns. Biomedical Concerns in Persons with Down Syndrome" PH Brookes 59-68, 1992

12 Pueschel SM, "Ocular disorders in children with Down syndrome" 1 (1): 129-132, 1993

13 Boudreau D, "Literacy skills in children and adolescents with Down syndrome" 15 (15): 497-525, 2002

14 Laws G, "Language and memory development in children with Down syndrome at mainstream schools and special schools: a comparison" 20 (20): 447-457, 2000

15 Atkinson J, "Infant Hyperopia: Detection, Distribution, Changes and Correlates-Outcomes From the Cambridge Infant Screening Programs" 84 (84): 84-96, 2007

16 Stewart RE, "In focus: the use of bifocal spectacles with children with Down’s syndrome" 25 (25): 514-522, 2005

17 Shankar S, "Hyperopia and emergent literacy of young children: pilot study" 84 (84): 1031-1038, 2007

18 McGraw PV, "Glasgow Acuity Cards: a New test for the measurement of letter acuity in children" 13 (13): 400-404, 1993

19 Nandakumar K, "Bifocals in Down Syndrome Study(BiDS): design and baseline visual function" 86 (86): 196-207, 2009

20 Al-Bagdady M, "Bifocals and Down's syndrome: correction or treatment?" 29 (29): 416-421, 2009

21 Stewart RE, "Association between accommodative accuracy, hypermetropia, and strabismus in children with Down's syndrome" 84 (84): 149-155, 2007

22 Leat SJ, "Accommodative response in pre-presbyopes with visual impairment and its clinical implications" 48 (48): 3888-3896, 2007

23 Cregg M, "Accommodation and refractive error in children with Down syndrome: cross-sectional and longitudinal studies" 42 (42): 55-63, 2001

24 Turner S, "Academic attainments of children with Down's syndrome: a longitudinal study" 73 (73): 563-583, 2003