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1 ISSN(print) (2): , June 2016 < 초청논문 > Effect of Accommodation Control by Applying Fogging Method in Subjective Refraction and Auto-Refraction in Ametropia Kang-Cheon Lee, Sang-Yeob Kim, Hyun Gug Cho, Dong-Sik Yu, and Byeong-Yeon Moon* Dept. of Optometry, Kangwon National University, Samcheok 25949, Korea (Received May 4, 2016: Revised May 27, 2016: Accepted June 9, 2016) Purpose: To analyze the effect of accommodative control and change values between subjective refraction (SR) and auto-refraction (AR) according to application of fogging after accommodative stimulation depending on ametropia type. Methods: Myopic ametropia 76 eyes and hyperopic ametropia 52 eyes participated for this study. SR and AR values measured by three test conditions (Before accommodative stimulation; Before AS, After accommodative stimulation; After AS, and After application of fogging; After AF) were compared, respectively. Results: In myopic eyes, ( ) spherical power by SR and AR in After AS test was significantly increased as compared to Before AS test, ( )spherical power in After AF test was decreased to the level of Before AS test. The differences of spherical power between SR and AR were highly measured by SR in After AS test, and highly measured by AR in After AF test, respectively. In hyperopic eyes, (+)spherical power of SR significantly decreased in After AS test compared to Before AS test, more (+)spherical power was detected in After AF test compared to Before AS test. (+)spherical power of AR have no significant difference between Before AS and After AS test, but more (+)spherical power was detected in After AF test compared to Before AS test. The differences of (+)spherical power between SR and AR were significant in all test conditions. Among 52 eyes which were measured as hyperopic ametropia, 7 eyes were measured as myopia by SR in After AS test. In case of AR, 25 eyes among 52 eyes were mismeasured as myopia of ranges from 0.25 D to 1.25 D in Before AS test, 26 eyes in After AS test, and 19 eyes in After AF test were mismeasured as myopia of ranges from 0.25 D to 1.25 D. Conclusions: Regardless of ametropia type, accommodative control by After AF test was effective on both refraction process. However, in auto-refraction for hyperopic eyes, the misdetermined proportion of refractive error's type was high due to consistent accommodative intervention in all test condition. Therefore, in order to obtain an accurate value of refractive errors, full correction should be determined by subjective refraction process after fogging method. Key words: Accommodative control, Fogging, Subjective refraction, Auto-refraction, Hyperopic ametropia, Myopic ametropia 서론굴절이상도를측정하는방법으로는크게타각적굴절검사법과자각적굴절검사법으로나눌수있다. [1] 이중자동굴절력계를이용한타각적굴절검사는다른검사과정에비하여특별한기술을요하지않고신속한측정이가능하여임상현장에서안경처방을위한유용한참고값으로사용되고있다. [2-4] 자동굴절력계가빠르게상용화되기시작한 1970년대이래, 자동굴절력계의정확도에대한연구도활발히진행되어왔다. Weseman과 Rassow는모형안의굴절이상도를 S+12 D ~ S-12 D범위에서다양하게유발시킨후자동굴 절력계를통한자동굴절검사를실시한결과, 실험에사용된모든기종에서유발시킨모형안의굴절이상도와자동굴절검사값간의측정오차는모형안의굴절이상도가 S± 2 D를벗어나면서부터점차적으로증가함을보고하였다. [5] Joubert와 Harris는다양한연령대의실험참가자를대상으로자동굴절검사값과자각적굴절검사값을비교하였다. 그결과자동굴절검사값이자각적굴절검사값과비교해보다높은근시로측정됨을밝혀냈고, 이차이는연령이증가함에따라감소된다고하였다. [6] 또한근시성비정시안을대상으로한국내의연구에서도유사하게, 자동굴절검사값이자각적굴절검사값보다높게측정되고, 대상자의근시도가높을수록두검사값간의차이도증가한다는결과를 *Corresponding author: Byeong-Yeon Moon, TEL: , bymoon@kangwon.ac.kr 본연구의일부는 2016 대한시과학회춘계학술대회에서포스터발표되었음. 119

2 120 Kang-Cheon Lee, Sang-Yeob Kim, Hyun Gug Cho, Dong-Sik Yu, and Byeong-Yeon Moon 보고하였다. [7] 반면, 조절마비제를사용하여두측정값을비교한많은연구들에서는비조절마비하검사와비교해두검사간의측정오차는현저하게감소되는결과를보여주고있다. [8-12] 자동굴절력계는실제굴절이상도와의측정오차를줄이기위해기기내부에조절이완을유도하는운무시스템이존재하지만, 광학적원리를이용하여수초내의 auto-fogging 기능이제공된상태에서측정된값을제공하기때문에피측정자의굴절이상유형이나조절이완의정도에따라측정값은실제굴절이상도와다르게검출될수있다. [13] 결국안경원임상현장에서조절마비제를사용하지않고적절한조절이완상태를유도하기위한방법으로는강한플러스렌즈를일정시간착용하는운무법이있으나, [14] 임상현장에서자각적굴절검사전이러한운무과정을생략하는경우가많은것으로판단된다. 더욱이자동굴절력계의활용도와의존도가매우높은임상현장의실정을고려해볼때, 자동굴절검사에서운무적용에따른조절제어효과에대해서도평가해볼필요성이있다. 따라서본연구에서는비정시의유형에따라일시적인조절자극후운무적용에따른자각적및자동굴절검사값의변화를각각비교하여운무에따른두측정법간의조절제어효과를분석하고, 임상현장에서정확한굴절이상도의검출을위해검사전운무적용의필요성을강조하고자하였다. 대상및방법 1. 대상본연구의취지에동의하고자각적굴절검사를통해검출된근시성비정시 38명 76안 ( 평균나이 21.18±1.77세 ) 과원시성비정시 26명 52안 ( 평균나이 23.08±2.33세 ) 을대상으로하였다. 문진을통해전신질환, 안질환, 사시, 약시및시력에영향을미칠수있는약물복용이없음을확인하였고, 단안교정시력이 1.0 미만이거나양안시기능이상및조절기능이상이있는대상자는선정과정에서제외하였다. 2. 연구방법자각적굴절검사는수동포롭터 (Phoropter 11625B, Reichert, USA) 와 6 m용 LCD 시력표 (LUCID'LC, Everview, Korea) 를이용하여단안완전교정값을측정하였고, 자동굴절검사는폐쇄형자동굴절력계 (LRK-2600, Luxvision, USA) 를이용하여 3회측정후평균값을사용하였다. 실험에사용된자동굴절력계는 calibration을통해오차가없음을확인하였고, 검사실의조도는 800±40 lx로유지하였다. 먼저자동굴절력계를이용한자동굴절검사를실시한후, 자각적굴절검사를실시하였다 ( 조절자극전검사 ). 그후실험대상자가소지하고있는개인스마트폰을 30~40 cm 앞에두고 30분간휴식없이사용하게한뒤자동굴절검사와자각적굴절검사를차례대로실시하였다 ( 조절자극후검사 ). 그리고자각적굴절검사를통해얻은최초의단안완전교정값을기준으로 S+3.00 D가부가된시험테를착용하고흐린상태를유지하며, 15분동안원용시력표를보도록하였다. [15] S+3.00 D가부가된시험테를제거한직후, 동일하게두검사를실시하였다 ( 운무적용후검사 ). 조절자극전검사와비교하여조절자극후및운무적용후에서자각적굴절검사를통해측정된단안완전교정값과자동굴절력계를통해측정된단안자동굴절검사값간의변화와운무에의한조절제어효과를비정시의유형별로비교분석하였다. 3. 통계처리자료분석은 SPSS(ver 21.0 for windows) 를사용하여반복측정분산분석 (Repeated measures ANOVA) 과대응표본 t-검정 (Paired t-test), 그리고빈도분석을하였고, 모든분석은 p<0.05를통계적으로유의성이있는것으로판단하였다. 결과및고찰 1. 근시성비정시안에서각검사조건에따른자각적및자동굴절검사값의변화근시성비정시안에서조절자극전 후및운무적용후 Table 1. Changes of refractive errors according to each test condition in myopic ametropia Classification SR AR Before accommodative stimulation Condition After accommodative stimulation After application of fogging N p post-hoc Sph 2.40±1.50 a 2.74±1.49 b 2.34±1.60 c * a, c < b 76 Cyl 0.67± ± ± Sph 2.41±1.43 a 2.61±1.47 b 2.45±1.47 c * a, c < b 76 Cyl 0.73± ± ± SR: subjective refraction, AR: auto-refraction, Sph: spherical, Cyl: cylindrical * : significant differences between subgroups by post-hoc analysis LSD of repeated measures ANOVA

$Effect of Accommodation Control by Applying Fogging Method in Subjective Refraction and Auto-Refraction in Ametropia 121 에따른자각적및자동굴절검사값의변화는 Table 1과같다. 먼저자각적굴절검사에서단안구면굴절력값의평균변화를살펴보면, 조절자극전검사에서 2.40±1.$

3 Effect of Accommodation Control by Applying Fogging Method in Subjective Refraction and Auto-Refraction in Ametropia 121 에따른자각적및자동굴절검사값의변화는 Table 1과같다. 먼저자각적굴절검사에서단안구면굴절력값의평균변화를살펴보면, 조절자극전검사에서 2.40±1.50 D이었고, 조절자극후검사에서는 2.74±1.49 D로조절자극전과비교해유의하게증가하였고, 운무적용후에서는 2.34 ±1.60 D로측정되어조절자극전의근시도수준으로감소하였다 (p < 0.05). 자동굴절검사에의한평균단안구면굴절력의경우, 조절자극전검사에서 2.41±1.43 D, 조절자극후검사에서 2.61±1.47 D, 운무적용후검사에서 2.45±1.47 D로각각측정되어조절자극후근시도는조절자극전과비교해유의하게증가하였다가운무적용후다시조절자극전의수준으로감소하였다 (p < 0.05). 반면단안원주굴절력의경우에서는자각적및자동굴절검사모두에서각검사조건간의의미있는차이를보이지않았다 (p > 0.05). Owens와 Wolf-Kelly [16] 는근거리작업을한후, 구면굴절력의평균변화량이 0.43 D라고하였고, Ehrlich [17] 의연구에서는평균 S 0.29 D 근시성변화를보고하였다. 30 분간의근거리작업후측정한본연구에서도단안구면굴절력값의변화는자각적굴절검사에서평균 0.34 D, 자동굴절검사에서는평균 0.20 D의근시성변화를보여두측정법모두에서짧은시간의조절자극에의해쉽게근시성변화를유발하는것을알수있었다. 하지만운무적용후에는두측정법모두에서단안구면굴절력값이조절자극전의측정값수준으로다시회복되어근시안에서운무적용은효과적인조절제어과정임을알수있었다. 각검사조건별로자각적굴절검사와자동굴절검사로측정된단안구면굴절력의비교결과는 Fig. 1과같다. 먼저조절자극전검사에서두측정값간의유의한차이는없었다 (p > 0.05). 하지만조절자극후검사에서자각적굴절검사값이자동굴절검사값보다 S 0.13 D 높게측정되었고 (p < 0.05), 운무적용후검사에서는자동굴절검사값이자각적굴절검사값보다 S 0.11 D 높게측정되었지만 (p < 0.05) 두측정방법에따른차이값은임상적인측면에 Fig. 1. Comparison of spherical power between subjective refraction and auto-refraction according to each test condition in myopic ametropia. Before AS: Before accommodative stimulation, After AS: After accommodative stimulation for 30 mins, After AF: After application of fogging for 15 mins, * p<0.05: significant differences between subjective refraction and auto-refraction by paired t-test 서볼때미미한것으로판단된다. Lee 등 [7] 은근시안에서자동굴절검사값이자각적굴절검사값보다높게측정되었다고보고하였고, Kinge 등 [13] 은그차이가 S 0.11 D ~ S 0.23 D 정도인것으로제시하였다. 본연구결과에서조절자극전실시한두측정법간의단안구면굴절력은의미있는차이를보이지않았는데, 이런결과는실험에사용된측정기기의상이함에의한것과부가적으로선행연구와달리검사전 calibration과정을통해자동굴절력계의기계적오차를제거시킨효과로생각된다. 2. 원시성비정시안에서각검사조건에따른자각적및자동굴절검사값의변화원시성비정시안에서조절자극전 후및운무적용에따른자각적및자동굴절검사값의변화는 Table 2와같다. 먼저자각적굴절검사에서단안구면굴절력값의평균변화 Table 2. Changes of refractive errors according to each test condition in hyperopic ametropia Classification SR AR Before accommodative stimulation Condition After accommodative stimulation After application of fogging N p post-hoc Sph +0.80±0.80 a +0.54±0.80 b +1.00±0.84 c * a<b<c 52 Cyl 0.69± ± ± Sph +0.17±0.88 a +0.12±0.79 b +0.30±0.85 c * a, b < c 52 Cyl 0.81± ± ± SR: subjective refraction, AR : autorefraction, Sph : spherical, Cyl : cylindrical * : significant differences between subgroups by post-hoc analysis LSD of repeated measures ANOVA

4 122 Kang-Cheon Lee, Sang-Yeob Kim, Hyun Gug Cho, Dong-Sik Yu, and Byeong-Yeon Moon 를살펴보면, 조절자극전검사에서 +0.80±0.80 D로측정되었고, 조절자극후검사에서는 +0.54±0.80 D로측정되어조절자극전과비교해원시도는유의하게감소하였다. 운무적용후검사에서는 +1.00±0.84 D로조절자극전측정값보다더높은원시도가검출되었다 (p < 0.05). 자동굴절검사에서단안구면굴절력값의평균변화를살펴보면, 조절자극전검사에서 +0.17±0.88 D, 조절자극후검사에서 +0.12±0.79 D로큰변화를보이지않았고, 운무적용후검사에서 +0.30±0.85 D로측정되어조절자극전 후측정값과비교해평균원시도는유의하게증가하였다 (p < 0.05). 따라서두측정법모두에서조절자극전과비교해더높은 (+) 구면굴절력값이검출되어원시안에서도운무적용은효과적인조절제어과정임을확인하였다. 반면단안원주굴절력의경우에서는자각적및자동굴절검사모두에서각검사조건간의의미있는차이를보이지않았다 (p > 0.05). 이러한결과는원시안을대상으로 15분간의운무법과비운무법간의자동굴절검사값의차이는없다고보고한 Oh [18] 의연구와는상반된것이었다. 이런차이는운무를위해 S+2.00 D렌즈를사용한선행연구와달리, 본연구에서는 S+3.00 D를통한보다강한운무과정을실시한효과로보여진다. 따라서굴절검사에서운무적용의효과를위해서는대략적인굴절이상교정상태에서최소 S+3.00 D 이상을가입해야할것으로생각된다. 각검사조건별로자각적굴절검사와자동굴절검사로측정된단안구면굴절력의비교결과는 Fig. 2와같다. 조절자극전검사에서자각적굴절검사값이자동굴절검사값보다평균 S+0.63D 더높게측정되었고 (p < 0.05), 조절자극후검사에서는자각적굴절검사값이자동굴절검사값보다평균 S+0.42 D만큼더높게측정되었다 (p < 0.05). 또한운무적용후검사에서도두검사값은차이는평균 S+0.70 D 로자각적굴절검사에서자동굴절검사값과비교해더높은원시도가검출되었다 (p < 0.05). 따라서근시성비정시안과 Fig. 2. Comparison of spherical power between subjective refraction and auto-refraction according to each test condition in hyperopic ametropia. Before AS: Before accommodative stimulation, After AS: After accommodative stimulation for 30 mins, After AF: After application of fogging for 15 mins, * p<0.05: significant differences between subjective refraction and autorefraction by paired t-test 달리원시성비정시안의경우모든검사조건에서자동굴절검사값은자각적굴절검사값과비교하여현저한근시성변화를보이므로, 검사자는자동굴절검사값을기초로자각적굴절검사를실시할때참고하여야하겠다. 3. 원시성비정시안에서각검사조건에따른근시성변화분석 Table 3은원시성비정시 52안중각검사조건에따른단안구면굴절력의측정결과가근시성비정시로나타나는대상안의비율과오차범위를나타낸것이다. 먼저원시성비정시 52안중조절자극후자각적굴절검사에서근시성으로측정된대상안은 7안 (13.46%) 으로나타났고, 7안모두에서 S 0.25 D로측정되었다. 하지만운무적용후검 Table 3. The range of the myopic ametropia measured in each test condition despite hyperopic ametropia by subjective refraction Condition Measured values to hyperopia Subjective refraction Measured values to myopia Measured values to hyperopia Auto-refraction Measured values to myopia Range (D) ~ ~ ~ 1.25 n(%) 52(100%) 0(0%) 27(51.92%) 25(48.08%) Range (D) 0.00 ~ ~ ~ 1.25 n(%) 45(86.54%) 7(13.46%) 26(50.00%) 26(50.00%) Range (D) ~ ~ ~ 1.25 n(%) 52(100%) 0(0%) 33(63.46%) 19(36.54%) 1: Test before accommodative stimulation, 2: Test after accommodative stimulation for 30 mins, 3: Test after application of fogging for 15 mins

5 Effect of Accommodation Control by Applying Fogging Method in Subjective Refraction and Auto-Refraction in Ametropia 123 Table 4. Individual analysis of myopic shift between subjective and auto-refraction before accommodative stimulation Serial No Subjective refraction (D) 사에서는근시성으로측정되었던 7안은다시원시성비정시로검출되었다. 반면자동굴절검사값의경우에는조절자극전검사에서부터원시성비정시 52안중 25안 (48.08%) 이 S 0.25 D ~ S 1.25 D 범위의근시성으로측정되었다. 또한조절자극후검사에서는 26안 (50.00%) 이, 운무적용후검사에서도 19안 (36.54%) 이여전히 S 0.25 D ~ S 1.25 D 범위의근시성비정시로측정되었다. Table 4는원시성비정시 52안중조절자극전자각적굴절검사값을기준으로자동굴절검사결과값이근시성비정 Auto-refraction (D) Accommodative intervention (D) Mean +0.44± ± ± are number of eyes that were measured as myopic ametropia by auto-refraction despite hyperopic ametropia by subjective refraction. Data are expressed as spherical power. Table 5. Individual analysis of myopic shift between subjective and auto-refraction after application of fogging Serial No Subjective refraction (D) Autorefraction (D) Accommodative intervention (D) Mean +0.54± ± ± are number of eyes that were measured as myopic ametropia by auto-refraction despite hyperopic ametropia by subjective refraction. Data are expressed as spherical power. 시로나타난 25안에대한개별적변화값을분석한것이다. 근시성으로나타난 25안의조절자극전자각적굴절검사값은평균 S+0.44±0.27 D이었고, 자동굴절검사에의해평균 S 0.52±0.33 D로측정되어자동굴절력계를측정하는순간평균 0.96±0.41 D의조절이개입된상태로보여진다. 또한 Table 5는원시성비정시 52안중운무적용후자각적굴절검사값을기준으로자동굴절검사에의해근시성비정시로나타난 19안에대한개별적변화값을분석한것이다. 근시성으로나타난 19안의조절자극전자각적굴절검사값은평균 S+0.54±0.33 D이었고, 자동굴절검사에의해평균 S 0.47 ±0.28 D로측정되어자동굴절력계를측정하는순간평균 1.01±0.33 D의조절이개입된상태로보여진다. 실험결과에따르면, 미교정원시안에서는비록자각적굴절검사과정을시행하더라도검사전작용했던조절자극의영향에따라의도치않게일부피검사자에서는조절이

6 124 Kang-Cheon Lee, Sang-Yeob Kim, Hyun Gug Cho, Dong-Sik Yu, and Byeong-Yeon Moon 개입된상태의굴절이상도가검출될수있음을의미한다. 하지만운무적용후검사에서는근시성비정시로나타났던모든대상안이다시원시성비정시로검출되어 15분의짧은운무과정을통해피검사자의조절개입을최대한제거할수있음을알수있었다. 하지만자동굴절검사의경우에는조절자극전검사에서부터무려 25안 (48.08%) 이, 운무적용후검사에서도여전히 19안 (36.54%) 이자각적굴절검사를통한원시도를기준으로대략 1 D의조절개입으로인해평균 S 0.50 D의근시성비정시로측정되는경우가발생하였다. 미교정원시안에서각검사조건에따른자동굴절검사의평균변화에보면운무적용을통해조절제어가효과적인것처럼보일수있으나, 개별적분석을통해사실상모든검사조건에서조절이개입된상태에서측정되고있음을말해준다. 그러므로임상현장에서자동굴절력계를통한결과값이약도의근시로나타날경우, 측정중미교정원시안의습관적인조절개입으로인해굴절이상의분류가다르게판정될가능성도염두해야할것이다. 결과들을종합해보면, 비정시의유형에관계없이두굴절검사법모두에서운무적용은피검사자의조절을효과적으로제어하는과정이되는것을알수있었다. 특히원시성비정시안에서는운무적용을통해조절자극전의측정값보다더높은 (+) 구면굴절력이검출되었다는점을감안할때운무에따른조절제어과정은상대적으로원시성비정시안에서더효과적인것으로생각된다. 하지만근시성과달리원시성비정시안의경우, 모든검사조건에서자각적및자동굴절검사를통해각각측정된 (+) 구면굴절력값은큰차이를나타내고있다. 결국자동굴절력계는기기내부에강한 (+) 렌즈를이용해조절이완을유도하는운무시스템이존재하지만, [19] 측정기기에밀착해측정함으로써발생하는근접성조절의개입과 [20] 미교정원시안의습관적인조절이완전히제어되지않는상태에서순간적으로측정된값을제공함에따라자각적굴절검사값과비교해상당한근시성변화를보인것으로보여진다. 따라서정확한굴절검사값을얻기위해서는조절의개입을최소화한상태에서검사하는것이중요하므로 [21] 검사전문진을통해피검자의시생활환경을고려한선택적인운무적용이요구되고, 반드시자동굴절검사후자각적굴절검사과정을통해완전교정값을결정해야할것이다. 더불어본연구에서는실험대상자가조절력이풍부한 20대로한정되었다는제한점이있으며, 추후다양한연령대에서의변화도조사할필요가있다고사료된다. 결론조절자극후운무적용에따른자각적및자동굴절검사 값의변화와비정시에유형에따른조절제어효과를분석한본연구의결론은아래와같다. 1. 근시성과원시성비정시모두에서자각적및자동굴절검사의평균구면굴절력변화는조절자극전과비교해조절자극후 ( ) 방향으로, 운무적용후 (+) 방향으로굴절력이증가하여운무적용에따른조절제어는효과적이었다. 2. 근시성비정시에서조절자극후자각적굴절검사에의한평균 ( ) 구면굴절력값은자동굴절검사값보다높게측정되었고, 운무후검사에서는낮게측정되었다. 하지만두검사값의차이는임상적으로미미하였다. 원시성비정시에서는모든검사조건에서자각적굴절검사에의한평균 (+) 구면굴절력값이자동굴절검사값보다높게측정되었다. 3. 조절자극전자각적굴절검사를통해검출된원시성비정시안중 48.08% 가자동굴절검사에서근시성으로측정되었고, 운무적용후에서도 36.54% 에서근시성비정시로나타났다. 결론적으로운무를통한조절제어는비정시의유형에상관없이두굴절검사과정모두에서효과적으로적용되었다. 하지만원시안의자동굴절검사에서는모든검사조건에서조절이개입된상태로측정되어자각적굴절검사와비교해굴절이상의분류가다르게판정될가능성이있으니검사자는주의하여야하겠다. 따라서정확한굴절이상도를검출하기위해서는운무과정을실시한후반드시자각적굴절검사과정을통해완전교정값을결정해야할것이다. 감사의글 2015년도강원대학교학술연구조성비로연구하였음 ( 관리번호 ). REFERENCES [1] Moon NJ, Kim JC, Koo BS. The study on the necessity of cycloplegic refraction in school children. J Korean Ophthalmol Soc. 1988;29(3): [2] Kim YS, An HS, and Jin YH. A study about the accuracy of automated refraction. J Korean Ophthalmol Soc. 1995;36(12): [3] McBrien NA, Millodot M. Clinical evaluation of the Canon Autoref R-1. Am J Optom Physiol Opt. 1985; 62(11): [4] Mallen EA, Wolffsohn JS, Gilmartin B, Tsujimura S. Clinical evaluation of the Shin-Nippon SRW-5000 autorefractor in adults. Ophthalmic Physiol Opt. 2001;21(2): [5] Wesemann W, Rassow B. Automatic infrared refractors-a comparative study. Am J Optom Physiol Opt. 1987;64(8):

7 Effect of Accommodation Control by Applying Fogging Method in Subjective Refraction and Auto-Refraction in Ametropia 125 [6] Joubert L, Harris WF. Excess of autorefraction over subjective refraction: dependence on age. Optom Vis Sci. 1997;74(6): [7] Lee JW, Lee KS, Hong HK. Research of difference between the refractive powers by autorefractometer and the prescription using phoropter. 2014;19(2): [8] Choong YF, Chen AH, and Goh PP. A comparison of autorefraction and subjective refraction with and without cycloplegia in primary school children. Am J Ophthalmol. 2006;142(1): [9] Chat SW, Edwards MH. Clinical evaluation of the Shin- Nippon SRW-5000 autorefractor in children. Ophthalmic Physiol Opt. 2001;21(2): [10] Steele G, Ireland D, Block S. Cycloplegic autorefraction results in pre-school children using the Nikon Retinomax Plus and the Welch Allyn SureSight. Optom Vis Sci. 2003;80(8): [11] Salvesen S, Kohler M. Automated refraction. A comparative study of automated refraction with the Nidek AR-1000 autorefractor and retinoscopy. Acta Ophthalmol (Copenh). 1991;69(3): [12] Cordonnier M, Dramaix M, Kallay O, de Bideran M. How accurate is the hand-held refractor Retinomax(R) in measuring cycloplegic refraction: a further evaluation. Strabismus. 1998;6(3): [13] Kinge B, Midelfart A, Jacobsen G. Clinical evaluation of the Allergan Humphrey 500 autorefractor and the Nidek AR-1000 autorefractor. Br J Ophthalmol. 1996;80(1): [14] Benjamin WJ. Borish s clinical refraction, 2nd Ed. St. Louis: Butterworth-Heinemann. 2006; [15] Kang HS. Introduction to Optometry, 6th Ed. Seoul: Shinkwang publishing company. 2011;236. [16] Owens DA, Wolf-Kelly K. Near work, visual fatigue, and variations of oculomotor tonus. Invest Ophthalmol Vis Sci. 1987;28(4): [17] Ehrlich DL. Near vision stress: vergence adaptation and accommodative fatigue. Ophthalmic Physiol Opt. 1987; 7(4): [18] Oh SY. A study on refraction by fogging and unfogging method for hyperoic refractive errors. MS Thesis. Konyang University, Daejeon. 2014; [19] Gallagher JT, Citek K. A Badal optical stimulator for the Canon Autoref R-1 optometer. Optom Vis Sci. 1995;72(4): [20] Rosenfield M, Gilmartin B. Effect of target proximity on the open-loop accommodative response. Optom Vis Sci. 1990;67(2): [21] Yang SW, Lee NY, Kim SY. The effect of cycloplegia on vision and stereopsis: comparison between before and after cycloplegia. J Korean Ophthalmol Soc. 2006;47(9):

8 126 Kang-Cheon Lee, Sang-Yeob Kim, Hyun Gug Cho, Dong-Sik Yu, and Byeong-Yeon Moon 비정시안에서운무적용에따른자각적및자동굴절검사의조절제어효과 이강천, 김상엽, 조현국, 유동식, 문병연 * 강원대학교안경광학과, 삼척 투고일 (2016 년 5 월 4 일 ), 수정일 (2016 년 5 월 27 일 ), 게재확정일 (2016 년 6 월 9 일 ) 목적 : 비정시의유형별조절자극후운무적용에따른자각적및자동굴절검사값의변화와조절제어효과를분석하고자하였다. 방법 : 근시성비정시 76 안과원시성비정시 52 안을대상으로하였다. 세가지검사조건에서측정된 ( 조절자극전, 조절자극후, 운무적용후 ) 자각적및자동굴절검사값을각각비교하였다. 결과 : 근시성비정시안에서자각적및자동굴절검사의 ( ) 구면굴절력값은조절자극전과비교해조절자극후에서유의하게증가하였고, 운무적용후에서는조절자극전의수준으로감소하였다. 자각적및자동굴절검사간의 ( ) 구면굴절력차이는조절자극후에서자각적굴절검사값이높았고, 운무적용후검사에서는자동굴절검사값이높게측정되었다. 원시성비정시안에서자각적굴절검사의 (+) 구면굴절력값은조절전과비교해조절자극후에서유의하게감소하였고, 운무적용후에서는조절자극전보다더높은 (+) 구면굴절력이검출되었다. 자동굴절검사의 (+) 구면굴절력값은조절자극전 후간의유의한차이는없었고, 운무적용후에서는조절자극전보다더높은 (+) 구면굴절력이검출되었다. 자각적및자동굴절검사간의구면굴절력은모든검사조건에서유의한차이를보였다. 원시성비정시 52 안중조절자극후자각적굴절검사에서 7 안이근시로측정되었다. 자동굴절검사의경우, 원시성비정시 52 안중조절자극전검사에서 25 안이 0.25 D ~ 1.25 D 범위의근시로나타났고, 조절자극후검사에서는 26 안이, 운무적용후검사에서도 19 안이 0.25 D ~ 1.25 D 범위의근시로측정되었다. 결론 : 비정시의유형에상관없이운무를통한조절제어는두굴절검사과정모두에서효과적이었다. 하지만원시안에서자동굴절검사는모든검사조건에서일정량의조절이개입된상태로측정되어굴절이상의분류가다르게검출되는비율이높았다. 따라서정확한굴절이상도를검출하기위해서는운무과정을실시한후반드시자각적굴절검사과정을통해완전교정값을결정해야할것이다. 주제어 : 조절제어, 운무, 자각적굴절검사, 자동굴절검사, 원시성비정시, 근시성비정시

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770>

<283732372D3733312920B4D9C3CAC1A120BCD2C7C1C6AEC4DCC5C3C6AEB7BBC1EEC0C720B3EBBEC8C0C720BDC3B7C2BAB8C1A4BFA120B4EBC7D120C0AFBFEBBCBA20C6F2B0A1283035292E687770> 대한안과학회지 제 49 권 제 5 호 2008 J Korean Ophthalmol Soc 49(5):727-731, 2008 DOI : 10.3341/jkos.2008.49.5.727 다초점 소프트콘택트렌즈의 노안의 시력보정에 대한 유용성 평가 김현경 1 김효명 2 정성근 1 가톨릭대학교 의과대학 성모병원 안과학교실 1, 고려대학교 의과대학 안암병원 안과학교실