【專業解析】隱形眼鏡配戴法則回顧整理
亨泰光學 研發中心
林文賓博士1,2,3
陳亞憶1,2,3
尹子祐3
國際隱形眼鏡教育者學會 會士(FIACLE)1
台灣隱形眼鏡學會 會員2
台灣註冊驗光師3
本篇文章為擷取CLINICAL INSIGHTS BASED IN CURRENT RESEARCH雜誌，原文請見文獻參考。本篇內容將針對隱形眼鏡配戴者的使用方式敘明再教育，也會探討未來的技術發展。最近一次美國的新聞中提到，有一名女性的眼睛裡有27片軟式隱形眼鏡，又有另外一名女性把硬式隱形眼鏡戴在眼睛裡28年從未取下。這些我們看似離譜的事情卻是實際發生在我們身邊的例子，這些新聞帶出了隱形眼鏡配戴者並沒有嚴格遵守鏡片的最佳配戴及保養方式，也顯示現今的環境，隱形眼鏡配戴者對如何安全配戴隱形眼鏡沒有明確的概念。
自我評估及影響因子
在隱形眼鏡配戴者的自我評估裡，他們的自我感覺跟現實上有著巨大的落差。當詢問到他們的鏡片配戴及保養上，大約85%的受訪者回答他們有好好的遵守醫師/驗光師的指示，但經過深入的調查後，現實是只有少於一半(1-50%)的受訪者有真正地遵守指示。1-3調查人員發現，在所有受訪者裡，99%的隱形眼鏡配戴者至少發生一項有風險的隱形眼鏡保養行為。4這類行為的發生跟缺乏相關知識沒有太大的關係，因為80%的受訪者都了解相關行為的危險因子。2此觀點也被其他文獻證實，因為遵守規範的比例在眼科醫師、非眼科醫師、護理師跟外行人之間沒有明顯的差異。5這些結果顯示單純跟隱形眼鏡配戴者講述危險因子不能讓他們加強自律遵守規範的機會。因此從業人員必須另找方法讓配戴者加強其保養習慣。
很多不同的環境因素都可能影響使用者的不良配戴習慣，包括同儕6、高估自己的保養習慣6、及僥倖心態7。不良配戴習慣的原因通常是因為省錢8及忘記何時應該更換新的鏡片9。調查發現，定期回診、年紀較大的高收入女性擁有最好的隱形眼鏡配戴習慣。9,10
超時配戴
隱形眼鏡如果配戴過夜，角膜浸潤(CIEs)的機會是正常的四倍11，還有至少五倍機率會感染微生物角膜炎(MK)12，有研究甚至估計風險比每天配戴水膠隱形眼鏡的配戴者高十倍13。不過，大約25%的受訪者還是偶爾會做出配戴過夜的行為。14超時配戴的風險不只跟每日消毒行為有關，有研究顯示受測者在長期配戴的環境下，其不良事件反應機率跟每日消毒的受測者沒有明顯的差異。15從業人員應該注意小睡時配戴隱形眼鏡的頻率，有47 - 87%的受訪者都有這種情況。16,17
更換鏡片
隱形眼鏡因為材質的關係，鏡片表面很容易卡髒污蛋白及累積沉積物，其情形會跟著配戴時間越久越明顯18-19因此嚴格遵守建議更換鏡片頻率是非常重要的。日拋隱形眼鏡在過去十年越來越受歡迎，其中原因就可能與為這樣的拋棄頻率能有效減低表面沉積物產生有關。一個研究發現，日拋隱形眼鏡的不良事件反應機率只有0.6 – 1.6%，根據隱形眼鏡的材料而略有不同。20對比長戴型隱形眼鏡的3 – 4%，是一個較低的數字。而且，日拋隱形眼鏡的配戴者，對比雙周拋或月拋的配戴者，更願意遵守更換鏡片的守則，9,21相反地，雙周拋跟月拋的配戴者更不願意遵守隱形眼鏡的建議更換頻率。21-24
不只是配戴者，眼科醫師也比較願意遵從日拋及月拋的廠商建議更換頻率去推薦配戴者，而雙周拋的鏡片則不，21這可能影響前述的不願意遵守更換頻率的數字。購買隱形眼鏡的地點跟金額也會影響更換鏡片頻率的準確度，而經統計發現，購買一年份隱形眼鏡的配戴者通常最會遵守更換鏡片的頻率。9
手部衛生
我們在無意中常接觸無數的細菌、真菌、原生動物，因此在處理隱形眼鏡前一定要徹底的清潔雙手。不好的手部衛生是滅菌25及微生物角膜炎26的危險因子。正確使用肥皂及清水，比只用清水洗手或不洗手，可以降低隱形眼鏡盒的汙染27。年輕人比較不願意在處理鏡片前徹底清潔雙手，28而且隱形眼鏡配戴者更傾向在配戴前洗手，而非卸下鏡片前洗手。9
隱形眼鏡配件
隱形眼鏡消毒用品及儲存容器會對生物膜的發展及其相關併發症的風險造成巨大的影響。鏡片儲存容器提供一個潛在的感染源，根據不同研究，23 – 81%的容器被微生物汙染，2,27,29,30且汙染程度隨著時間惡化。
根據一個探討隱形眼鏡配戴者行為的研究顯示，只有26%的受訪者經常清潔鏡片儲存容器，同樣百分比的受訪者會在一年內更換一次儲存容器。23根據一個研究隱形眼鏡操作原則的文獻提出，隱形眼鏡配戴者會因為美國食物及藥物管理局(FDA)、隱形眼鏡保養液生產商及驗光師之間的指示不同而感到混亂。32文獻指出最有效的避免容器汙染的方法是，使用消毒保養液搓洗及沖洗、再用衛生紙擦乾內表面，最後倒放使其通風。33
即便有90%的受訪者表示自己有良好的鏡片保養習慣，但卻有27%受訪者只使用生理食鹽水，43%受訪者只使用自來水來清潔鏡片。1沒有每天晚上使用新的隱形眼鏡保養液清潔鏡片，會增加相關併發症的風險，例如2004年在美國爆發的棘阿米巴角膜炎。4,34還有其他行為會增加鏡片容器的汙染風險，但根據一個研究容器污染的文獻指出，沒有任何一個完全符合要求的受訪者的容器受到明顯的汙染。35
保存於自來水中的風險
隱形眼鏡若浸泡在水裡一直都是產生微生物角膜炎的危險習慣，36特別是對眼睛較有傷害的棘阿米巴角膜炎，37,38有研究表示他在英國有爆發的跡象。39根據一個研究隱形眼鏡配戴者跟鏡片保存環境之間的關係指出，即便水暴露行為比較常見於配戴硬式隱形眼鏡的配戴者上，31%的軟式隱形眼鏡配戴者使用自來水來清洗鏡片，還有15%的受訪者把鏡片儲存在自來水裡。40年紀較輕的受訪者更傾向使用自來水去清洗或儲存鏡片。41很多隱形眼鏡配戴者使用水來清潔他們的鏡片容器，不管是單用自來水或者是搭配肥皂，這些都會將鏡片暴露於不恰當的保存環境。23
在游泳或者洗澡時配戴隱形眼鏡也是讓鏡片暴露於風險中。美國FDA和疾病控制及防護中心(CDC)建議避免在游泳、洗澡和泡澡時配戴隱形眼鏡。42,43同樣的，在洗澡時4,34,44和游泳時45配戴隱形眼鏡會增加患上微生物角膜炎的風險。在游泳時配戴也會增加隱形眼鏡的細菌聚集程度。45
科技技術更新
隱形眼鏡材料及配件的研究跟發展會讓配戴者對隱形眼鏡併發症的綜合知識增加。不同的動物模型試驗反映出抗菌鏡片材料帶來的正面效果。三聚氰胺鍍膜所做的隱形眼鏡比起未鍍膜鏡片，會讓細菌在鏡片的附著力降低，也降低角膜浸潤的徵象與程度。46,47最近的研究測試一個聚維酮碘消毒系統，報告指出4小時的試驗會造成廣譜抗菌活性的效果，有效抵抗細菌、真菌、及棘阿米巴角膜炎。48
連鏡片容器本身也可以具有抗菌的特性。使用銀浸漬的鏡片容器可以減低整體的容器汙染及隔絕少量的生物在容器上。49當鏡片容器的成分加入硒之後，會減少革蘭氏陽性菌及革蘭氏陰性菌的存在，而且硒比銀的成本較低，副作用也比較少。50
從業人員的角色
已知普遍民眾對隱形眼鏡保養守則不甚熟識，從業人員應該負起更大的責任。我們更應該著重於隱形眼鏡的保養操作及衛教。下表有一些可以加強隱形眼鏡保養習慣的方法：
| 提示 | 出處 |
| 使用開放式的問題去了解客人的日常隱形眼鏡使用方式 | |
| 考慮在工作室當眼處擺放衛教海報 |
https://www.cdc.gov/contactlenses/posters.html https://www.bcla.org.uk/Public/Member_Resources |
| 於每次回診評估及觀察客人的隱形眼鏡處理程序 | |
| 於每次回診評估鏡片與鏡盒有無定期更換 | |
| 發放紙本的隱形眼鏡衛教手冊，客人看到說明會比單聽從指示更願意配合26 |
隱形眼鏡教育協會(AOCLE)有軟式、硬式和鞏膜鏡的手冊。54 隱形眼鏡製造/販售廠商發行 |
只要驗光師跟客人願意注意細節，那些不正確的隱形眼鏡配戴行為是可以被改善的。從業人員在提供正確及安全配戴隱形眼鏡的訊息上扮演一個重要的角色。在衛教水平提升及未來科技進步的狀況下，期許大家能一起降低配戴隱形眼鏡相關併發症發生的頻率。
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