視覺功能篩檢與視覺訓練方案對特殊需求幼兒視覺復能之研究
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2024
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研究目的：
本研究分為兩個部分，第一部分為量化研究 ; 第二部分為質性研究。量化研究的研究目為透過視覺功能篩檢了解東臺灣幼兒園大班的幼兒雙眼視覺功能的現況。質性研究有兩個階段：（一）個案研究：視覺訓練方案的介入對雙眼視覺功能異常幼兒之雙眼視覺功能及視知覺的影響 ; （二）深度訪談：透過訪談分析特殊需求幼兒照護者參與視覺訓練方案之前後經驗分析研究。
研究方法：
一、 量化研究：本研究之量化研究分為兩個部份，第一部份屬橫斷面研究，透過大規模篩檢就讀幼兒園大班的幼兒，除了解幼兒雙眼視覺功能的現況外，也針對不同的背景變項（城鄉、性別、族籍、有無收到通知單、視力異常等）進行分析。
二、 質性研究：（一）個案研究：透過第一部分篩檢的結果，發現雙眼視覺功能異常的幼兒，在家長或監護人的同意下，經回診眼科醫師確診異常問題後，依照視覺訓練方案進行訓練，並在介入視覺訓練方案期間，追蹤其雙眼視覺功能及視知覺能力的改變，由訓練的歷程漸次建構兒童發展之支持系統。（二）深度訪談：本研究以質性研究取向中的敘事研究法作為研究方法，對參與視覺訓練方案的照護者進行深度訪談，經資料蒐集整理後，做歸納分類並形成主題，再進行綜合的分析。
研究結果：
一、 視覺功能篩檢：本研究共計篩檢501位幼兒園之幼兒，其中幼兒視覺功能異常的比例以聚合近點的（融像恢復）能力為最高（23.8%）、其次為追視（5.6%）、聚合近點（維持融像）能力（4.6%）、躍視能力（4%）。視力異常確實可以反應許多視覺功能的連動問題，然而城鄉、族群、性別的分析結果都指出視覺健檢僅有視力篩檢，無法真正找出視覺功能異常的幼兒。
二、 質性研究：
（一） 個案研究：三位個案共同主訴：弱視、斜視、無立體視及個別的日常生活問題，例如：時常跌倒、上下樓梯踩空、身體歪斜、頭部不正、橫向閱讀障礙、擁擠效應、複雜背景搜尋困難等問題。隨著介入視覺訓練方案後，皆無弱視、眼位變正，有立體視，移除視覺訓練方案後，仍可保持良好穩定功能，且解除了上列個案的生活困擾問題。
（二） 深度訪談：
1. 視覺能力不僅是視力一項，如果仍持著視力及視覺的概念，非一般屈光問題的學童，其就醫經驗就變得困難。
2. 斜弱視治療除了遮蓋治療與開刀還有視覺訓練可加強治療效果。
3. 應仔細觀察幼兒的行為與學習習慣，在日常生活中有無視力以外的困擾。
4. 視覺訓練方案為針對視覺功能異常的幼兒與照護者所設計的視覺復能教育計畫。
5. 視覺訓練方案需要跨領域的專業的團隊通力合作或主持人需具備誇專業整合能力。
6. 家庭支持是視覺訓練方案的最重要關鍵因素之一。
7. 一個好的視覺訓練方案，不僅會解決幼兒的視覺功能問題，也可以改變其生活困擾，進而提升學習的效果甚至心理層面的改變。
8. 對醫療制度的建議：衛教說明應清楚、需告知除手術外視覺訓練可以處理斜弱視、視覺訓練應納入早療評估項目，如果有健保給付可以讓減輕家長的負擔。
結論與討論
根據本研究的三個部分所搜集的結果給予以下的意見：1. 眼科團隊需擁有視力值以外的視覺功能檢驗能力與落實轉診。2.應告訴學童有斜弱視問題的家長，除了遮蓋治療、斜視手術以外，還有視覺訓練可以加強治療效果。3.視覺訓練需要跨專業團隊或是具有跨專業整合能力。4.建議早療服務將視覺訓練方案導入在視覺功能異常的幼兒服務中。可解決沒有健保支持的問題，解決因經濟問題無法就醫的困難。5.給學校的建議：在視力篩檢通知單上，除視力以外可註明學習、生活、行動上的問題及建議適合的回診的醫療單位。6.家庭支持是視覺訓練方案的最重要關鍵因素之一。
Purpose of the Study: This research is divided into two parts: quantitative and qualitative studies. The quantitative study aims to understand the current status of binocular visual functions of kindergarten children in eastern Taiwan through visual function screening. The qualitative study was divided into two stages: (1) Case studies: to investigate the impact of visual training programs on binocular visual functions and visual perception in children with binocular vision abnormalities; (2) In-depth interviews: to analyze the experiences of caregivers of children with special needs before and after participating in visual training programs.Methods: Quantitative Study: The quantitative research was classified into two parts. First, it was a cross-sectional study to understand the binocular visual functions of kindergarten children after large-scale screening. Furthermore, different factors for the background of those children, such as urban/rural, gender, ethnicity, received/ not received any notices, visual abnormalities, etc.). Qualitative Study: 1. Case Studies: Based on the screening results from the first part, children withabnormalities in binocular visual function were identified. These children were first diagnosed by an ophthalmologist with the consent of their parents or guardians. Then, they were treated with visual training programs. The changes in their binocular visual functions and visual perception were monitored during the period of intervention. Gradually, a support system for children's development through the training process was built. 2. In-depth Interviews: Narrative research methods in a qualitative research orientation were used. Caregivers who participated in the visual training programs were in-depth interviewed. All these data were collected, organized, classified, and thematically analyzed. Results: Visual Function Screening: A total of 501 kindergarten children were screened. Among them, the proportion of children with abnormal visual function was highest in thosewith the near point of convergence (fusion recovery) ability (23.8%), followed by pursuits (5.6%), near point of convergence (maintaining fusion) ability (4.6%) and saccadic ability (4%). Visual abnormalities indeed reflected various linkage of visual function issues. However, the results indicated that vision screening alone cannot effectively identified the children with abnormal visual function from the analyses of urban/rural, ethnicity, and gender.Qualitative Research:Case Studies: Three cases were with common complaints: amblyopia, strabismus, lack of stereopsis, and individual daily life problems, such as frequent falls, missing steps when going up and down stairs, body tilt, head misalignment, horizontal reading difficulties, crowding effect, and search difficulties in searching complex background. After the intervention of visual training program, the children no longer had amblyopia, and their eye alignment was improved and regained stereopsis. Taken together, they maintained good, stable visual functions and alleviate their daily life problems even after the intervention program ended,In-depth Interviews:• Visual ability encompasses more than just visual acuity. Understanding visual functions is crucial for children with non-refractive issues.• Clear communication about the visual training program is essential before its initiation.• Careful observations of children's behavior and learning habits are necessary in order to discover issues other than visual acuity. • A multidisciplinary team with professional background is required for an effective visual training program. • Family support is one of the crucial elements for successful visual training programs. • A well-designed visual training program not only solve visual function problems, but also alleviates life challenges, thereby improving learning effects and even psychological well-being. Conclusionand Discussion: Based on the findings from the three parts of this study, the following suggestions are given:• The ophthalmology team was expected to have had the capability to conduct visual function examinations beyond just visual acuity and to have implemented appropriate referrals.• It was recommended that parents of children with amblyopia and strabismus be informed that, in addition to occlusion therapy and strabismus surgery, visual training could have enhanced treatment outcomes.• Visual training was considered to have required a multidisciplinary team or professionals with multidisciplinary integration capabilities.• It was suggested that early intervention services could have incorporated visual training programs into services for children with visual function abnormalities. This approach might have addressed the lack of support from health insurance and alleviated the difficulties faced by economically disadvantaged families in seeking medical care.• For schools, it was recommended that vision screening notification forms, in addition to noting visual acuity, could have included information about learning, daily life, mobility issues, and suggestions for appropriate medical follow-up.• Family support was identified as one of the most critical factors for the success of visual training programs.
Purpose of the Study: This research is divided into two parts: quantitative and qualitative studies. The quantitative study aims to understand the current status of binocular visual functions of kindergarten children in eastern Taiwan through visual function screening. The qualitative study was divided into two stages: (1) Case studies: to investigate the impact of visual training programs on binocular visual functions and visual perception in children with binocular vision abnormalities; (2) In-depth interviews: to analyze the experiences of caregivers of children with special needs before and after participating in visual training programs.Methods: Quantitative Study: The quantitative research was classified into two parts. First, it was a cross-sectional study to understand the binocular visual functions of kindergarten children after large-scale screening. Furthermore, different factors for the background of those children, such as urban/rural, gender, ethnicity, received/ not received any notices, visual abnormalities, etc.). Qualitative Study: 1. Case Studies: Based on the screening results from the first part, children withabnormalities in binocular visual function were identified. These children were first diagnosed by an ophthalmologist with the consent of their parents or guardians. Then, they were treated with visual training programs. The changes in their binocular visual functions and visual perception were monitored during the period of intervention. Gradually, a support system for children's development through the training process was built. 2. In-depth Interviews: Narrative research methods in a qualitative research orientation were used. Caregivers who participated in the visual training programs were in-depth interviewed. All these data were collected, organized, classified, and thematically analyzed. Results: Visual Function Screening: A total of 501 kindergarten children were screened. Among them, the proportion of children with abnormal visual function was highest in thosewith the near point of convergence (fusion recovery) ability (23.8%), followed by pursuits (5.6%), near point of convergence (maintaining fusion) ability (4.6%) and saccadic ability (4%). Visual abnormalities indeed reflected various linkage of visual function issues. However, the results indicated that vision screening alone cannot effectively identified the children with abnormal visual function from the analyses of urban/rural, ethnicity, and gender.Qualitative Research:Case Studies: Three cases were with common complaints: amblyopia, strabismus, lack of stereopsis, and individual daily life problems, such as frequent falls, missing steps when going up and down stairs, body tilt, head misalignment, horizontal reading difficulties, crowding effect, and search difficulties in searching complex background. After the intervention of visual training program, the children no longer had amblyopia, and their eye alignment was improved and regained stereopsis. Taken together, they maintained good, stable visual functions and alleviate their daily life problems even after the intervention program ended,In-depth Interviews:• Visual ability encompasses more than just visual acuity. Understanding visual functions is crucial for children with non-refractive issues.• Clear communication about the visual training program is essential before its initiation.• Careful observations of children's behavior and learning habits are necessary in order to discover issues other than visual acuity. • A multidisciplinary team with professional background is required for an effective visual training program. • Family support is one of the crucial elements for successful visual training programs. • A well-designed visual training program not only solve visual function problems, but also alleviates life challenges, thereby improving learning effects and even psychological well-being. Conclusionand Discussion: Based on the findings from the three parts of this study, the following suggestions are given:• The ophthalmology team was expected to have had the capability to conduct visual function examinations beyond just visual acuity and to have implemented appropriate referrals.• It was recommended that parents of children with amblyopia and strabismus be informed that, in addition to occlusion therapy and strabismus surgery, visual training could have enhanced treatment outcomes.• Visual training was considered to have required a multidisciplinary team or professionals with multidisciplinary integration capabilities.• It was suggested that early intervention services could have incorporated visual training programs into services for children with visual function abnormalities. This approach might have addressed the lack of support from health insurance and alleviated the difficulties faced by economically disadvantaged families in seeking medical care.• For schools, it was recommended that vision screening notification forms, in addition to noting visual acuity, could have included information about learning, daily life, mobility issues, and suggestions for appropriate medical follow-up.• Family support was identified as one of the most critical factors for the success of visual training programs.
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Keywords
特殊教育, 視覺訓練, 視覺功能, 家庭支持, 斜弱視, Special Education, Visual Training, Visual Function, Family Support, strabismus and amblyopia