목적: 비사시성 수평 안위 이상안을 대상으로 원, 근거리 사위군에서 폭주부족을 CISS(Convergence insufficiency symptom survey) 설문지를 이용하여 측정하고 상관성을 분석하고자 하였다. 방법: 경남 김해에 거주하고 굴절이상이 구면도수 ±6.00 D 이하, 원주도수 ±2.00D 이하인 대학생 94명 (남; 36명, 여; 58명, 평균나이 22.56 ± 3.72세)을 대상으로 하였으며, 전신질환 및 안질환이 있거나, 양안의 차이가 2.00 D 이상인 굴절이상안은 제외하였다. 비사시성 수평안위이상 검사를 위해 완전융합제거사위는 마 독스 로드를 이용하였고, 일부융합제거사위는 Wesson 주시시차 카드를 이용하였으며, CISS 설문결과에 따라 폭주부족의 증상군과 비증상군으로 나누었다. 통계분석은 SPSS 22.0을 이용하였고, CISS 증상군과 비증상군의 사위도에 따른 평균 값 비교는 Mann-Whitney U test를 이용하였으며 사위의 분류에 따른 비율은 교차 분석을 이용하였으며, ROC curve는 통계프로그램 Medcalc version 17.5.5(Medcalc Software, Mariakerke, Belgium)를 사용하여 민감도, 특이도 및 AUC 값을 구하여 비교하였고 유의수준은 p<0.05로 하였다. 결과: 원거리 완전융합제거사위 검사에서 외사위군(n=62)에서는 CISS 증상군이 36명(43.4%), 비증상군 이 26명(31.3%)이며, 내사위군(n=21)에서는 증상군이 12명(14.5%), 비증상군이 9명(10.8%)으로 나타났으며, 원거리 사위 종류에 따라서 CISS 폭주부족 증상군과 비증상군의 비율은 차이가 없었다(χ2 =0.131, p=0.937). 근거리 완전융합제거사위 검사에서 외사위군(n=64)에서 증상군 37명(39.4%), 비증상군 27명(28.7%), 내사위 군(n=18)에서 증상군은 12명(12.8%), 비증상군은 6명(6.4%)으로 근거리 사위종류에 따라 증상군과 비증상 군의 비율은 차이가 없었다(χ2 =0.424, p=0.809). 일부융합제거사위 검사에서 외편위군(n=61)에서는 증상군 이 36명(38.3%), 비증상군은 25명(26.6%), 내편위군(n=10)에서 증상군은 6명(10.7%), 비증상군은 4명(10.5%) 으로 나타났으며, 편위의 종류에 따라 증상군과 비증상군의 비율은 차이가 없었다(χ2 =2.474, p=0.290). 사위검사방법의 민감도와 특이도 및 AUC는 각각 원거리 완전융합제거검사 41.3%, 75.2%, 0.542, 근거리 완전융합제거검사 69.7%, 53.1%, 0.560, 일부융합제거검사 87.2%, 특이도 2.4%, 0.541로 나타났지만 검사법에 따라 차이가 없었다. 결론: 원, 근거리 완전융합제거사위 검사로 분류한 사위의 종류에 따라 CISS 설문지로 조사한 폭주부족 증상군과 비증상군의 비율은 차이가 없었고, 일부융합제거 사위 검사로 분류한 편위의 종류에 따라서도 차이가 없었다.

Subjects: To analyze the correlation between the degree of distance and near phoria and convergence insufficiency using the CISS (convergence insufficiency symptom survey) questionnaire in those with non-strabismic horizontal misalignment. Methods: A total of 94 college students (36 males and 58 females, mean age: 22.56 ± 3.72 years) in Gimhae, Gyeongnam province were enrolled. The refractive error of the subject was spherical power below ± 6.00 D and cylinder power below ± 2.00 D. Those with systemic and ocular diseases and more than 2 D difference between the two eyes were excluded from this study. Associated phoria and dissociated phoria tests were performed using the Maddox rod and the Wesson fixation disparity card, respectively. According to the results of the CISS questionnaire, the subjects were divided into two groups as being symptomatic and asymptomatic. Statistical analysis was performed using SPSS 22.0, A Mann-Whitney U test was applied to compare the mean values according to the degree of phoria between CISS symptomatic and asymptomatic group. The sensitivity, specificity and AUC (area under an ROC curve) of the phoria tests are compared using statistical program Medcalc version 17.5.5 (Medcalc Software, Mariakerke), and the significance level was p<0.05. Results: In the distance exophoria group (n=62), the number of CI (convergence insufficiency) symptomatic group was 36 (43.4%) and CI asymptomatic group was 26 (31.3%) and in the distance esophoria group (n=21) CI symptomatic group was 12 (14.5%), and CI asymptomatic group was 9 (10.8%). There was no significant difference between CI symptomatic and asymptomatic group in the associated phoria group at distance (χ2 =0.131, p=0.937). In the near exophoria group (n=64) CI symptomatic and asymptomatic groups were 37 (39.4%) and 27 (28.7%), respectively, and in the near esophoria group (n=18), CI symptomatic and asymptomatic groups were 12 (12.8%) 6 (6.4%), respectively. There was no significant difference between CI symptomatic and CI asymptomatic groups according to the associated phoria at near (χ2 =0.424, p=0.809). In exo-deviation group(n=61), thirty-six (38.3%) were CI symptomatic and twenty-five (26.6%) were CI asymptomatic, p and in the eso-deviation group (n=10), six (10.7%) were CI symptomatic and four (10.5%) were CI asymptomatic. There was no significant difference between CI symptomatic and asymptomatic groups in the dissociated phoria test (χ2 =2.474, p=0.290). In the associated phoria test, the ROC curve showed a sensitivity, specificity and AUC of 41.3% and 75.2%, 0.524 at distance and 69.7%, 53.1% and 0.560 at near, respectively. In the dissociated phoria test, the ROC curve showed a sensitivity of 87.2% and a specificity of 2.4% and AUC of 0.541, showing that there was no significant difference among phoria tests. Conclusions: There was no significant difference in the ratio of the CI symptomatic and asymptomatic groups using the CISS questionnaire according to the associated phoria tests at distance and near. There was no correlation between the fixation disparity and CI symptomatic and asymptomatic groups.

Ⅰ. 서 론
 Ⅱ. 연구대상 및 방법
  1. 연구 대상
  2. 연구 방법
 Ⅲ. 연구결과
  1. 연구 참여 대상
  2. 완전융합제거사위 대상자의 사위도와CISS 검사 결과
  3. 일부융합제거사위 대상자의 사위도와CISS 검사 결과
  4. 사위의 종류에 따른 ROC 커브 비교
 Ⅳ. 고 찰
 Ⅴ. 결 론
 References

• Jin Yeong Kim(Dept. of optometry, Gimhae College, 김해대학교 안경광학과) | 김진영
• Koon-Ja Lee(Dept. of optometry, Eulji University, 을지대학교 안경광학과) | 이군자