心因性視覚障害による調節障害に対して近用眼鏡，被写界深度延長眼鏡が有効であった15歳女子の1例

A case of a 15-year-old girl who was effectively treated with near vision glasses and extended depth of field glasses for accommodation disorders caused by psychogenic visual disturbances

要約　目的：心因性視覚障害による調節障害に対して近用眼鏡，被写界深度延長（EDOF）眼鏡が有効であった1例を報告する。

症例：15歳，女性。主訴は羞明，近見時の不快感。遠方視力は右1.2（矯正不能），左0.7（1.2×cyl−0.50D 180°），近方視力は右0.6（1.0＋1.00D），左0.4（1.0＋1.50D），動的量的視野は正常。他覚的屈折値は調節麻痺剤の使用の前後で著明な差なし。眼位，瞳孔反応に異常なし。輻湊も可能であった。その他の眼科一般検査に異常なし。9歳の頃には心因性視覚障害として大学病院眼科に通院していた。当時の視力は右（0.04），左（0.04）。求心性視野狭窄を認めた。現在，進学校での勉強，友達関係もスムースとはいえない。ケラトメータによる調節値は右3.32D，左3.64Dであり，40歳台の値であった。心因性視覚障害による調節障害と診断し，近用眼鏡（加入度は＋1.25D）を処方した。外斜視はなく輻湊が良好であるためプリズムは加入していない。さらに，遠方〜中間距離の視機能改善のためにEDOF眼鏡を追加処方した。現在，日常生活にはEDOF眼鏡，学習などの作業時には近用眼鏡と使い分けている。

考按：本症例は幼少時に心因性視覚障害と診断されている。この児なりの成長によって，視力，視野は改善したが調節機能の低下は残存し，高校生になって近見作業の時間や負担が増加することで不自由が強くなった。心因性視覚障害が調節障害をきたすことはあまり周知されていないが，積極的に検査を行い解決策を提案することでquality of lifeの改善を得た。

Abstract　Purpose：To report a case who was effectively treated with near vision glasses and extended depth of field（EDOF）glasses for accommodation disorders caused by psychogenic visual disturbances（PSD）.

Case presentation：A 15-year-old girl complained of near vision difficulty, and photophobia. The distant visual acuity was RV＝1.2（1.2）, LV＝0.7（1.2×cyl−0.50D 180°）. The near visual acuity was RV＝0.6（1.0＋1.00D）, LV＝0.4（1.0＋1.50D）. Goldman perimetry was normal. Objective refraction values did not differ before and after the use of cycloplegics. No abnormalities were found in eye movements, pupillary reactions, and convergence as well. No abnormalities were found in the general ophthalmological examination. At the age of nine, she was introduced to a university hospital presenting with psychological visual disturbance. The visual acuity at that time was（0.04）, and concentric construction of visual field was observed in both eyes. Her social life and learning abilities were affected. The objective accommodation value was 3.32D in the right eye and 3.64D in the left eye, which is equivalent to those in their 40 s. The patient was diagnosed with an accommodation disorder due to psychogenic stress, and near vision glasses（＋1.25D）were prescribed. Since there was no extropia and good convergence, prism lenses were not added. In addition, EDOF glasses were prescribed to improve visual performance in the long-to-intermediate range. Currently, she uses EDOF glasses for daily life and near vision glasses as required for writing and reading.

Findings：She was diagnosed with PSD in her childhood. As she grew up, her visual acuity and visual field had improved, but her accommodation function remained impaired. As a high school student, she may have felt inconvenienced because the burden of near-field-work increased. It is not well-known that accommodation disorders can be accompanied with psychogenic visual disturbance. We, however, have improved her quality of life by actively conducting clinical examination and proposing solution.