2024 年 09 月 19 日 
衛教大使郭子乾：我也是黃斑部病變照護者！親自陪伴/電話關心化解抗病焦慮
穩定抗病決勝點竟非減少注射頻率？療程有望快速消除水腫更關鍵
新一代雙機轉眼內注射藥物納健保 有望助快速控制水腫、最久可能四個月打一次
根據111年全民健康保險醫療統計結果[1]，我國約690萬人因眼科疾病就診，較去年新增了約11萬人[2]，平均每三人約有一人因視力問題就醫[3]。「進一步檢視患者的年齡與居住地，會發現50歲以上的就醫人口高達45%[4]，且約30%患者並不住在六都之內[5]。可以推測有視力問題的國人中，居住於偏鄉的長輩佔一定比例」，中華民國愛盲協會理事長暨臺北市立萬芳醫院眼科專任主治醫師吳建良指出，「偏鄉的長輩可能因為醫療資源相對有限、可近性待提升，導致眼科疾病的檢查、治療較為消極！為此，中華民國愛盲協會特別攜手台灣羅氏，並邀請身兼黃斑部病變照護者的郭子乾擔任衛教大使，齊聲喊出『Eye的醫療距離 因愛變得靠近』口號，期盼用愛的力量，募集學界、產界的志工與資源，並於包含離島在內的全台偏鄉舉辦公益黃斑部病變篩檢活動，提供極具便利性且免費的檢查，幫助黃斑部病變的患者早篩早治，治療贏在起跑點。
「台灣羅氏為了實踐聯合國永續發展目標（Sustainable Development Goals，簡稱SDGs），不僅以企業內部為起點，積極實踐多元共融（Diversity, Equity and Inclusion，簡稱DE&I），也致力於實踐醫療平權，翻轉城鄉間醫療資源、健康狀態不平等的現況」，台灣羅氏總經理Girish Mulye表示，「有鑑於黃斑部病變是視力健康的重大威脅，不僅每4位具視力障礙的年長者中，就有1位源於黃斑部病變[6]；更有一成長輩失明的原因與之有關[7]，台灣羅氏一直致力於推動疾病衛教活動。本年度很榮幸可以與愛盲協會合作，一同在偏鄉地區提供便利的黃斑部病變篩檢活動，盼能幫助民眾及早發現、及時治療，以減少疾病對國人的衝擊，進而提升全民的視力健康。」
吳建良理事長強調，凡事起頭難，除了提供便利的篩檢讓民眾知道自己是否罹患黃斑部病變以外，能在療程初期建立治療信心，也有助於提升患者長期治療的積極度。感謝衛生福利部中央健保險署，自今(113)年1月1日起，給付「新一代雙機轉眼內注射藥物」，其除了具有與現行藥物相同、可以減少不正常血管增生的機轉，還增加了可以讓血管更加穩定的功能[8]，獨特的雙機轉相較於僅控制一個致病原因，患者有機會更快達成良好的疾病控制、改善生活品質。不僅幫助患者在治療前期就建立抗病信心；在病程穩定控制後，患者也可以再與主治醫師討論延長治療週期的可能，平均一至四個月、最久有機會四個月治療一次即可。透過「先快速控制疾病、再延長治療頻率」的重要觀念，打造療效與便利性兼具的療程。
黃斑部病變衛教大使—郭子乾分享，自己的岳母也是黃斑部病變的患者，所以深知對於所有的患者而言，疾病控制是一條漫長的道路，所幸，在新一代雙機轉眼內注射藥物的幫助下，長期困擾著岳母的視力問題，在治療前期就獲得一定改善，因罹病而擔心失明的陰霾，也隨著「視」界中、因病而引起的水霧感一同散去，在減少黃斑部病變症狀衝擊減輕後，岳母的生活品質與心情明顯提升，對於未來的治療也更為積極！也鼓勵大家，除了患者本身積極治療以外，也邀請家屬們透過陪伴，讓長輩的抗病之路不孤單。無論是一通電話溫馨提醒家人回診追蹤、治療；或是親力親為、陪伴他們到醫院，都可以驅散患者的焦慮與無助，使其獲得穩定與黃斑部病變抗衡的動力。
黃斑部病變如同漏水屋 越早治療越心安 消極控制可能導致永久性視力受損與失明
「老化與糖尿病的發生，都可能加速黃斑部的病變，引起因老化而起的『濕性年齡相關性黃斑部退化病變（Neovascular Age-related Macular Degeneration，簡稱nAMD）』、『多足型脈絡膜血管病變型黃斑部病變（Polypoidal Choroidal Vasculopathy，簡稱PCV）』，以及糖尿病患者的視力刺客『糖尿病黃斑部水腫（Diabetic Macular Edema，簡稱DME）』，三大疾病的致病機轉相似但源自不同地方的血管增生和滲漏」，吳建良理事長形容，「黃斑部發生病變的過程，近似於買到漏水屋！沒有及時修補水管，一開始可能只是潮濕、出現壁癌等小問題，但不採取行動，讓房子盡快恢復『乾燥』，就會造成結構上的嚴重損害，有可能造成永久性視力受損，甚至失明。」
近三成五患者難堅持療程 提升積極度不只要「減少注射」 「治療快速有感」更為更關鍵
儘管過去就已經有多元且有效的藥物，可以幫助患者控制黃斑部病變，不過根據黃斑部病變白皮書，儘管有高達89%的受訪者認為規律治療黃斑部病變很重要，但仍有34%的患者難以規律回診治療[9]，可見提升患者治療穩定性仍是重要的挑戰。「許多患者與家屬會以減少治療頻率為目標，但事實上，這樣還不夠好！」吳建良理事長強調，「對於患者而言，視力的改善是更為直觀的感受，想要提升治療積極度，決勝點就在於能否快速控制病程，幫助其揮別霧濛濛、扭曲、黯淡、出現黑點的『視界』，進而改善生活品質！在患者對療程具有足夠的信心後，再視患者治療情況、需求，調整治療頻率，更是幫助患者長期對抗黃斑部病變的關鍵。」
「很感謝政府看見患者的需求，啟動新一代雙機轉眼內注射藥物的健保給付，有望嘉惠於與年齡有關的『濕性年齡相關性黃斑部退化病變（Neovascular Age-related Macular Degeneration，簡稱nAMD）』、『多足型脈絡膜血管病變型黃斑部病變（Polypoidal Choroidal Vasculopathy，簡稱PCV）』，以及糖尿病患者的視力刺客『糖尿病黃斑部水腫（Diabetic Macular Edema，簡稱DME）』」，吳建良理事長進一步形容，「新一代雙機轉眼內注射藥物可以同時減少不正常血管增生，並讓血管更穩定[10]，可以避免漏水屋中，有出現更多破裂的水管，同時也改善原本水管漏水的問題，雙管齊下達到『速乾』的成效。除了可以幫助患者及早控制病程、改善症狀以外，未來也有望將治療週期延長至每四個月一次，打造患者感受與便利性兼具的療程。」
每個月花30秒就能免費檢測黃斑部病變？！ 阿姆斯勒方格出現四大症狀就可能有風險
吳建良理事長也提醒，為了守護自己與家人的視力健康，建議每個月都透過阿姆斯勒方格表（Amsler grid），用短短的30秒快速檢測是否有黃斑部病變風險。「在檢測前，先戴起自己的老花或是近視眼鏡，並確保雙眼與方格表保持30公分的距離；檢測時，先以左眼單眼凝視表格中心黑點，完成後則換成右眼再做一次，即可完成」，吳建良理事長強調，「凝視表格時，只要出現模糊、扭曲、出現黑點、顏色黯淡四大症狀，無論明顯或是只有一點點變化，都具備黃斑部病變的風險，建議一定要及早到醫療院所進行檢查。」
[1]衛生福利部統計處 全民健康保險醫療統計《111年度全民健康保險醫療統計年報》表4、門、住診合計(包括急診)人數統計——按疾病別、性別及年齡別分，VII 眼與附器疾病 Diseases of the eye and adnexa https://dep.mohw.gov.tw/dos/lp-5103-113.html
[2] 參考衛生福利部統計處 全民健康保險醫療統計《111年度全民健康保險醫療統計年報》及《110年度全民健康保險醫療統計年報》表4、民國111/110年門、住診合計(包括急診)人數統計——按疾病別、性別及年齡別分，VII 眼與附器疾病 Diseases of the eye and adnexa https://dep.mohw.gov.tw/dos/lp-5103-113.html。 111年共計6896491人就醫，110年共計6784592人就醫，故6896491人減6784592人，等於111899人、約11萬人。
[3] 衛生福利部統計處 全民健康保險醫療統計《111年度全民健康保險醫療統計年報》表4、門、住診合計(包括急診)人數統計——按疾病別、性別及年齡別分，https://dep.mohw.gov.tw/dos/lp-5103-113.html 。全年就醫人數總計數量為22327442人，因眼與附器疾病就醫人數為6896491人，故6896491人除以22327442人，約等於31%
[4] 衛生福利部統計處 全民健康保險醫療統計《111年度全民健康保險醫療統計年報》表4、門、住診合計(包括急診)人數統計——按疾病別、性別及年齡別分，。，VII 眼與附器疾病 Diseases of the eye and adnexa https://dep.mohw.gov.tw/dos/lp-5103-113.html。 111年共計6896491人就醫，其中50歲以上之就醫人數總數為3099699人，故3099699人除以6896491人，約等於45%
[5] 衛生福利部統計處 全民健康保險醫療統計《111年度全民健康保險醫療統計年報》表5、門、住診合計（包括急診）人數統計－按疾病別及戶籍縣市別分。，VII 眼與附器疾病 Diseases of the eye and adnexa https://dep.mohw.gov.tw/dos/lp-5103-113.html。 111年共計6896491人就醫，其中非六都(台北市、新北市、桃園市、台中市、台南市、高雄市)之就醫人數總數為2042857人，故6894691人除以2042857人，約等於30%
[6] Joao M Furtado, Jost Jonas, Tunde Peto, Jaimie D Steinmetz, Paul S Briant, Tien Y Wong, Mingguang He, Alain Bron, Serge Resnikoff, John H Kempen, Tasanee Braithwaite, Rupert R A Bourne, Theo Vos, Hugh R Taylor; Global vision loss due to age-related macular degeneration. Invest. Ophthalmol. Vis. Sci. 2021;62(8):3504.
[7] StahlA.TheDiagnosisandTreatmentofAge-RelatedMacularDegeneration.DtschArzteblInt.2020Jul20;117(29-30):513-520
[8] Canonica J, et al. Front Cell Neurosci. 2023 Jun 12;17:1192464.
[9] The Angiogenesis Foundation《Summit and White Paper Report: PatientCentered Outcomes and Age-Related Macular
Degeneration https://www.pcori.org/sites/default/files/EA-Saville009-Final-Summary-Report.pdf ，P.13
[10] Canonica J, et al. Front Cell Neurosci. 2023 Jun 12;17:1192464.
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