緑内障などの眼疾患による視野障害からの交通事故リスク推定法の確立 平成27年度（中間報告） タカタ財団助成研究論文 ISSN 2185

緑内障などの眼疾患による視野障害からの

交通事故リスク推定法の確立

― 平成 27 年度（中間報告） タカタ財団助成研究論文 ―

ISSN 2185-8950

研究実施メンバー

研究代表者

東京大学 医学部 附属病院眼科

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ሗ࿌᭩ᴫせ

  ᮏࣉࣟࢪ࢙ࢡࢺࡣ㸪       㸨௨ୗグ㍕ᵝᘧࢧࣥࣉࣝ

        ┠ ḟ㸦 㺬㺽㺐㺻㺢ኴᩥᏐ㸧

 ⥳ෆ㞀࡞࡝ࡢ║⑌ᝈ࡟ࡼࡿど㔝㞀ᐖ࠿ࡽࡢ஺㏻஦ᨾࣜࢫࢡ᥎ᐃἲࡢ☜❧ ➨  ❶ࡣࡌࡵ࡟ ◊✲⫼ᬒ ┠ⓗ ➨  ❶᪉ἲ ୧║ど㔝᥎ᐃἲ ஺㏻஦ᨾ࡜どᶵ⬟ࡢ㛵㐃 ➨  ❶⤖ᯝ ୧║ど㔝᥎ᐃἲ ஺㏻஦ᨾ࡜どᶵ⬟ࡢ㛵㐃 ➨  ❶⪃ᐹ ➨  ❶ࡲ࡜ࡵ࡜௒ᚋࡢㄢ㢟    ཧ⪃ᩥ⊩ ௜㘓        ୧║ど㔝᥎ᐃἲ ┠ⓗ㸸ඃ఩║࡟ࡼࡗ࡚⿵ṇࢆ⾜࠸ OLQHDU VFDOH ⾲♧ࡋࡓ༢║ど㔝ࢆ⏝࠸ࡿ࡜୧║ど㔝ண  ್ࡀᨵၿࡉࢀࡿ࠿᳨ウࡍࡿࡇ࡜ ᪉ἲ㸸㛤ᨺ㝮ゅ⥳ෆ㞀  ே  ║ ༢║ど㔝ࡲࡓࡣ୧║ど㔝 ᐃ࡟ࡣࣁࣥࣇ࣮ࣜど㔝᳨ᰝ  6,7$VWDQGDUG ࢆ⏝࠸ࡓ ඃ఩║ ᐃࡣ୧║࡜ࡶ஧ᅇࡎࡘ⾜࠸ ᖹᆒ್ࢆゎᯒ࡟⏝࠸ ࡓ ᐃࡉࢀࡓ୧║ど㔝ࡣ௨ୗࡢ  ࡘࡢ᪉ἲࢆ⏝࠸࡚༢║ど㔝࠿ࡽண ࢆ⾜ࡗࡓ ձ ,9) PHWKRG ղ PRQRFXODU VHQVLWLYLW\ VXPPDWLRQ PHWKRGV RQ WKH G% VFDOH ճ OLQHDUVFDOH/DPEHUWմPRQRFXODUVHQVLWLYLW\VXPPDWLRQPHWKRGVRQWKHOLQHDU VFDOHDGMXVWHGIRUWKHRFXODUGRPLQDQFH ⤖ᯝ㸸⤯ᑐ್࡛⾲♧ࡋࡓ ᐃㄗᕪࡣ OLQHDU VFDOH PHDQs6' sࡀ ,9) PHWKRGsࡼࡾࡶ᭷ព࡟ᑠࡉ࠿ࡗࡓS   ࡉࡽ࡟ ඃ఩║࡟ࡼࡗ࡚⿵ṇ ࡋࡓ᪉ἲ sࡀ ⿵ṇࡋ࡞࠸᪉ἲࡼࡾࡶඃ఩࡟ ᐃㄗᕪࡀ᭷ព࡟ᑠࡉࡃ࡞ࡗ ࡓS  WKHG%VFDOHVXPPDWLRQPHWKRGsࡣ௚ࡢ᪉ἲࡼࡾࡶ ᐃㄗ ᕪࡀ኱ࡁࡃ࡞ࡗࡓS ࡲ࡜ࡵ㸸᭱ࡶṇ☜࡞୧║ど㔝ண ࡣඃ఩║⿵ṇࢆ⾜ࡗࡓ OLQHDUVFDOHࢆ⏝࠸ࡿࡇ࡜࡛࠶ ࡿ㸬 ஺㏻஦ᨾ࡜どᶵ⬟ࡢ㛵㐃 㸯㸷㸯౛ࡢ⥳ෆ㞀౛࡟஺㏻஦ᨾ࡟㛵ࡍࡿ⪺ࡁྲྀࡾㄪᰝࢆ⾜ࡗࡓࠋࡇࡢ⤖ᯝࢆ฼⏝ࡋ࡚ࠊどຊࠊ ୧║ど㔝ࠊᖺ㱋ࠊᛶูࠊERG\PDVVLQGH[ ࡢ࠺ࡕࠊ஺㏻஦ᨾṔ࡟㛵㐃ࡀ࠶ࡿࡢࡣࠊᝏ࠸᪉ࡢ ║ࡢどຊ࡛࠶ࡗࡓࠋ ௒ᚋ࡬ࡢᒎᮃ /LQHDUVFDOH ࢆ⏝࠸ࡓຍ⟬ἲ࡟ࡼࡾ᥎ᐃࡉࢀࡿ୧║ど㔝࡜஺㏻஦ᨾࡢ㛵㐃ࢆゎᯒࡍࡿࡇ࡜ࠋ ᭦࡟ࠊ✀ࠎࡢᶵᲔᏛ⩦ἲ࡞࡝ࡶ㥑౑ࡋ࡚ࡼࡾṇࡋࡃ஺㏻஦ᨾࣜࢫࢡࢆணぢ࡛ࡁࡿ࠿᳨ドࡍࡿ ࡇ࡜ࠋ  

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ࡣࡌࡵ࡟

 ◊✲⫼ᬒ  ⮬ື㌴஦ᨾ࡟ࡼࡿṚஸ⪅㸪Ṛയ⪅ࡣᩘᖺ๓࠿ࡽῶᑡࡋ࡚ࡁ࡚࠸ࡿࡶࡢࡢ㸪 ᖺࡢ⮬ື㌴ ஦ᨾ࡟ࡼࡿṚஸ⪅ࡣ  ே㸪Ṛയ⪅ࡣ  ୓ே௨ୖ࡛㸪࠸ࡲࡔከࡃࡢேࡀ⮬ື㌴஦ᨾࡢ≛≅ ࡟࡞ࡗ࡚࠸ࡿ㸬㏆ᖺ࡟࡞ࡗ࡚║⑌ᝈ࡟ࡼࡿどᶵ⬟㞀ᐖ࡜஺㏻஦ᨾࡢ㛵㐃ࡀὀ┠ࡉࢀ࡚࠾ࡾࠊ ║⑌ᝈࡢ஺㏻஦ᨾ࡟୚࠼ࡿᙳ㡪ࢆゎᯒࡍࡿࡇ࡜ࡣ㔜せ࡛࠶ࡿ࡜⪃࠼ࡽࢀࡿ ⥳ෆ㞀ࡢᮏ㑥࡟࠾ࡅࡿ᭷⑓⋡ࡣ  ṓ௨ୖࡢ⣙㸳㸣࡛࠶ࡾࠊࡲࡓᮏ㑥࡟࠾ࡅࡿ୰㏵ኻ᫂ࡢཎ ᅉ࡜ࡋ࡚᭱ࡶከ࠸ࡶࡢ࡛࠶ࡿ. ᮏ◊✲࡛ࡣ᭱ࡶ௦⾲ⓗ࡞║⑌ᝈࡢ୍ࡘ࡛࠶ࡿ⥳ෆ㞀࡟࠾ࡅࡿࠊ どᶵ⬟㞀ᐖ࡜஺㏻஦ᨾࡢ㛵㐃ࢆゎᯒࡋࡓ. ⥳ෆ㞀ᝈ⪅ࡣᙜ↛㏻ᖖ୧║ࢆゎᨺࡋࡓ≧ែ࡛⏕άࡋ࡚࠸ࡿࠋࡇࢀࡲ࡛ࡢ◊✲࠿ࡽ୧║ど㔝 ࡀどぬ⏕ά㞀ᐖᗘ㸦Quality of Visual Life㸧QoV ࡜㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡀศ࠿ࡗ࡚࠸ࡿ. ౛࠼

ࡤQoVL ࡜ Esterman ど㔝᳨ᰝ࡛ ᐃࡉࢀࡓ୧║ど㔝࡜ࡢ㛫࡟ᙉ࠸┦㛵㛵ಀࡀ࠶ࡿࡇ࡜ࡀ

௨๓ࡼࡾሗ࿌ࡉࢀ࡚࠸ࡿ.[1-7] ᚑࡗ࡚ ஺㏻஦ᨾ࡜ど㔝ࡢ㛵㐃ࢆゎᯒࡍࡿ㝿࡟ࡶᙜ↛୧║

ど 㔝 ࢆ ⏝ ࠸ ࡿ ࡭ ࡁ ࡛ ࠶ ࡿ. Esterman ୧║ど㔝ࡣ Humphrey

ど㔝ィ(HFA㸹Zeiss-Humphrey Systems, Dublin, CA)ࡸ Octopus 900 (Haag-Streit, Koniz, Switzerland) ࡞࡝ࡢ㟼ⓗ⮬ືど㔝ィࢆ⏝࠸࡚ ᐃࢆ⾜ࢃࢀࡿࡀ ་⒪⌧ሙ࡟࠾࠸࡚୧║ど㔝ࡀ ᐃࡉࢀࡿ ࡇ࡜ࡣ࡯࡜ࢇ࡝࡞ࡃ ከࡃࡢ᪋タ࡛༢║ど㔝ࢆ ᐃࡋ ᶵ⬟ホ౯ࢆ⾜ࡗ࡚࠸ࡿ. ࡑࡢ⤖ᯝ࡜ ࡋ࡚༢║ࡢど㔝ࢆ⤫ྜࡋࡓ᥎ᐃ୧║ど㔝㸦IVF㸧ࡀ⏝࠸ࡽࢀ࡚࠸ࡿ.[8-11] IVF ࡣ∦║ ࡎࡘࡢど㔝᳨ᰝ⤖ᯝࢆẚ㍑ࡋࡓ㝿࡟ ᑐᛂࡋࡓ∦║ࡢど㔝᳨ᰝⅬ࠿ࡽ ࡼࡾឤᗘࡢ㧗࠸㜈್

ࢆ୧║ど㔝ឤᗘ࡜ࡋ࡚᥇⏝ࡍࡿ. ௨ୖࢆ඲࡚ࡢ᳨ᰝⅬ࠾࠸࡚⾜࠸ ୧║ど㔝ࢆᵓ⠏ࡍࡿ. ⥳ෆ㞀ᛶど㔝Ḟᦆ࡟࠾࠸࡚ IVF ࡣ Esterman ど㔝࡜㏆ఝࡍࡿࡇ࡜ࡀሗ࿌ࡉࢀ࡚࠾ࡾ ⱥᅜ ࡛ࡣ⥳ෆ㞀ᝈ⪅ࡢ㐠㌿㐺ᛶホ౯࡟ࡶ⏝࠸ࡽࢀ࡚࠸ࡿ.[9,11] ࡉࡽ࡟IVF ࡣEsterman ど 㔝ࡼࡾࡶ⥳ෆ㞀ᝈ⪅࡟࠾ࡅࡿQoVL ࡢᝏ໬࡜ᐦ᥋࡟㛵㐃ࡋ࡚࠸ࡿࡇ࡜ࡀ♧ࡉࢀ࡚࠾ࡾ ⥳ෆ 㞀ᝈ⪅࡟࠾ࡅࡿ QoVL ホ౯ࡢ㝿࡟ ከࡃࡢ◊✲࡛ IVF ࡀ⏝࠸ࡽࢀ࡚࠸ࡿ.[3,11-21] ᡃࠎ ࡣ㐣ཤ࡟ ࡼࡾⰋ࠸ឤᗘ࡛ᵓᡂࡍࡿ᪉ἲ࡜ IVF ࡢ㛫࡟㐪࠸ࡀ࠶ࡿࡇ࡜ࢆሗ࿌ࡋࡓ.[22] Nelson-Quigg ࡽࡣ IVF ࡣ୧║ຍ⟬ࣔࢹࣝ(ᩘᘧ㸹SR_࡜SL_{ࡣࡑࢀࡒࢀdB ⾲グࡉࢀࡓྑ} ║࡜ᕥ║ࡢ༢║ࡎࡘࡢឤᗘࢆ♧ࡋ࡚࠸ࡿ.[17]) ࡜ẚ㍑ࡍࡿ࡜ ࡼࡾጇᙜ࡞୧║ど㔝ண ࡀ ྍ⬟࡛࠶ࢁ࠺࡜ሗ࿌ࡋ࡚࠸ࡿ.[23] ࡋ࠿ࡋ࡞ࡀࡽ ୧║ຍ㔜ࣔࢹࣝࡢィ⟬ࡢ㝿࡟ ༢║ࡢど 㔝ឤᗘࡀdB ⾲グ࠿ linear ⾲グࡢ࡝ࡕࡽࢆ⏝࠸ࡽࢀࡿ࡭ࡁ࡞ࡢ࠿᳨ウࡉࢀ࡚࠸࡞࠸. ࡇࡢศ 㔝࡛ᗈࡃᘬ⏝ࡉࢀ࡚࠸ࡿ୧║ຍ㔜ࣔࢹ࡛ࣝ࠶ࡿ Michelson ࣔࢹࣝ[24]࡟࠾࠸࡚ࡣ linear brightness ⾲グࢆ⏝࠸࡚࠸ࡿ.[25-28] 㐣ཤࡢ࡝ࡢࣔࢹࣝࡶ ୧║ຍ⟬ࡢ㝿࡟ ║ඃ఩ᛶࡣ⪃៖ࡉࢀ࡚࠸࡞࠸. ୧║ど㔝㜚 தࡣ ୧║࡟␗㉁ࡢどᶆࢆぢࡏࡓሙྜ࡟㉳ࡇࡿどぬࡢ⌧㇟࡛࠶ࡿ. ࡇࡢ㝿 ࡑࢀࡒࢀࡢ║࡛ ▱ぬࡋࡓ࢖࣓࣮ࢪࡣ㔜ࡡྜࢃࡏ࡚ᵓ⠏ࡉࢀࡿࢃࡅ࡛ࡣ࡞ࡃ ∦║࠿ࡽ࢖࣓࣮ࢪࢆᢚไࡍࡿࡇ ࡜࡟ࡼࡗ࡚ ᕥྑ║࡝ࡕࡽ࠿ࡢ࢖࣓࣮ࢪࢆ஺஫࡟▱ぬࡋ࡚࠸ࡿ.[29] ⥳ෆ㞀࡟࠾࠸࡚ࡣ ᕥྑ║࡛ᑐᛂࡋࡓ⟠ᡤࡢど㔝ឤᗘࡀ ኱ࡁࡃ␗࡞ࡿሙྜ࡟࠾࠸࡚ ࡇࡢ୧║ど㔝㜚தࡀ㉳ࡇ ࡗ࡚࠸ࡿྍ⬟ᛶࡀ࠶ࡿ. ║ඃ఩ᛶࡣ ୧║࡛ࡢ࢖࣓࣮ࢪࡢᢚไ㢖ᗘࡢ㐪࠸ࡢ⤖ᯝ࡛࠶ ࡿ.[30] ᡃࠎࡣ║ඃ఩ᛶࢆ⪃៖ࡍࡿࡇ࡜࡛୧║ど㔝ホ౯ἲࡀᨵၿࡉࢀࡿࡢ࡛ࡣ࡞࠸࠿࡜⪃ ࠼ࡓ.

᭦࡟ ࡇࢀࡲ࡛࡟౛࠼ࡤࢻࣛ࢖ࣅࣥࢢࢩ࣑࣮ࣗࣞࢱ࣮ࢆ⏝࠸ࡓ⤖ᯝ࡜ ,9) ࡢ㛵ಀࢆ ㄪ࡭ࡓ◊✲࡞࡝ࡣሗ࿌ࡉࢀ࡚࠸ࡿࡀ ᐇ㝿ࡢ஺㏻஦ᨾṔ࡜どᶵ⬟ࡢ㛵㐃ࢆヲ⣽࡟ㄪ࡭ࡓሗ ࿌ࡣ↓࠸ࡇࡢ◊✲ࡢࡶ࠺୍ࡘࡢ┠ⓗࡣࠊ⥳ෆ㞀ᝈ⪅࡟࠾࠸࡚ᐇ㝿ࡢ஺㏻஦ᨾṔࢆ⫈ྲྀࡋ どᶵ⬟࡜஺㏻஦ᨾࡢ㛵㐃ࢆヲ⣽࡟ㄪ࡭ どᶵ⬟ィ ್࠿ࡽ஺㏻஦ᨾࣜࢫࢡࢆணぢࡍࡿࡇ࡜ࡀ ྍ⬟࡛࠶ࡿ࠿ࢆ᳨ドࡍࡿࡇ࡜࡛࠶ࡿ   ┠ⓗ  ࡇࡢ◊✲ࡢ᭱ึࡢ┠ⓗࡣ linear ⾲グ࡛ࡢ༢║ど㔝ឤᗘࢆ⏝࠸ࡿ᪉ἲࡸ║ඃ఩ᛶ࡛ ࡢ⿵ṇࢆ⾜࠺ࡇ࡜࡟ࡼࡗ࡚ ࡼࡾṇ☜࡞୧║ど㔝ண ࡀྍ⬟࠿࡝࠺࠿ㄪ࡭ࡿࡇ࡜࡛࠶ࡿ.  ࡇࢀࡲ࡛࡟౛࠼ࡤࢻࣛ࢖ࣅࣥࢢࢩ࣑࣮ࣗࣞࢱ࣮ࢆ⏝࠸ࡓ⤖ᯝ࡜ ,9) ࡢ㛵ಀࢆㄪ࡭ࡓ ◊✲࡞࡝ࡣሗ࿌ࡉࢀ࡚࠸ࡿࡀ ᐇ㝿ࡢ஺㏻஦ᨾṔ࡜ どᶵ⬟ࡢ㛵㐃ࢆヲ⣽࡟ㄪ࡭ࡓሗ࿌ࡣ↓ ࠸ࡇࡢ◊✲ࡢࡶ࠺୍ࡘࡢ┠ⓗࡣ⥳ෆ㞀ᝈ⪅࡟࠾࠸࡚ᐇ㝿ࡢ஺㏻஦ᨾṔࢆ⫈ྲྀࡋどᶵ ⬟࡜஺㏻஦ᨾࡢ㛵㐃ࢆヲ⣽࡟ㄪ࡭ どᶵ⬟ィ ್࠿ࡽ஺㏻஦ᨾࣜࢫࢡࢆணぢࡍࡿࡇ࡜ࡀྍ⬟ ࡛࠶ࡿ࠿ࢆ᳨ドࡍࡿࡇ࡜࡛࠶ࡿ 

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᪉ἲ

୧║ど㔝᥎ᐃἲ ࡇࡢ◊✲ࡣᮾி኱Ꮫ་Ꮫ㒊௜ᒓ⑓㝔ࡢ೔⌮つᐃጤဨ఍࡟࠾࠸࡚ᢎㄆࡉࢀᑐ㇟࡜ ࡞ࡗࡓᝈ⪅࠿ࡽᮏ◊✲ཧຍࡢᢎㅙ᭩ࢆ᭩㠃࡟ࡼࡾྲྀᚓࡋࡓᮏ◊✲ࡣ࣊ࣝࢩࣥ࢟ᐉゝ࡟

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Table 3. MVC + ࢢ࣮ࣝࣉ࡜ MVC-ࢢ࣮ࣝࣉࡢẚ㍑ .

MVC + (mean ± s.d.) MVC - (mean ± s.d.) P value

N 28 163 ᖺ㱋 (years) 66.9 ± 11.4 63.1 ± 9.6 0.07 ᛶู (male/female) 20/8 121/43 0.76 B.M.I 22.4 ± 2.5 22.7 ± 3.0 0.65 Ⰻ࠸║ࡢどຊ (LogMar) 0.00 ±0.00 0.00 ± 0.02 0.26 ᝏ࠸║ࡢどຊ (LogMar) 0.03 ± 0.01 0.01 ± 0.003 0.01 Ⰻ࠸║ࡢMD (dB) -3.0 ± 4.0 -2.5 ± 4.0 0.35 ᝏ࠸║ࡢMD (dB) -7.1 ± 7.2 -7.0 ± 6.2 0.92 IVF-MD (dB) -2.1 ± 3.9 -1.6 ± 3.7 0.52 ⥳ෆ㞀㐍⾜ᗘ (᪩ᮇ/୰ᮇ/ ᪂ᚋグ) 18/4/6 88/42/33 0.52 㐣ཤࡢMVCs (Yes/No) 32.1%=9/28 21.5%=35/163 0.23 㐌ࡢ㐠㌿㊥㞳 (km) 107.9 ± 180.5 98.3 ± 89.2 0.12





 Table 4 ከ㡯ᘧࣟࢪࢫࢸ࢕ࢵࢡᅇᖐࡢ⤖ᯝ





➨  ❶

⪃ᐹ

࣭୧║ど㔝᥎ᐃἲ࡟ࡘ࠸࡚



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Variable Coefficient Std. Error P ᖺ㱋 0.043305 0.024268 0.0744 Ⰻ࠸║ࡢどຊ 19.59581 6.68125 0.0034 ᝏ࠸║ࡢどຊ -452.12236 138446.52478 0.9974 BMI -0.099944 0.084664 0.2378 ᛶู㸦ዪᛶ㸧 0.060366 0.50413 0.9047 IVFMD -0.055465 0.061179 0.3646 㐣ཤࡢMVCs 0.76108 0.47716 0.1107

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➨  ❶

ࡲ࡜ࡵ࡜௒ᚋࡢㄢ㢟

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