上海市社区学龄前儿童初级眼保健模式探讨

目的了解儿童视力和眼病情况,探索建立社区学龄前儿童初级眼保健模式。方法整群抽取上海徐汇区1个社区10所托幼机构,入园对2134名社区幼儿园儿童行远视力检查,视力可疑异常者转诊至社区医院做进一步睫状肌麻痹下自动电脑验光、主觉验光和其他眼科检查。结果入园初筛检查完成1782人（83．5％）,832人（49．6％）视力可疑异常转诊至社区医院,转诊应答率为51．8％。1782名2—6岁儿童视力达到“正常视力”5．0的比例分别为0．0％、1.3％、6．1％、22．1％、39．6％．50％百分位数视力值依次为4．6、4．7、4．8、4．9和4．9。1676名3～6岁儿童近视、远视、散光和弱视患病率估计分别为2．4％、4．6％、8．8和3．8％％。以视力指标筛查弱视的特异度为52.3％,对需转诊儿童进行视力复测后再转诊的弱视筛查特异度为73.3％。每位儿童入园初筛成本为4．5元．每位弱视儿童发现成本为357．0元。结论上海市康健社区幼儿园儿童群体屈光不正和弱视人群占有一定比例。可建立以社区为基础的、眼视光专科资源支持的儿童初级眼保健模式。

Discussion on Patterns of Primary Eye Care for Preschool Children in Shanghai Community

bstract OBJECTIVE The present study aims to develop the community-based primary eyecare service for preschool children, understand the situation of children＇s visions and eye diseases, so as to provide the basis for exploring and establishing the pattern of primary eye care for preschool children in community. METHODS Ten nurseries were selected from one community of Xuhui District in Shanghai as a overall group. The examination of distant vision was conducted on 2 134 children in the kindergartens, in which the children suspected with abnormal visions were transferred to the community hospital for further examinations, such as automatic computer optometry and subjective optometry under cycloplegic conditions, and other ophthalmic examinations. RESULTS The primary screening examination was completed in 1 782 children, in which 832（49.6%） children were suspected with abnormal vision and transferred to community hospital for further treatment.The referral response rate was 51.8%. The proportion rates of 1 782 2-6 year children reaching the ＂normal vision＂ up to 5.0 were 0.0%, 1.3%, 6.1%, 22.1% and 39.6% respectively. The midian vision values of 2- 6-year old children in the worse eye were 4.6, 4.7, 4.8 and 4.9 respectively. The prevalence rates of 1 676 3-6 year children with myopia, hyperopia, astigmatism and amblyopia were estimated as 2.4%, 4.6%, 8.8% and 3.8% respectively. The specificity of visual acuity in amblyopia screening was 52.3%, whether the specificity in amblyopia screening was 73.3% when the visual acuity repeatedly tested before transferred. The cost of primary screening for each child was 4.5 yuan; the cost of determination for each child with amblyopia was 357 yuan. CONCLUSION There was a certain proportion of ametropia and amblyopia in kindergarten children population in Kangjian Community of Shanghai, so that the community-based primary eye-care pattern could be established for children, which was supported by specialist optical eye resource.