拥挤Kay图片视力表在学龄前儿童视力筛查中的应用

目的：采用拥挤Kay图片视力表检测学龄前儿童视力,并和标准对数视力表检测结果进行比较,探讨2种视力表检测结果是否具有一致性,以补充不能完成标准对数视力表检测的学龄前儿童的视力筛查。方法：前瞻性自身对照研究。于2021年1─5月随机选取济南市章丘区某幼儿园152名学龄前儿童进行全面眼科筛查,分别使用拥挤Kay图片视力表及标准对数视力表对其进行视力检测,并采用Wilcoxon检验进行2种视力差异性的比较,Spearman秩相关分析及Bland-Altman分析进行相关性及一致性分析。结果：152名儿童参与筛查,其中129名儿童屈光状态正常且能配合2种视力表检测。129名儿童中男74名,女55名,年龄为（52.3±7.0）个月;拥挤Kay图片测得LogMAR视力为0.10（0.09,0.10）,标准对数视力表视力为0.10（0.10,0.22）;2种视力检查方法有较好的相关性（r=0.436,P<0.001）,拥挤Kay视力表检测结果略高于标准视力表约0.04 LogMAR,差异有统计学意义（Z=-6.124,P<0.001）,Bland-Altman散点图显示98.4%的点均在一致性范围内;参与筛查儿童Kay图片视力检查配合度更高（χ2=18.007,P<0.001）。不同月龄拥挤Kay图片视力检测结果差异有统计学意义（H=13.791,P=0.003）,随年龄增长,视力呈递增趋势。结论：拥挤Kay图片视力表用于学龄前儿童视力检测,患儿配合程度高,其结果与标准对数视力表相比有较好的一致性,但Kay图片视力表所检查的视力结果高于标准视力表约0.04 LogMAR,在参考视力结果时应相应调整视力标准。     

两种视力表检查89位学龄前儿童视力的对比研究

目的比较学龄前儿童Lea Symbols与Tumbling E两种视力表的检测率、单眼视力值．建立3。4周岁儿童正常的视力值。方法招募温州市区29—53月龄的89名学龄前儿童，入选标准是身体一般情况良好。智力发育正常，除屈光不正外无其他眼病。以随机顺序用两种视力表检查儿童单眼视力，用间插的logMAR记分方法记录结果。招募23名成人志愿者，分别用两种视力表检查单眼视力．获得两者之间的换算关系。结果成人44眼Lea Symbols的平均视力比Tumbling E高0．02logMAR。89名儿童Lea Symbols视力表的检测率为88％．而Tumbling E视力表的检测率为65％，统计学分析两者差异有显著性（P〈0．01）。60位儿童中115眼能同时配合查Lea Symbols与Tumbling E,Lea Symbols的平均视力为0．17±0．09．Tumbling E的平均视力为0．25±0．09．两者作配对t检验差异具有显著性（P〈0．01）。两种视力表视力相关性高（r=-0．73，P〈0．01），两种视力表视力差值不随视力水平的改变而变化（P=-0．60）。正常屈光状态下儿童Lea Symbols 平均视力0．16±0．07（120眼）。Tumbling E的平均视力0123±0.07（91眼）。结论Lea Symbols视力表和Tumbling E视力表是测量视力可靠且有效的方法．检查4周岁以下儿童的视力时首选Lea Symbol视力表。与Tumbling E视力表相比，Lea Symbol视力表过高估计视力．原因可能在于两种视力表的不同设计以及儿童的认知水平差异。     

噪声视力表在儿童视力检查中的可重复性分析

目的探讨噪声视力表对儿童视力检查的可重复性及其相关影响因素。方法在门诊首诊患儿中,随机选择无理解障碍及除屈光不正外无其他器质性眼病儿童200例,使用噪声视力表进行噪声视力重复检查。采用配对t检验进行统计学分析。结果两次视力测量之间差异的均数为O.03行,（P=0.515）;两次视力测量结果按性别分组无明显差异（P=1.0,P=0.262）;按年龄分组亦无明显差异（P=0.159,P=0.786）;按屈光不正分组,其中近视组两次视力测量结果有明显差异（P=0.010）。近视儿童视力检查一致性较差,而正视及远视儿童的视力检查一致性较好（P=0.133,P=0.083）。结论结果提示噪声视力表适合儿童视力检查,建议推广使用。     

Psychometric视力表对弱视儿童视力的评估作用

目的评价Psychometric视力表在弱视儿童诊治中的应用价值．拥挤现象对正常视力儿童和弱视儿童的影响是否相同。方法我院门诊5～15岁儿童113人，男65人，女48人，平均年龄（7.42±2．03）岁，用标准对数视力表和包含拥挤现象的Psychometric视力表分别检查左右眼的两种视力，比较正常眼和弱视眼两种视力的差别。结果正常视力儿童和弱视儿童的两种视力差异都有显著性（P〈0．05）。对数视力比P视力高。弱视儿童的两种视力差别比正常儿童大。不同弱视类型之间视力差别不大．不同弱视程度之间两种视力有差别。结论儿童都受拥挤现象的影响，但是弱视儿童的拥挤现象更明显。拥挤现象影响程度与弱视程度有关。与弱视类型关系不大。Psychometric视力表适合弱视患者的视力检查。     

有晶状体眼人工晶状体Verisyse植入对高度近视患者视觉质量的影响

目的观察高度近视患者有晶状体眼人工晶状体Verisyse植入术后的视觉质量。方法表面麻醉下对54例（54眼）高度近视患者（-12．00～-24．00D）行Verisyse植入术。手术前后分别检查术眼裸眼及矫正视力、对比敏感度及调节力。将各项检查结果进行t检验或单因素方差分析。结果术后所有术眼裸眼远、近视力均达到或高于术前最佳矫正视力；术眼手术前后在3cpd、6cpd、12cpd、18cpd空间频率的对比敏感度有显著性差异，手术后较术前明显提高（P=0．000）；术眼术前调节力平均为（2．19±1．36）D，术后3个月调节力平均为（5．27±2．18）D，较术前明显增加（P=0．036）。结论Verisyse眼内植入术提高了高度近视患者的视觉质量。     

北京市羊坊店学区两个年级组小学生远视力和眼轴的关系

目的观察不同年级小学生远视力和眼轴长度相关性,为近视防治寻找监控点。设计横断面调查。研究对象北京市羊坊店学区全部小学的一年级、四年级学生2970例。方法采用标准对数视力表测量远视力,光学相干生物测量仪（IOLMaster）测量眼轴长度。取右眼测量值统计分析。主要指标远视力,眼轴长度,视力不良比例。结果一年级组（年龄6．44±0．52岁）、四年级组（9．25±0．46岁）眼轴长分别为（22．73±0．72）mm（n=1270）、（23．66±0．93）mm（n=1672）（P=0．000）;一年级组、四年级组远视力分别为（1．02±0．26）（n=1282）、（0．86±0．42）（n=1494）（P=0．000）。一年级组眼轴长与远视力无明显相关性（r=0．019,P=0．495）;四年级组眼轴长与远视力呈明显负相关性（r=-0．425,P=0．000）。眶轴长〉24．00mm的学生,视力不良率最高。结论小学生视力和眼轴发育随着年龄的增加而改变,小学生眼轴超过24mm是近视防治监控点。     

新型对数视力表与“C”形对数视力表的一致性与稳定性分析

目的评价新型对数视力表与具有8个方向视标选项的“C”形对数视力表之间的一致性与稳定性。方法 横断面研究。对48例应届高中毕业生分别进行新型对数视力表与“C”形对数视力表的视力检查,采用组内相关系数（ICC）和Cronbach′s Alpha系数分析视力测量结果的重复性,采用Bland-Altman分析一致性。结果 “C”形对数视力表Cronbach′s Alpha系数在0.8以上,ICC接近0.9,新型对数视力表Cronbach′s Alpha系数接近0.8,ICC＞0.75,均显示较好的重测稳定性。2种视力表第1次和第2次视力测量均具有较好的一致性,95％一致性界限分别为（0.173,-0.133）logMAR和（0.198,-0.116）logMAR。结论 新型对数视力表检查结果稳定,和“C”形对数视力表一致性较好。     

Lea Symbols视力表在42～78个月儿童视力检查中的重复测量可信度分析

目的：探讨Lea Symbols视力表在学龄前儿童视力检查中的重复测量可信度。方法：横断面研究。 2017年4-5月对泉州市泉港区实验幼儿园的250名42～78（61.9±10.3）个月的学龄前儿童进行全面 的眼科检查,使用Lea Symbols视力表重复测量右、左眼的单眼远视力,采用LogMAR记录法记录 视力值。采用Bland-Altman分析、加权Kappa检验、组内相关系数3种统计分析方法衡量2次测量之 间的重复测量可信度。结果：3种分析方法均显示Lea Symbols视力表在学龄前儿童视力检查中的重 复测量可信度较好,2次测量间视力的差值94.3%在1行以内,2次测量的视力值之间的相关性较高 （r=0.753,P<0.001）。在139名屈光正常儿童中,2次测量的视力值（LogMAR）平均相差0.014。在 139名屈光正常儿童中,视力与月龄的相关性是显著的,月龄越大视力越好（r第1次=-0.335,P<0.001; r第2次=-0.424,P<0.001）;性别对可重复性没有影响（P=0.197）。结论：Lea Symbols视力表可用于 中国42个月及以上学龄前儿童的视力检查,可以在临床视力检查中推广使用。     

弱视儿童瞬态图形视觉诱发电位视力与国际标准视力的比较

目的研究弱视儿童瞬态图形视觉诱发电位（pattern visual evoked potential．PVEP）视力与国际标准视力表视力之间的相关性．探讨用视觉诱发电位技术检测弱视儿童客观视力的可行性及临床实用性。方法检测32例（64眼）3-11岁的弱视患儿的瞬态图形视觉诱发电位视力（PVEP视力）及国际标准视力表视力并进行相关分析。PVEP检测使用美国LKC公司生产的UTAS—E3000电生理诊断系统。使用5个不同空间频率的水平条栅作为刺激,时间频率为2Hz,将能够观察到典型PVEP波形的最高空间频率作为患儿的PVEP视力。结果瞬态图形视觉诱发电位视力与国际标准视力表视力之间有良好的相关性（r=0．712,P〈0．05）;弱视程度不同．瞬态图形视觉诱发电位视力的分布亦有显著差异：国际标准视力表视力与瞬态图形视觉诱发电位视力存在一定数值对应规律。重度弱视组,PVEP视力100％在0．85cpd（最低空间频率）;中度弱视组,PVEP视力分布相对较分散,集中分布在3．40cpd和6．80cpd,无1眼达13．60cpd;轻度弱视组．PVEP视力集中分布在3．40cpd和6．80cpd两个空间频率．其中达6．80cpd者占71．2％;视力≥0．9组．全部PVEP视力≥6．80cpd。四组PVEP视力呈相对集中分布。随国际标准视力提高．PVEP视力也相应提高。结论在无法使用国际标准视力表检查弱视儿童视力时,可以运用瞬态图形视觉诱发电位技术进行客观视力评估．尤其是低龄弱视儿童。     

准分子激光原位角膜磨镶术后五年外伤致角膜瓣移位一例

患者男，26岁。因右眼被螺丝刀刺伤后伴眼痛、流泪、视物模糊半小时于2002年11月12日以“右眼角膜板层裂伤”收入院。既往患者因近视于1997年9月12日行双眼准分子激光原位角膜磨镶术，术前右眼裸眼视力0．06，矫正视力1．0，近视屈光度数-6．00D，角膜厚度为161μm；术后裸眼视力为1．0。本次就诊全身体检正常。眼部检查：右眼裸眼视力0．04，矫正视力不提高，左眼视力为1．0，双眼眼压18mmHg（1mmHg=0．133kPa）。     

An evaluation of the M&S technologies smart system II for visual acuity measurement in young visually-normal adults.

PURPOSE: To compare visual acuity measures obtained with the M&S Technologies Smart System II (SSII) and the revised Early Treatment of Diabetic Retinopathy Study (ETDRS) charts in terms of accuracy and test-retest repeatability. METHODS: Monocular visual acuities were taken in 57 young, visually normal adults on two separate visits in which both the SSII system and the ETDRS charts were tested in random order by two masked examiners. The eye to be tested throughout was chosen randomly at the initial visit. Measurements were made through an optimal phoropter correction, determined by a noncycloplegic refraction for a 10-foot distance. Both charts were presented at 10 feet, and were matched closely for luminance. RESULTS: The mean visual acuity in the group was -0.16 log minimum angle of resolution (MAR) for the ETDRS chart and -0.18 log MAR for the SSII, a small but statistically significant difference. A 95% confidence interval for the mean difference in visual acuity between the two charts was -0.033 log MAR to -0.003 log MAR. The test-retest repeatability was not significantly different in the two tests. The 95% limits of agreement for test-retest repeatability were -0.13 log MAR to +0.17 log MAR for the SSII and -0.12 log MAR to +0.13 log MAR for the ETDRS charts. CONCLUSIONS: The SSII can provide an accurate (mean difference<0.033 log MAR) and repeatable alternative to the ETDRS charts for visual acuity measurement in young, visually normal, well-corrected individuals.     

Comparison of logMAR ETDRS chart and a new computerised staircased procedure for assessment of the visual acuity of children

The validity and repeatability of visual acuity measures are particularly important in the detection and monitoring of childhood visual anomalies such as amblyopia. The repeatability and sensitivity of a new computerised visual acuity test, 'Staircased Procedure' is compared with the now gold standard visual acuity test, the early treatment of diabetic retinopathy study (ETDRS). Twenty-seven visually normal children (mean age: 6.7 +/- 1.1 years) and 27 children with amblyopia (mean age: 6.1 +/- 0.7 years) were tested with the ETDRS and Staircased Procedure. A retest was administered 4-5 weeks later and 30 min later for the visually normal and the amblyopic children, respectively. The staircased procedure produced significantly better visual acuity than the ETDRS for visually normal and amblyopic children. Repeatability was similar for both tests (ETDRS: 0.11 log units; staircased procedure: 0.13 log units). In conclusion, the Staircased Procedure was an acceptable test with high repeatability and validity.     

Normal visual acuity in 17--18 year olds

PURPOSE: The aim of this work was to establish visual acuity norms in 17-18-year-olds. METHODS: In a previous, population-based study carried out in 1998, a total of 1046 12-13-year-old children were examined with a full eye examination. In 2003, 25% (n=262) of these children were randomly selected and invited to a re-examination; 147 subjects agreed to participate and 116 attended. The examined group did not significantly differ from the original sample in terms of the prevalence of ocular and visual disorders. Best corrected monocular visual acuity (VA) was assessed with the revised 2000 ETDRS logMAR chart. RESULTS: Mean best corrected VA was -0.10 logMAR across the examined group. There was no significant difference between right and left eyes. By excluding nine subjects who had significant ametropia and/or ocular or visual pathology, mean VA increased to -0.12 logMAR (SD 0.07). The mean interocular difference in VA among normal subjects was 0.04 logMAR. CONCLUSIONS: Visual acuity in teenagers is significantly better than 0.0 logMAR and the interocular difference is low in healthy eyes.     

Repeatability of ETDRS visual acuity in children

PURPOSE: To evaluate repeatability of the best corrected log minimum angle of resolution (MAR) Early-Treatment Diabetic Retinopathy Study (ETDRS) acuity in a group of 6- to 11-year old children with myopia. METHODS: Best corrected monocular visual acuity (VA) of a subset of children (n = 86) enrolled in the Correction of Myopia Evaluation Trial (COMET; mean spherical equivalent refractive error -2.35 D with no more than 1.25 D astigmatism) was measured at baseline and 1 month later with ETDRS logMAR charts. Children started with logMAR 0.4 (6/15 or 20/50) and read each letter on all subsequent lines until they missed all letters in 1 line. RESULTS: At baseline, the mean best corrected logMAR VA was 0.003 +/- 0.076 (6/6 or 20/20 +/- 3.8 letters) in the right eye and 0.008 +/- 0.059 (6/6 or 20/20 +/- 2.95 letters) in the left eye. The signed difference between VA measured at baseline and that measured at 1 month was not significantly different from zero in either eye. Repeatability was not associated with age, but a small, statistically significant association with gender was detected in the left eye, with boys approximately 2 letters more variable than girls. The kappa statistic (agreement within 1 line) was good to excellent. CONCLUSIONS: Based on the 95% limits of agreement, the criterion for a statistically significant change in VA is no more than +/-0.15 logMAR (or +/-8 letters). This value is similar to those reported for adults and indicates that logMAR VA provides a repeatable measure of acuity in children.     

A modified ETDRS visual acuity chart for European-wide use.

PURPOSE: The log MAR visual acuity (VA) chart developed for use in the Early Treatment Diabetic Retinopathy Study (ETDRS) is composed of 10 Sloan letters, which are not used in the Greek, Cyrillic, and Central European alphabets. In this study we evaluate a modified ETDRS chart, the University of Crete (UoC) chart, which contains a set of letters readable by all European citizens. METHODS: In the UoC charts, the letters C, D, R, N, V, S, and Z were substituted with E, P, B, X, Y, A, and T, respectively. The similarity between the modified and the standard acuity charts was evaluated using two procedures. First, VA of 227 secondary school children (454 eyes) was evaluated using both sets of charts. Second, the relative difficulty for the identification of individual Sloan letters used in both charts, as well as letter M, was assessed from psychometric functions for five subjects. RESULTS: Bland-Altman plots revealed no statistical significant differences in the value of VA between the standard and the UoC set of charts. Although, estimates of identification log MAR threshold showed relatively significant interletter variability, in total, the new set of Sloan letters was equally identifiable with the original set. CONCLUSIONS: The overall pattern of results suggests that the modified log MAR UoC charts forms a valid alternative to the ETDRS for assessing VA in multinational clinical trials, offering the advantage of containing letters recognizable by a wider population basis, such as European citizens, as well as subjects from countries using the Cyrillic alphabet.     

A computerized resolution visual acuity test in preschool and school age children

AIM: To study if one of the two molecules could lead to a lower number of follow up visits and intra-vitreous injection (IVI) with the same efficacy. METHODS: ELU (or “elected” in French) study is a retrospective study conducted in real life in patients presenting suboptimal response after ranibizumab IVI (phase 1) and secondary switched to aflibercept (phase 2). The number of follow up visits and IVI were compared in both phases. Visual acuity (VA) evolution and “switching” reasons were secondary analyzed. RESULTS: We retrospectively included data of 33 patients (38 eyes) with age-related macular degeneration (AMD; mean age: 77±7.7y). The number of monthly follow up visits [Median (Q1; Q3)]: was significantly lower with aflibercept (phase 2), respectively 1.0 (0.81; 1.49) visits in phase 1, versus 0.79 (0.67; 0.86) visits in phase 2. The median number of monthly IVI also significantly decreased in phase 2, respectively 0.67 (0.55; 0.90) IVI in phase 1, versus 0.55 (0.45; 0.67) IVI in phase 2. The mean VA evolution (VA final-VA initial) was similar in both phases, (P>0.05). Whatever the reason for “switching” (loss of efficacy, tachyphylaxis, tolerance problems), there was no incidence on VA evolution over the time. CONCLUSION: Our results show that switching from ranibizumab to aflibercept in “suboptimal” patients, significantly reduced the number of follow up visits and IVI, with a comparable efficacy. This decrease in visit number could improve patients’ quality of life and reduce surgical risk by reducing the number of injections.     

A comparison of visual acuity measured by ETDRS chart and Standard Logarithmic Visual Acuity chart among outpatients

AIM:To compare the results of visual acuity(VA)measured by Early Treatment Diabetic Retinopathy Study(ETDRS)chart,5 m Standard Logarithm Visual Acuity(5 SL)chart,and 2.5 m Standard Logarithm Visual Acuity(2.5 SL)chart in outpatients of age 12-80 y.METHODS:Each patient(totally 2000 outpatients)had both eyes tested with ETDRS chart at 4 m,5 SL chart at 5 m,and 2.5 SL chart at 2.5 m in random order.The VA values of outpatients were categorized by ages.VA values were expressed by log MAR recording method.RESULTS:The mean VA results of ETDRS charts,5 SL,and 2.5 SL chart were 0.52±0.28,0.50±0.30,and 0.46±0.28 log MAR,respectively.There was a statistically significant difference in the three eye charts in the whole group(P<0.001).For all subjects,the correlation of VA tested with three charts was statistically significant(Spearman correlation coefficient=0.944,0.937,0.946,all P<0.001).Bland–Altman analysis shows the 95%limits of agreement between the 5 SL and 2.5 SL chart were-0.182 to 0.210,-0.139 to 0.251,and-0.151 to 0.235 log MAR,respectively.CONCLUSION:The agreement between the three eye charts is not high.The VA measured by 5 SL chart is slightly better than that by ETDRS chart and 5 SL chart would be a suitable alternative when ETDRS chart are not available in the clinical situation.The VA measured by 2.5 SL chart is about 0.5 line better than VA tested with ETDRS chart,which may overestimate VA.