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。     

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。     

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。     

Lea Symbols电子视力表与灯箱视力表在儿童视力检查中的对比研究

目的 比较类纸屏承载的电子视力表与灯箱视力表在儿童视力检查中的准确性、一致性及差异。方法前瞻性自身对照交叉设计临床试验研究。以分层整群抽样方法选取拉萨市7所小学共1506名二年级儿童,其中男生802名,女生704名,平均年龄8.5±0.5岁。在相同测试环境下,由经过培训的专业人员使用以Lea symbols为视标的灯箱视力表和类纸屏电子视力表进行检查,两种视力表的检查顺序随机决定,并以LogMAR计数进行分析。采用组内相关系数计算两种视力表测量值的相关性,使用散点图及Bland-Altman检验图观察两种视力表测量的分布情况。结果 灯箱视力表测得平均LogMAR视力为右眼0.13±0.19,左眼0.14±0.20,电子视力表测得平均LogMAR视力为右眼0.08±0.20,左眼0.09±0.20。两种视力表测得总体视力值一致性较好且呈明显正相关趋势(ICC_OD=0.91,ICC_OS=0.89,P<0.001)。灯箱视力表和类纸屏电子视力表测量的总体平均差值为右眼0.05±0.11,左眼0.05±0.12,在各个视力范围内电子视力表测量的...     

Lea对比度视力表在弱视治愈儿童中的应用

目的 用Lea对比度视力表检查研究正常儿童以及弱视治愈儿童的视觉功能状态,寻求Lea对比度视力表是否存在某对比度水平对弱视治愈者具有特别的敏感性。方法 正常视力儿童18例（36眼）,弱视治愈者25例（41眼）,参加实验者单眼均在最佳矫正基础上均完成100%,25%,10%以及5%对比度的Lea视力表的检查。结果 正常儿童随着Lea对比度的下降视力有显著性下降（F（3,140）=6.618,P〈0.001）,弱视治愈眼随着Lea对比度的下降视力有显著性下降（F（3,160）=17.677,P〈0.001）;弱视治愈眼Lea对比度视力在100%,25%,10%,5%对比度下均比年龄匹配的正常儿童显著低下（P〈0.05）,各对比度之间的视力的变化在5%对比度下变得更加明显（P=0.022）。结论 Lea对比度视力表可以用于临床弱视治愈儿童的视功能检查;正常儿童和弱视治愈眼的Lea对比度视力,随着对比度的下降明显降低;本研究中的弱视治愈眼仍未达到正常视觉功能,临床上需要进一步的治疗。     

Lea图形与HOTV字母视力表对3～4.5岁儿童视力检查的比较

目的:比较分析Lea图形与HOTV字母视力表在3~4.5岁学龄前儿童视力检查中的适用情况及视力发育情况。方法:采用调查研究,以随机顺序先后应用两种视力表对广州地区两所幼儿园共133例266眼进行视力检查,视力值及其差异均用logM AR记录方法表示。结果:Lea视力较HOTV视力总体可测率高(96.24%vs92.48%),但差异无统计学意义(P>0.05)。儿童单眼两种视力差异均无统计学意义(右眼t=0.517,P=0.606;左眼t=-0.618,P=0.538)。儿童左右眼之间的视力差异均无统计学意义(Lea视力表:t=0.638,P=0.525;HOTV视力表:t=-0.897,P=0.372)。男性儿童的两种视力均优于女性儿童,但差异无统计学意义(均P>0.05)。3岁、3.5岁、4岁、4.5岁四个年龄组单眼的两种视力检查结果显示,儿童的视力随年龄增长逐渐提高,但四个年龄组间Lea视力差异无统计学意义(右眼:F=2.662,P=0.052;左眼:F=1.850,P=0.143),HOTV视力差异具有统计学意义(右眼:F=4.518,P=0.005;左眼:F=3.893,P=0.011)。结论:两种视力表都适合于3~4.5岁学龄前儿童的视力筛查;3~4.5岁儿童单眼的两种视力结果相似;视力发育与眼别、性别均无关;年龄大于3岁的儿童基本都可以接受主观视力检查,且在学龄前早期主观视力发育较快。     

儿童视力自动检测系统在婴幼儿视力评价 中的初步应用

目的：采用北京大学第一医院与北京大学信息科学技术学院、心理与认知科学学院共同研制开发的 儿童条栅视力自动检测系统（AACP）对婴幼儿视力进行测量,探讨该系统的应用价值。方法：前瞻 性临床研究。于2018年2月至2021年10月利用北京大学多个院系联合研制开发的AACP,对5个月 ~6岁儿童进行视力自动检测,并同时使用条栅视力检测卡（TAC-II）进行人工检测,将2种检测所得 结果做对比研究。采用Wilcoxon检验进行2种视力间的差异比较,Spearman相关进行相关性分析, Bland-Altman图进行一致性分析。结果：33例（66眼）3~6岁儿童全部完成AACP与TAC-II的双眼视 力检测,其中30例（54眼）儿童完成AACP与TAC-II的单眼视力检测,双眼视力检查完成率100%, 单眼检查完成率90.0%。194例（388眼）5~30个月龄婴幼儿中,141例（282眼）完成2种检测方法的双 眼视力检测并得到有效数据,完成率为72.7%。33例3~6岁儿童的AACP与TAC-II双眼视力及单眼视 力均呈正相关（r=0.40,P=0.021;r=0.55,P<0.001）。141例5~30月龄婴幼儿的AACP与TAC-II双眼 视力有较强的相关性（r=0.88,P<0.001）,相关系数高于3~6岁儿童,Bland-Altman图显示90.8%的点 在一致性范围内,不同月龄间AACP与TAC-II视力均存在明显正相关（r=0.82~0.94,均P<0.05）,不 同月龄间AACP视力差异有统计学意义（H=32.02,P<0.001）,视力随月龄增长而逐渐递增。结论： AACP与TAC-II所得到的婴幼儿视力结果存在正相关,在低年龄婴幼儿中有更好的相关性和一致性。 AACP有望成为适合临床条栅视力评估及婴幼儿视力筛查的检查工具。     

早产对无早产儿视网膜病变的早产儿眼发育和发病的影响

目的调查无早产儿视网膜病变（ROP）的学龄前和学龄期早产儿的眼球发育和发病率。方法对26名5～7岁无ROP的早产儿童进行全面的眼科检查,包括矫正视力、散瞳验光、色觉以及眼前后段检查。测量数据包括前房深度、晶体厚度、玻璃体长度和眼轴长度。结果早产儿视力和屈光状态之间没有相关性。2名（7.7%）有斜视,2名（7.7%）有弱视,3名（11.5%）有屈光参差。眼轴长与胎龄（r=0.822,P〈0.001）和胎重（r=0.569,P=0.003）有相关性,玻璃体长度与胎龄（r=0.744,P〈0.001）和胎重（r=0.553,P=0.004）有相关性。讨论本研究显示眼球的增长是因为胎龄和胎重增加,但这种情况不会导致明显的屈光不正。通过文献对比,无ROP的早产儿童的斜视、弱视和屈光参差的发病率要明显高于同年龄段的正常儿童。     

ETDRS对数视力表在儿童视力检查中的可重复性分析

目的：探讨ETDRS对数视力表对儿童视力检查的可重复性及其影响的相关因素。方法：在流行病学调查的过程中，随机使用ETDRS对数视力表，为250位裸眼视力低于0．5和98位视力正常儿童进行裸眼视力重复检查。结果：两次视力测量之间差异的均数为0．004log±0．07；Kappa分析结果具有很好的一致性（k=0．71）；性别与视力检查一致性无明显相关（P=0．845）；年龄与视力检查一致性有显著相关性（P=0．019），年龄越小视力检查一致性越差；屈光不正与视力检查一致性也有显著相关性（P=0．000），近视度数在-1．00D—-5．00D之间的儿童视力检查一致性相对差．而正视眼的视力检查一致性较好。结论：结果提示ETDRS对数视力表适合儿童视力检查，建议推广使用。眼科学报2008；24：48-52．     

不同光照环境下弱视儿童眼间抑制深度比较

目的：比较弱视患儿和正常儿童对光照环境下的适应情况。方法：系列病例研究。收集2020 年 1─11月在温州医科大学附属眼视光医院门诊就诊的屈光参差性弱视儿童作为弱视组,并选择同期门诊就诊的视力正常儿童作为对照组。利用偏振片+中灰密度镜（ND）定量测量不同光照环境下（分别为15、220、2 000 lx）的眼间抑制情况,分析弱视儿童的抑制深度与环境亮度的相关性,并比较弱视儿童和正常儿童对光照环境的适应情况。数据分析采用重复测量方差分析、独立样本t检验及 Spearman相关性分析。结果：共纳入弱视组27例,对照组10例。与15 lx相比,2 000 lx下弱视组（近距离q=5.76,P<0.001;远距离q=4.85,P=0.0027）和对照组（近距离q=6.93,P<0.001;远距离q=8.31, P<0.001）的眼间抑制更明显,差异均有统计学意义。3种光照环境下弱视组与正常组的眼间抑制差别不同,在2 000 lx光照时差别较明显（近距离P=0.0114、P=0.0014、P=0.0018;远距离均P<0.001）。 弱视患儿在15 lx时的抑制深度与在220 lx（近距离r=0.9318,P<0.001;远距离r=0.9172,P<0.001）和 2 000 lx时（近距离r=0.8699,P<0.001;远距离r=0.7445,P<0.001）的抑制深度均有相关性。结论：眼间抑制受不同光照环境影响,环境越亮的情况下眼间抑制越深。与正常儿童相比,弱视儿童存在对亮环境代偿更差的现象,且受环境亮度的影响较大。     

The repeatability of best corrected acuity in normal and amblyopic children 4 to 12 years of age

PURPOSE: The main purpose of this work was to measure repeatability of line-by-line logMAR (logarithm of the minimum angle of resolution) acuity in normal and amblyopic children, while adequately controlling for optical defocus. METHODS: The Lea Symbols Chart is a constant-crowding, equal-logMAR increment chart similar in design to the Early Treatment Diabetes Retinopathy Study [ETDRS] chart. LogMAR visual acuity was tested twice in each eye of 32 amblyopic and 11 normal children. Each test commenced with screening in which one of the three central symbols was chosen for identification starting with the 1.0- or 0.9-logMAR line, progressing to every second line until incorrect identification occurred. Symbol-by-symbol presentation then commenced at the logMAR line containing the last correctly identified symbol. The threshold was recorded as the last logMAR line where four of four or four of five correct responses occurred (i.e., line-by-line scoring). Retesting by the same examiner was identical and occurred within the same session. RESULTS: There was no significant difference in repeatability among normal, fellow, or amblyopic eyes. The difference between test and retest thresholds lay between +/-0.10 logMAR in 93% of eyes. The 95% limits of agreement for the difference was +/-0.18 logMAR. Repeatability in eyes tested first did not differ from that in those tested second in either the normal or amblyopic groups. CONCLUSIONS: In the age-group tested, the line-by-line method of threshold scoring compares favorably with previous reports of both line-by-line and interpolated threshold scoring. There was no clinically meaningful difference in repeatability between the normal and amblyopic children tested.     

Visual acuity results in school-aged children and adults: Lea Symbols chart versus Bailey-Lovie chart.

PURPOSE: To compare visual acuity results obtained using the Lea Symbols chart with visual acuity results obtained with the Bailey-Lovie chart in school-aged children and adults using a within-subjects comparison of monocular acuity results. METHODS: Subjects were 62 individuals between 4.5 and 60 years of age, recruited from patients seen in five optometry clinics. Each subject had acuity of the right eye and the left eye tested with the Lea Symbols chart and the Bailey-Lovie chart, with order of testing varied across subjects. Outcome measures were monocular logarithm of the minimum angle of resolution (logMAR) visual acuity and inter-eye acuity difference in logMAR units for each test. RESULTS: Correlation between acuity results obtained with the two charts was high. There was no difference in absolute inter-eye acuity difference measured with the two acuity charts. However, on average, Lea Symbols acuity scores were one logMAR line better than Bailey-Lovie acuity scores, and this difference increased with worse visual acuity. CONCLUSIONS: The Lea Symbols chart provides a measure of inter-eye difference that is similar to that obtained with the Bailey-Lovie chart. However, the monocular acuity results obtained with the Lea Symbols chart differ from those obtained with the Bailey-Lovie chart, and the difference is dependent on the individual's absolute level of visual acuity.     

Sensitivity and specificity of a visual acuity screening protocol performed with the Lea Symbols 15-line folding distance chart in preschool children

PURPOSE: The aim of this study was to assess the feasibility of a visual acuity (VA) test using the Lea Symbols 15-line folding distance chart and its diagnostic validity in detecting VA deficiency in preschool children. METHODS: A group of 149 children aged 38-54 months underwent VA examination performed with the Lea 15-line folding optotype at a distance of 3 metres, according to a test protocol described in the Methods section. After the VA test, a complete ophthalmological examination, including cycloplegic retinoscopy, a cover test and examination of the anterior and posterior segments, was performed on each child in order to detect any VA-threatening ocular abnormality. The Lea Symbols test's sensitivity, specificity, positive and negative likelihood ratios (LR +, LR -) and the receiver operating characteristic (ROC) curve were calculated by means of standard procedures using each VA level of the chart from 0.1 to 1 (1-0 logMAR) as a cut-off point. RESULTS: The Lea Symbols test could be successfully used in 95.9% of the population. The most useful cut-off points for screening preschool children were found to be 0.8 (LR + 5.73, LR - 0.05) or 0.63 (LR + 11.7, LR - 0.23). CONCLUSION: The Lea Symbols test proved to be clinically useful in detecting VA deficiency in preschool children. The choice between the two best performing cut-off levels should be made according to the expected cost-effectiveness of the screening programme.     

Threshold visual acuity testing of preschool children using the crowded HOTV and Lea Symbols acuity tests

PURPOSE: To compare the testability and threshold acuity levels for very young children on the crowded HOTV logMAR distance visual acuity test presented on the BVAT apparatus and the Lea Symbols logMAR distance visual acuity chart. METHODS: Subjects were 87 Head Start children from age 3 to 3.5 years. Testing consisted of binocular pretraining at near using a lap card as needed, binocular pretraining at 3 m, and threshold testing for each eye. The testing procedure, adapted from the Amblyopia Treatment Study, presented optotypes until the child was unable to correctly name or match three of three or three of four optotypes of a given size. Threshold acuity was the smallest size for which at least three optotypes were correctly identified. RESULTS: Both near and distance pretraining were completed by 71% of children for HOTV and by 75% for Lea Symbols (P =.39). The distribution of threshold acuities differed between the two tests. For the 69 eyes of 53 children who were successfully tested with both optotypes, results from the crowded HOTV acuity test were on average 0.25 logMar (2.5 lines) better than those from the Lea Symbols acuity test (P <.001). CONCLUSIONS: The proportion of children between 3 and 3.5 years of age whose monocular visual acuity could be assessed was high and was similar for the two charts tested. Crowded HOTV acuity results were better on average than results using Lea symbols. The different formats of the two tests may explain the observed differences in threshold acuity level.     

像差引导的准分子激光联合角膜胶原交联治疗早期圆锥角膜的临床观察

目的：观察像差引导的经上皮准分子激光屈光性角膜切削术（WG-TransPRK）联合快速角膜胶原交 联术（A-CXL）治疗早期圆锥角膜的临床疗效和安全性。方法：回顾性系列病例研究。收集在武汉爱 尔眼科医院汉口医院行WG-TransPRK同期联合A-CXL的早期圆锥角膜患者7例（12眼）,并于术前, 术后1周、1个月、3个月、6个月、1年分别行裸眼视力（UCVA,LogMAR）、最佳矫正视力（BCVA, LogMAR）、屈光度、角膜地形图、共焦显微镜和角膜像差检查。数据采用配对t检验分析。结果： 术后1年,UCVA从0.77±0.25改善到0.34±0.26（P=0.001）,BCVA从0.18±0.21改善到0.05±0.09 （P=0.034）;角膜前表面平坦曲率（K1）、角膜前表面陡峭曲率（K2）、角膜前表面最大角膜曲率（Kmax） 分别从（43.85±1.72）D、（46.64±2.36）D、（48.88±3.62）D降至（40.63±2.13）D（t=9.48,P=0.001）、 （42.27±1.89）D（t=8.29,P=0.001）、（45.43±1.54）D（t=3.02,P=0.014）,差异均有统计学意义（均 P<0.05）。共聚焦显微镜观察上皮下神经纤维密度降低（P=0.001）;浅、中层基质细胞密度降低（均 P<0.05）,深基质及内皮细胞密度变化差异无统计学意义。4 mm直径分析区域角膜总像差与角膜球 差降低,差异均有统计学意义（均P<0.05）。结论：WG-TransPRK联合A-CXL能安全有效治疗早期圆 锥角膜,提升患者视力。     

非球面散光型和非球面型人工晶状体植入术后效果

目的：比较非球面散光型和非球面型人工晶状体（IOL）植入术后效果。方法：前瞻性非随机对照研究。 选择2016年5月至2018年1月在抚顺市眼病医院白内障科就诊的术前角膜散光为1.25 D以上的年龄相关性白内障患者106例（172眼）。根据自愿原则,其中50例（80眼）患者行超声乳化白内障吸除术后植入Acrysof IQ Toric IOL（SN6AT）作为Toric组,56例（92眼）患者植入AcrySof IQ IOL（SN60WF） 作为对照组。术前Toric组和对照组散光分别为（2.08±0.74）D、（2.14±0.95）D。术后6个月评估2组患者的裸眼远视力（UDVA）、矫正远视力（CDVA）、脱镜率、残余眼散光和轴位旋转、对比敏感度、 波前像差、视觉满意度问卷调查等。采用t检验、Mann-Whitney U检验、χ2 检验进行数据分析。结果：9例失访,失访率为8.5%,最终纳入对照组为51例（84眼）,Toric组为46例（73眼）。术后6个月对照组和Toric组的UDVA（LogMAR）分别为0.22±0.14和0.15±0.20,差异有统计学意义（t=-2.14, P<0.001）;CDVA（LogMAR）分别为0.11±0.09和0.09±0.08,差异无统计学意义;Toric组看远脱镜率为77.8%（21/27）,对照组为27.3%（9/33）,二者差异有统计学意义（χ2 =15.15,P<0.001）。Toric组残余眼散光为（0.77±0.39）D,对照组为（1.99±1.12）D,二者差异有统计学意义（t=-7.56,P<0.001）; Toric组的轴位旋转4.6°±5.7°。Toric组低阶像差低于对照组,差异有统计学意义（U=1.57,P=0.006）。 2组术后明视、暗视、暗视眩光情况下对比敏感度、视觉满意度调查问卷比较差异均无统计学意义。 结论：与非球面型IOL相比,非球面散光型可有效、安全地矫正白内障患者的术前角膜散光,稳定性好,大大提高术后脱镜率,且低阶像差更低。     

学龄前儿童视力和屈光状态分析

目的:了解北京市通州区学龄前儿童的视力现况,并对其屈光状态进行分析。方法:横断面调查研究。于2021-12/2022-01采用整群随机抽样法选取北京市通州区9所幼儿园3～6岁儿童1 513人3 026眼,均进行视力和屈光度检查,并分析不同年龄段儿童视力和屈光度分布情况。结果:纳入儿童视力低常率为15.47%,屈光异常率为14.24%,且随着年龄增长,屈光异常检出率减少,而屈光异常类型以单纯近视性散光为主(11.46%),随着年龄增加,单纯性远视率逐渐降低,单纯性近视率逐渐增加。屈光度检查结果显示,纳入儿童球镜度为0.50(0.25,1.00)D,柱镜度为-0.25(-0.50,-0.25)D,等效球镜度为0.375(0,0.625)D。不同年龄段儿童球镜度和等效球镜度均无差异(P>0.05),但柱镜度有差异(P<0.001)。结论:3～5岁儿童视力低常率随年龄增加逐渐降低,6岁后又呈增加趋势。3～6岁儿童屈光异常以单纯近视性散光为主。学龄前儿童视力发育情况应重点关注,应定期进行视力和屈光状态检查。