学龄前儿童视力普查

为了更好地开展屈光不正、弱视的防治工作 ,使其能够早期发现、早期治疗。笔者对广州 40所幼儿园 12 85 7名 4～6 a儿童进行视力普查 ,对 937例裸眼视力 <1.0者进行屈光检查 ,现将调查结果报告如下。1　资料和方法1.1　一般资料　本组为 1998～ 1999年 2 a间对广州市 40所幼儿园 4～ 6岁 12 85 7名儿童视力检查 ,男 6 6 5 1名 ,女6 2 0 6名。1.2　方法　使用国际标准视力表测视力 ,视力 <1.0者 ,用10 g· L- 1 阿托品点眼 ,每天 1次 ,连续 3d后行检影验光并检查眼前后段。屈光不正者酌情配戴眼镜 ,矫正视力 <0 .9者行弱视治疗。1.3　评价标…     

福州市21952名学龄前儿童视力调查

目的探索学龄前儿童视力低常状况,及弱视患病率,为临床治疗提供依据.方法对福州市3～7岁21952名学龄前儿童进行视力普查,将单眼或双眼视力低于1.0者,通知到门诊复查,将矫正视力＜0.9,定为弱视.结果视力低常与年龄密切相关,患病率14.35%,其中男14.11%,女14.58%;弱视患病率3.38%,各年龄组弱视患病率差异无显著性(P＞0.05);视力低常者屈光不正分布远视81.96%,近视8.43%,混合散光9.61%,三者差异有显著性.结论学龄前儿童年龄越小,视力低常率越高;各年龄组弱视患病率无差异;对3～4岁儿童进行弱视诊断时应注意年龄因素.     

北京市大兴区学龄前儿童视力及弱视调查

目的:了解我区学龄前儿童视力低常及弱视发病情况,以便采取积极有效的群防群治措施。方法:对我区6所公立园所4～6岁学龄前儿童给予系统检查,排除器质性病变后进行视力检查,对视力低常和斜视者(≤0.8)进行验光检测。结果:我区学龄前儿童视力低常率(≤0.8)为9.12%,弱视患病率为4.20%,各年龄组间有显著性差异(P<0.05)结论:应定期加强学龄前儿童视力及弱视的普查工作,以便早期发现弱视,力争在儿童视觉发育敏感期得到及时治疗。     

武汉市新洲区学龄前儿童视力调查分析

目的:了解武汉市新洲区学龄前儿童视力发育状况及弱视患病率。方法:受检儿童3211例使用目前我国通用的国际标准视力表检查视力。3岁及以上视力低于0.5,4～5岁低于0.6,6～7岁低于0.7或双眼视力相差两行以上者,通知到医院门诊复诊。结果:受检儿童3211例视力异常检出率为7.51%。视力异常眼的屈光状态以远视为主;在屈光不正性弱视中,轻度弱视占比例最大,中度弱视次之,弱视患病率为6岁组3.68%,5岁组3.76%,4岁组7.93%,3岁组16.48%。各年龄组的视力随年龄增长而逐渐提高,各年龄组视力主要分布:3岁(0.5518±0.1910)、4岁(0.6444±0.1584)、5岁(0.6662±0.1544)、6岁(0.7601±0.1119)。视力异常率在3岁年龄组差异有统计学意义P<0.05,视力异常率在4～6岁年龄组差异无统计学意义,P>0.05。结论:儿童的视力呈动态发育过程,对弱视的诊断应考虑年龄因素。应加大弱视常识及危害性的宣传,提高家长、社会对弱视的认识和重视。     

上海市学龄前儿童视力现况分析

目的了解学龄前儿童视力现况,为儿童眼保健计划提供依据。方法选择上海市具有代表性的三个区部分学龄前儿童（〉3～6岁）进行常规远视力检查,对视力结果按眼别、性别、年龄等进行统计与分析。结果〉3-4岁、-5岁、-6岁视力低常率分别为90．46％、66．99％和36．75％。女性高于男性。以人数计高于以眼数计。不同眼别结果差异无显著性。不同地区视力低常率有显著性差异。视力低常者中,轻度低常占95．57％。结论学龄前儿童远视力普查是儿童眼保健的重要指标,结果受多种因素影响,必须正确分析检查结果。     

学龄前视力正常儿童屈光状态分析

目的分析学龄前正常视力儿童的屈光状态。方法采用手持自动验光仪对1698例视力正常的学龄前儿童屈光状态进行检查,包括球镜和柱镜的检查,进行统计分析。结果球镜度平均值3岁为＋1.59±0.52D,4岁为＋1.51±0.47D,5岁为＋1.57±0.52D,6岁为＋1.58±0.53D,各年龄段无统计学差异（P〉0.05）;柱镜度平均值3岁为-0.60±0.47D,4岁为-0.57±0.43D,5岁为-0.62±0.52D,6岁为-0.57±0.46D,各年龄段无统计学差异（P〉0.05）;等效球镜度值3岁为＋1.29±0.49D,4岁为＋1.22±0.43D,5岁为＋1.26±0.47D,6岁为＋1.29±0.48D,各年龄段无统计学差异（P〉0.05）。结论正常视力学龄前儿童屈光状态稳定,视力和简便的屈光度检查可以同时作为弱视筛查和视觉发育跟踪的手段。     

学龄前儿童视觉发育状况调查研究

目的 了解学龄前儿童视觉发育状况及斜弱视患病率.方法 对4610名城乡3～6岁学龄前儿童进行随机抽样调查,项目包括视力、屈光状态、眼位、斜视弱视等.用x2检验城乡及不同年龄视力分布差异.结果 3岁、4岁、5岁和6岁组儿童视力1.0以上检出率分别为28.4％、39.3％、46.2％、76.5％,各年龄组视力主要分布3岁(0.63±0.19)、4岁(0 69±0.16)、5岁(0.71±0.22)、6岁(0.79±0.29),乡镇较城市儿童视力好.屈光状态以远视为主;显性斜视检出率为2.21％,外斜视多见于内斜视;隐性斜视检出率为33.52％,主要是外隐斜;弱视患病率以现行诊断标准为6岁组2.93％,5岁组4.81％,4岁组16.21％,3岁组33.33％.结论 学龄前儿童视力随年龄增长而上升;国内弱视诊断中视力标准偏高,应尽快制定各年龄组弱视诊断视力标准.屈光不正、斜视和弱视是影响学龄前儿童正常视功能的主要因素,依然是儿童时期防盲治盲的重点.     

SureSight手持验光仪在3～6岁儿童屈光不正筛查中的应用

目的 探讨SureSight手持验光仪在3～6岁儿童屈光不正筛查中的应用价值.方法 横断面研究.对徐汇区康健街道内321例经初步筛查后视力可疑低常儿童,进行非睫状肌麻痹下SureSight手持式验光仪及睫状肌麻痹下Topcon台式验光仪检查.将所得检测结果进行Bland-Altman相关性检验,并利用ROC曲线计算SureSight屈光不正筛选标准以进行诊断性试验评价.结果 非睫状肌麻痹下SureSight验光测得的球镜度、柱镜度及SE均与睫状肌麻痹下Topcon验光仪所测得相应度数差异有统计学意义,在测量结果上两者有中度(球镜度:r=0.59,P＜0.05;SE:r=0.54,P＜0.05)到高度(柱镜度:r=0.89,P＜0.05)相关性.进一步以散瞳后Topcon测量值为金标准作ROC曲线,发现当SureSight SE测量值≤+1.13 D时,可划定为可疑近视,SE测量值≥+1.44 D时,划定为可疑远视,散光测量值≥0.88 D时,划定为可疑散光.散光、近视及远视的Youden指数分别为0.679、0.298及0.270.结论 3～6岁儿童非睫状肌麻痹下SureSight检测结果在散光的筛查中具有一定的临床意义,可协助划定可疑参考值范围,操作方便.但用于近视以及远视的筛查界定有一定的局限性.     

双目屈光筛查仪在4~5岁学龄前儿童视力筛查中的应用研究

目的评估双目屈光筛查仪在4~5岁学龄前儿童视力筛查中判定屈光性弱视危险因素(ARF)的精确度。方法横断面研究。于2016年9至12月在南京市雨花台区对4~5岁学龄前儿童使用双目屈光筛查仪进行非散瞳屈光度数筛查及综合性眼科检查。对其中疑似眼部异常儿童及主动接受详细检查的儿童进行睫状肌麻痹检影验光(CR)检查,采用Wilcoxon符号秩检验比较双目屈光筛查仪与CR检查屈光度数的差异,并用Bland-Altman法评估二者的一致性。参照美国斜视与小儿眼科学会(AAPOS)2013年发布筛查指南中的标准,以CR检查结果判定受试儿童是否具有屈光性ARF,并以此为金标准,评估双目屈光筛查仪以5种常用转诊标准(敏感性标准、Matta/Silbert标准、AAPOS2013标准、阿拉斯加州盲童探索组织2012标准、特异性标准)判定受试儿童屈光性ARF的准确度。采用受试者工作特征(ROC)曲线计算双目屈光筛查仪判定屈光性ARF的最佳截断值作为最佳转诊标准。结果共有1986名儿童行双目屈光筛查仪检查,年龄(4.57±0.29)岁,包括1084名男童和902名女童。双目屈光筛查仪的检查成功率为99.04%(1967/1986)。共有1892名儿童双目屈光筛查仪检查取得了检测数值,其中1827名(96.56%)儿童可在3次检测内获得可信结果。共有538名儿童接受了CR检查,除外1名被双目屈光筛查仪直接识别为远视的儿童后,剩余537名儿童进行了屈光度数对比分析,结果显示双目屈光筛查仪较CR低估球镜度数[0.75(0.50,1.25)D与1.25(1.00,1.75)D比较;Z=-10.36,P<0.01],高估柱镜度数[-0.50(-0.75,-0.25)D与-0.25(-0.75,0.00)D比较;Z=-11.10,P<0.01],低估等效球镜度数[0.63(0.38,0.88)D与1.00(0.75,1.50)D比较,Z=-13.33,P<0.01]。一致性分析显示,分别有96.28%(517/537)、95.34%(512/537)、96.65%(519/537)儿童的双目屈光筛查仪及CR检测值在球镜度数、柱镜度数、等效球镜度数的95%一致性界限内。CR检查结果显示47名儿童(8.74%)具有屈光性ARF,以此为金标准,双目屈光筛查仪以5种常用转诊标准判定屈光性ARF的敏感度为63.83%~97.87%,特异度为53.36%~97.56%,约登指数为0.51~0.80,阳性预测值为16.73%~74.51%,阴性预测值96.57%~99.62%。ROC曲线计算得出双目屈光筛查仪判定散光性ARF的最佳转诊标准为散光度数>1.38 D。结论双目屈光筛查仪在4~5岁学龄前儿童视力筛查中判定屈光性ARF的精确度较高。     

学龄前儿童散光特征分析

目的 探讨学龄前儿童散光的类型、程度及轴向分布情况.方法 对3～8岁儿童1980例(2288只眼)行1%阿托品常规散瞳检查,结果进行统计分析.结果 散光类型分布:复性远视散光最多占62.15%、混合性散光18.05%、复性近视散光9.31%.散光程度分布:0.50～2.0DC占75.88%、2.25～3.0DC占15.73%、3.25～4.0DC占6.78%、大于4.25DC占8.39%;散光轴向分布:顺规散光占96.24%、逆规散光占2.84%、斜轴散光占0.92%.所有患儿中弱视患者占58.83%.结论 复性远视散光是学龄前儿童散光的主要类型,以顺规散光为主.散光与弱视密切相关.     

重视儿童眼病手术后的双眼视功能重建

在各类常见儿童眼病,如斜视、白内障、青光眼、视网膜脱离等手术后进行屈光矫正、弱视治疗和双眼视功能训练,是患儿获得良好手术效果不可或缺的途径,应当引起高度重视。双眼视功能发育的研究进展为临床儿童眼病手术后重建双眼视功能提供了新的可能性。在提高视力的同时。关注术后双眼视功能重建,减少立体盲,才能使儿童获得适应现代社会生活的良好视觉功能。（中华眼科杂志．2006,42：865-867）     

瞬态图形视觉诱发电位在2至5岁正常儿童视力评价中的应用研究

目的 探讨瞬态图形视觉诱发电位(PVEP)在2～5岁儿童视力评价中的应用.方法 2007年9月至2008年1月,对179名(355只眼)2至5岁城市的正常儿童,进行图形视力和瞬态图形视觉诱发电位视力(PVEP-A)检测,并作对比研究.图形视力由儿童图形视力表进行单眼裸眼视力测试后得到,PVEP-A则是采用水平条栅翻转刺激诱导视觉诱发电位的方法检测.采用χ2检验及秩和检验方法对计数资料进行分析,将PVEP-A结果转换为国际标准视力,并与图形视力结果采用Logistic回归进行相关分析.结果 179名儿童检测结果显示,图形视力随年龄增长而逐渐递增,且全部受试儿童图形视力均≥0.4.PVEP-A检测值也与年龄分布呈正相关,受试儿童PVEP-A均达到3.4 c/d或以上.测试组间的PVEP-A差异均有统计学意义.瞬态PVEP-A与图形视力有较好相关性(r=0.673),且两眼PVEP-A差与两眼图形视力差的相关性系数r为0.664.显示受检儿童的PVEP-A发育早于图形视力.结论 应用PVEP进行客观视力评估是一种目前较为方便、稳定、可靠的方法.     

要特别重视儿童弱视诊断中的年龄因素

各国学者对弱视的视力界定数值不一,国内现行诊断标准（低于0．9）明显高于国外。我们调查发现3～6岁健康儿童的5％视力参考值下限低于0．70。矫正视力低于0．9作为弱视诊断标准对于低龄儿童过高,将一些视力发育中的低龄儿童诊断为弱视,导致数以百万计的儿童误诊误治。不能正确考虑幼儿年龄因素影响,可造成转诊率和假阳性率升高,增加筛查费用和家长经济负担。因此建议在诊断弱视时,应对不同年龄组儿童采用不同的视力标准。（中华眼科杂志,2007,43：961—964）     

Optotype and grating visual acuity in preschool children

PURPOSE: To investigate the contribution of stimulus and response differences to the different developmental courses of grating and optotype visual acuity at the preschool age range. METHODS: Binocular visual acuity at 228 cm was assessed in 205 children in 7 age groups between 2.5 and 6 years and in 12 adults. Acuities were obtained in three tasks: detection of a grating in one of two positions, discrimination of the orientation of a single grating, and discrimination of the orientation of the gap in an uncrowded Landolt-C optotype. The three paradigms were as similar as possible in stimulus contrast, luminance, presentation mode, and psychophysical procedure. RESULTS: Mean grating and optotype acuities were lower than adult acuities at all ages. Optotype acuity was overall higher and increased faster with age than grating acuities. Grating orientation acuity was slightly but not significantly lower than grating detection acuity in all but one age group. The grating detection task was successful at earlier ages (100% at 3.5 years) than both the optotype acuity task (100% at 4.5 years) and the grating orientation task (100% at 5.75 years). CONCLUSIONS: Optotype and grating acuities follow a different developmental course in children between 3 and 6 years of age, with optotype acuity growing superior to grating acuity in that age range. The similarity of grating orientation to grating detection acuities and the difference between grating and optotype acuities suggest that superior optotype acuity is due to stimulus characteristics rather than to the complexity of the response required.     

上海市杨浦区学龄前儿童弱视调查分析

ObjectiveTo investigate the amblyopia status of preschool children in the Yangpu district of Shanghai, and to analyze the incidence and distribution of amblyopia based on a new diagnostic standard. MethodsUsing a cross-sectional investigation method, 13 288 children aged 3 to 6 years who were enrolled in 96 kindergardens in the Yangpu District of Shanghai were included in this investigation. Visual acuity and refractive status were examined, and the incidence of amblyopia was evaluated using a new diagnostic criteria. Subsequently, the distribution of amblyopia was evaluated by a chi-square test and trend chi-square test. ResultsThe incidence of amblyopia was much higher when using the old criterion compared to the new one （63.52% and 0.91%, respectively, P<0.01）. In this cohort study of amblyopia, refractive error amblyopia accounted for 72.7%, anisometropic amblyopia accounted for 14.5%, strabismic amblyopia accounted for 9.1%, and deprivation amblyopia accounted for 3.6%. The incidence of amblyopia was much higher in 4-5 year olds （χ2=27.52, P<0.01）, but there was no difference in the incidence of amblyopia between genders（χ2=0.41, P>0.05）. ConclusionThe main reasons for amblyopia in preschool children in the Yangpu District were refractive error, anisometropia, strabismus and deprivation amblyopia. Taking into account the importance of visual development patterns in the diagnosis of amblyopia in children, age was considered as a factor in the diagnosis of amblyopia based on the new diagnostic criterion. This avoided a higher number of amblyopia diagnoses and excessive treatment.     

Screening for amblyopia in preschool children: Results of a population-based,randomised controlled trial

INTRODUCTION The rationale for preschool vision screening programmes has recently been questioned. Evidence about the effects of early treatment is needed, but it is not known how early the target conditions can reliably be detected. In this study, an intensive programme comprising several different screening methods, used at different ages up to 37 months, was compared with the usual practice of visual surveillance and ad hoc referrals.

METHODS Two groups were randomly selected from children in a population birth cohort study. The control group (n = 1461) received visual surveillance only. The intervention group (n = 2029) was offered in addition a programme of regular visual assessments by orthoptists testing visual acuity, ocular alignment, stereopsis and non-cycloplegic photorefraction.

RESULTS The intervention group programme yielded more children with amblyopia (1.6% vs. 0.5%, p < 0.01), and was more specific (95% vs. 92%, p < 0.01), than the control programme. The individual components of the intervention programme were compared. The cover test and visual acuity tests were poorly sensitive until the children were 37 months, but were always >99% specific. Photorefraction was more sensitive than acuity testing at all ages below 37 months, with specificity >95% at 31 and 37 months.

CONCLUSIONS Photorefraction would have detected more children less than 37 months of age with straight-eyed amblyopia than did visual acuity testing, but with more false positives. At 37 months, photore-fraction plus a cover test would have been comparable in effectiveness to visual acuity testing plus a cover test.