摄影验光法在婴幼儿眼病与屈光异常普查中的应用

目的研究探讨摄影验光法在婴幼儿眼病诊治中的可行性和可靠性.方法采用美国MTI公司瞬息图象筛分仪对162例10月～3岁婴幼儿进行摄影验光,将其结果与临床检查和阿托品眼膏散瞳验光结果对比,并以标准分析法进行评估.结果MTI照片普查在斜视、远视、近视及屈光参差的特异度分别为100%、96.79%、98.61%、93.98%;灵敏度分别为95.12%、74.85%、77.14%、77.78%.结论 摄影验光是一种安全、快速、有效的儿童眼病筛查方法，较其他常规检查能更早地发现儿童眼病及病及屈光异常。     

数码摄影验光法在儿童眼病与屈光异常普查中的应用

目的 探讨自行设计的数码摄影验光系统在儿童眼病和屈光异常诊治中的可行性和可靠性。方法 使用特殊光路设计的数码摄影系统对120例7个月到71个月的儿童进行视力筛查,使用计算机图像处理系统分析图片得出结果,与临床检查和阿托品眼膏散瞳验光结果对比,并以标准分析法进行评估。结果 数码摄影验光系统视力筛查在远视、近视、散光、屈光参差及斜视的灵敏度分别为87．62％、93．94％、80．77％、84．62％、91．67％;特异度分别为96．80％、97．46％、96．71％、99．07％、100％。结论 数码摄影验光系统视力筛查是一种安全、快速、经济、有效的儿童眼病筛查方法。较常规检查能更早地发现儿童眼病及屈光异常。     

Suresight手持式自动验光仪在社康中心婴幼儿屈光筛查中的作用

目的：观察Suresight手持式自动验光仪在社区健康服务中心(社康中心)婴幼儿屈光筛查中的使用情况。

方法：采用Suresight手持式自动验光仪对我院下属社区健康服务中心2013-06/12的836例1 672眼儿童保健婴幼儿进行屈光筛查。

结果：婴幼儿836例1 672眼中屈光异常202眼,可疑38眼,共转诊240眼,转诊率14.35%; 经眼科确诊屈光异常172眼,转诊者屈光异常阳性率71.67%,其中,予以配镜矫正46眼,占筛查人数2.75%,重点监测126眼,占筛查人数7.54%。

结论：在社区健康服务中心开展Suresight手持式自动验光仪对婴幼儿进行屈光筛查,方便有效,与上属医院眼科配合双向转诊,能够更早监测和干预婴幼儿的视力发育。     

MTI摄影验光在幼儿弱视筛查中的应用

目的 以新的筛查标准探讨眼瞬息图像筛查仪(MTI)摄影筛查技术应用于1～2岁儿童弱视危险因素筛查中的可行性.方法 对1～2岁儿童MTI摄影验光结果 与阿托品眼膏散瞳后人工检影结果 进行比较.结果 MTI摄影验光技术对弱视危险因素筛查敏感性为92.16％,特异性为65％;对MTI摄影筛查阳性的儿童的屈光状态及斜视进行分析,筛查敏感性最高的为近视,最低的为斜视;特异性最高的为屈光参差,最低的为散光.结论 MTI摄影筛查技术作为摄影验光法在幼儿弱视危险因素筛查中具有较高的敏感性,亦可用于流行病学调查.     

MTI摄影筛查仪在低龄儿弱视高危因素筛查中的作用

目的:探讨MTI筛查仪用于弱视高危因素筛查及用于大范围普查的可行性。方法:对2005-10/2006-05来我院就诊怀疑有屈光不正的415例婴幼儿进行MTI筛查,再行眼科常规散瞳验光检查。结果:MTI对斜视和屈光间质混浊的检出率为100.0%,对近视的检出率为68.0%,中高度远视的检出率为76.3%,散光的检出率为85.2%。结论:MTI可用于低龄幼儿弱视高危因素的筛查和大范围普查,是一种安全、快速、有效的儿童眼病筛查方法。     

Suresight手持式自动验光仪筛查学龄前儿童屈光不正的可行性探讨

目的通过对Suresight手持式自动验光仪在学龄前儿童中筛查屈光不正可行性的探讨,为其在婴幼儿屈光不正筛查中的应用提供理论支持,寻求一种能简单、方便、可靠、客观反映婴幼儿屈光发育情况的筛查方法。方法对就诊的4～6岁的学龄前儿童共148人次,296眼在自然状态下使用Suresight手持式自动验光仪进行屈光检查,与连用1%阿托品2次/日,5天后检影验光的结果比较。结果Suresight手持式自动验光仪屈光检查的结果中柱镜及其轴向与散瞳验光结果的差异无统计学意义(柱镜t=0.902,P=0.368;柱镜轴向t=0.935,P=0.350),球镜及等效球镜的差异有统计学意义(球镜t=2.231,P=0.026;等效球镜t=10.731,P=0.000),Suresight手持式自动验光仪屈光检查的结果球镜及等效球镜比散瞳验光结果轻度偏正,球镜平均0.1759±1.3444D,等效球镜平均0.8679 1.3796D。本文4～6岁的学龄前儿童296眼中远视性屈光不正占多数,比例为64.2%。结论Suresight手持式自动验光仪是一种用于学龄前儿童比较可靠的屈光不正的筛查工具。提示它在婴幼儿屈光不正的筛查中有一定的临床意义。     

6-48月龄婴幼儿Spot屈光度异常结果分析

目的：分析6-48月龄婴幼儿Spot屈光异常情况,为婴幼儿屈光不正矫正及弱视早期防治提供依据。

方法：对6-48月龄婴幼儿使用Spot双目视力筛查仪进行自然状况下验光,根据Spot屈光筛查仪4岁以下儿童转诊标准,收集屈光异常婴幼儿临床资料; 使用睫状肌麻痹剂视网膜检影验光,并对验光结果进行统计分析。

结果：根据转诊标准共收集Spot屈光度异常婴幼儿168例336眼。其中远视及散光异常占比高,分别为38.4%和28.6%,而近视占比低(12.2%)。168例Spot屈光度异常婴幼儿中,屈光参差(≥1.00 D)共90例,其中散光性屈光参差41例(45.6%)、远视性屈光参差33例(36.7%),近视性屈光参差16例(17.8%)占比最少。共109例Spot屈光度异常婴幼儿完成睫状肌麻痹剂视网膜检影验光。对其Spot屈光度与睫状肌麻痹后检影验光结果差异及相关性分析结果显示,两者散光度差异为0.34±0.64 D(P<0.001),远视度差异为-2.10±1.27 D(P<0.001),近视度差异为-0.43±0.91 D(P=0.023); 虽然二者结果存在统计学差异,但二者散光度、远视度及近视度均呈正相关(r=0.694、0.762、0.909)。

结论：6-48月龄婴幼儿Spot屈光异常主要以散光、远视异常和屈光参差为主,近视异常较少; 对Spot筛查异常者应进一步睫状肌麻痹剂视网膜检影验光,给予配镜矫正,有效防止婴幼儿屈光性弱视。     

MTI摄影筛查仪筛查婴幼儿斜视和屈光不正分析

目的 探讨MTI摄影筛查仪在眼科门诊对婴幼儿进行斜视和屈光不正筛查的价值。方法 对门诊的226例婴幼儿进行了筛查，阳性结果的病例再进行眼科常规检查，二者进行对比。结果 儿童合作率为100％，筛查结果异常率达22．84％，其中屈光不正占16．99％，斜视占5．75％。预测阳性率分别为斜视100％、远视100％、近视76．92％、散光88．88％、屈光参差87．50％。结论 MTI摄影筛查仪对婴幼儿斜视和屈光不正有很高的预测阳性率，它与眼科常规检查的结合可以提高防治弱视的效率。     

Suresight验光仪婴幼儿屈光筛查异常标准探讨

目的探讨Suresight验光仪筛查婴幼儿屈光的异常标准。方法采用suresight验光仪,对2108名6个月~3岁儿童进行屈光筛查,结合弱视发病率及视力不良情况分析检查结果,探讨Suresight验光仪检查婴幼儿屈光异常的合理判断标准。结果≤1岁婴儿屈光度最简表达式球镜S<-1.00或≥3.00,柱镜绝对值C≥2.00;1~2岁组S<-1.00或≥2.50,柱镜绝对值C≥1.50;2~3岁组S<-1.00或≥2.50,柱镜绝对值C≥1.25DC确定为屈光异常。结论根据婴幼儿屈光发育规律及特点,不同年龄确定不同屈光异常判断标准较合理,可以早期发现婴幼儿屈光异常,为指导儿童眼保健提供理论依据。     

国产HAR-800手持验光仪在学龄前儿童弱视筛查中的作用

目的:评估HAR-800手持自动验光仪筛查弱视的价值。方法:分析上海市静安区江宁街道7所托幼机构1027名学龄前儿童屈光检查结果和弱视关系,屈光检查通过HAR-800手持自动验光仪获得。绘制受试者屈光异常和弱视间的工作曲线,计算自动验光仪筛查弱视的敏感性、特异性、准确性和一致性。结果:其中44例儿童被确诊为弱视。屈光检查筛查弱视的ROC曲线图显示屈光参差、球镜、散光三个指标的ROC曲线下面积分别为0.92,0.89,0.21。屈光参差和球镜可以用作筛查弱视的指标。当屈光参差0.88D或远视在2.5D时作为弱视筛查的标准敏感性分别为77.3%,72.7%;特异性分别99%,98.8%;准确性分别为93.4%,93.3%;Kappa均大于0.4。结论:HAR-800手持验光仪可以用于学龄前儿童弱视的筛查。     

Can misalignments in typical infants be used as a model for infantile esotropia?

PURPOSE: To investigate the nature of early ocular misalignments in human infants to determine whether they can provide insight into the etiology of esotropia and, in particular, to examine the correlates of misalignments. METHODS: A remote haploscopic photorefraction system was used to measure accommodation and vergence in 146 infants between 0 and 12 months of age. Infants underwent photorefraction immediately after watching a target moving between two of five viewing distances (25, 33, 50, 100, and 200 cm). In some instances, infants were tested in two conditions: both eyes open and one eye occluded. The resultant data were screened for instances of large misalignments. Data were assessed to determine whether accommodative, retinal disparity, or other cues were associated with the occurrence of misalignments. RESULTS: The results showed that there was no correlation between accommodative behavior and misalignments. Infants were more likely to show misalignments when retinal disparity cues were removed through occlusion. They were also more likely to show misalignments immediately after the target moved from a near to a far position in comparison to far-to-near target movement. DISCUSSION: The data suggest that the prevalence of misalignments in infants of 2 to 3 months of age is decreased by the addition of retinal disparity cues to the stimulus. In addition, target movement away from the infant increases the prevalence of misalignments. These data are compatible with the notion that misalignment are caused by poor sensitivity to targets moving away from the infant and support the theory that some forms of strabismus could be related to failure in a system that is sensitive to the direction of motion.     

A comparison of photorefraction and retinoscopy in children

PURPOSE: To compare the results of photorefraction measurement obtained with a Plusoptix CR03 to those of cycloplegic retinoscopy as a standard refraction method in children. METHODS: We assessed the refractive status of 204 eyes in 204 healthy children. The values acquired via photorefraction (noncycloplegic refraction) with a Plusoptix CR03 device were compared with those obtained via cycloplegic retinoscopy. Both methods were used in the same eyes and in all children. The paired tt-test and Pearson's correlation analysis were used for statistical analysis. RESULTS: The mean age was 7.1 +/- 2.4 years (range, 9 months to 14 years). The average spherical refractive error was +0.05 +/- 0.65 D for photorefraction versus +0.75 +/- 0.77 D for cycloplegic retinoscopy (average difference, -0.70 D; p < 0.001), with moderate correlation between measures (r = 0.63). The average cylinder power was +0.43 +/- 0.38 D for photorefraction versus +0.29 +/- 0.38 D for cycloplegic retinoscopy (average difference, +0.14 D; p < 0.001), with moderate correlation between measures (r = 0.70). The average spherical equivalent was +0.26 +/- 0.63 D for photorefraction versus +0.90 +/- 0.76 D for cycloplegic retinoscopy (average difference, -0.64 D; p < 0.001), with moderate correlation between measures (r = 0.63). CONCLUSIONS: The Plusoptix CR03 device tends toward minus overcorrection in children, resulting in overdiagnosis of myopia. Studies of a population of subjects with a larger range of ametropia will be required to validate this instrument as a screening tool.     

Screening for refractive errors in 6-9 month old infants by photorefraction.

The method of isotropic photorefraction has been used in a trial of refractive screening of 6-9 month old infants. Data are presented on the calibration of the method against retinoscopic measurements and its reliability. In photorefractive screening of 1096 infants under cyclopentolate cycloplegia 5% were found to be hypermetropic (over +3.5 D), 4.5% myopic, and 1.3% anisometropic (over 1 D). These refractive errors were confirmed on retinoscopic follow-up (with the exception of a few anisometropes). Follow-up of controls shows that one small refractive error was missed in 52 infants. We conclude that photorefraction is a valid and practical screening technique. Longitudinal study of infants with refractive errors will assess the value of early detection, in particular for prediction and prevention of strabismus.     

Validation of the PowerRefractor for measuring human infant refraction.

PURPOSE: Eccentric photorefraction provides an opportunity to gather rapid and remote estimates of refraction and gaze position from infants. The technique has the potential for extensive use in vision screenings and studies of visual development. The goal of this study was to assess the refraction calibration of the PowerRefractor (Multichannel Systems) for use with uncyclopleged infants. METHODS: The defocus measurements from the instrument were compared with the results of simultaneous retinoscopy in one analysis and with known amounts of defocus induced with trial lenses in another. Data were collected from infants 1 to 6 months of age and adults. RESULTS: The PowerRefractor typically read < 1 D of myopia when the retinoscopy reflex was judged to be neutral at the same working distance in both infants and adults. The slopes of both infant and adult validation functions (trial lens power vs. measurement of induced defocus) were close to 1 over a 4D range. The infant slopes were significantly greater than those of the adults, however. CONCLUSIONS: The results suggest that the instrument is capable of detecting large amounts of defocus but needs individual calibration for detailed studies of accommodative accuracy and absolute levels of defocus, as has been recommended previously for adult subjects.     

Infant hyperopia: detection, distribution, changes and correlates-outcomes from the cambridge infant screening programs.

PURPOSE: To report on two population screening programs designed to detect significant refractive errors in 8308 8- to 9-month-old infants, examine the sequelae of infant hyperopia, and test whether early partial spectacle correction improved visual outcome (strabismus and acuity). The second program also examined whether infant hyperopia was associated with developmental differences across various domains such as language, cognition, attention, and visuomotor competences up to age 7 years. Linked programs in six European countries assessed costs of infant refractive screening. METHOD: In the first program, screening included an orthoptic examination and isotropic photorefraction, with cycloplegia. In the second program we carried out the same screening procedure without cycloplegia. Hyperopic infants (> or = +4 D) were followed up alongside an emmetropic control group, with visual and developmental measures up to age 7 years, and entered a controlled trial of partial spectacle correction. RESULTS: The second program showed that accommodative lag during photorefraction with a target at 75 cm (focus > or = +1.5 D) was a marker for significant hyperopia. In each program, prevalence of significant hyperopia at 9 to 11 months was around 5%; manifest strabismus was 0.3% at 9 months and 1.5 to 2.0% by school age. Infant hyperopia was associated with increased strabismus and poor acuity at 4 years. Spectacle wear by infant hyperopes produced better visual outcome than in uncorrected infants, although an improvement in strabismus was found in the first program only. The corrections did not affect emmetropization to 3.5 years; however, both corrected and uncorrected groups remained more hyperopic than controls in the preschool years. The hyperopic group showed poorer overall performance than controls between 1 and 7 years on visuoperceptual, cognitive, motor, and attention tests, but showed no consistent differences in early language or phonological awareness. Relative cost estimates suggest that refractive screening programs can detect visual problems in infancy at lower overall cost than surveillance in primary care. CONCLUSIONS: Photo/videorefraction can successfully screen infants for refractive errors, with visual outcomes improved through early refractive correction. Infant hyperopia is associated with mild delays across many aspects of visuocognitive and visuomotor development. These studies raise the possibility that infant refractive screening can identify not only visual problems, but also potential developmental and learning difficulties.     

Quantitative photorefraction using an off-center flash source

When an eye is refracted by "eccentric photorefraction" with a flash source off-centered from a camera lens, a crescent of light is formed in the margin of the pupil. The size of the crescent varies directly with the eye's refractive error. This photographic method has been used in vision screening studies of young children where the appearance of a crescent indicated that the refractive error was above a certain threshold. Usually quantification of the refraction could not be achieved by the photorefractor but relied upon subsequent testing using retinoscopy. My research aimed to expand eccentric photorefraction so as to enable it to provide quantification of the eye's refractive error. This was achieved by varying the eccentricity of the flash source from the camera lens and then calibrating the instrument over a large range of refractive errors. The calibration modified a previously derived optical relation which defined the eye's refractive error in terms of the eccentricity of the source for a given pupil size. Eccentric photorefraction of 26 infants and children aged 7 to 48 months showed a good correlation with retinoscopy (r = 0.82). It is concluded that this method would be complementary to other photorefractive methods (e.g., isotropic) particularly as it is able to measure a large range of refractive errors once the astigmatic meridians of the eye are known.     

Photokeratometric and photorefractive measurements of astigmatism in infants and young children

We have measured corneal and total astigmatism on 161 eyes of 90 normal infants and young children aged 2 months to 5 years using the techniques of photorefraction and photokeratometry. Both the mean corneal and mean total astigmatism were found to decrease with increasing age. We found large and significant correlations between corneal and total astigmatism in the 0-1, 1-2 and 2-3 year-old infants and children. Previous studies have shown that photorefractive measurements of astigmatism compare well with retinoscopic measurements of the same infants. As part of this study we measured the corneal astigmatism of 19 adults (38 eyes) by photokeratometry and with a clinical keratometer and found that the two measures were well correlated (r = 0.820). We conclude that the major component of total astigmatism seen in uncyclopleged infants of ages 0-3 years is corneal in nature.     

Possibilities and results of photorefraction operations for myopia after retinal detachment surgery]

Pathological changes in the retina in myopia of 1.5-17 diopters are analyzed, based on analysis of more than 4800 cases. Detachments of the retina were responsible for 0.5% cases. Photocoagulation of the retina was carried out using 2 lasers: diode DC-3000 NIDEK (790-830 nm) and Nd-YAG Alcon (532 nm). Photorefraction operations of two types (photorefraction keratectomy and LASIK) were carried out on a Nidek EC-5000 laser. The results evidence a possibility of photorefraction operations for correction of myopia 6 months to 11 years after a previous intervention for detachment of the retina (21 operations). Visual acuity without correction was 0.69 +/- 0.08, spherical equivalent of clinical refraction 0.80 +/- 0.34. Repeated laser coagulation at the retinal periphery for blocking newly forming ruptures was needed in 14.2% cases. No relapses occurred during 3 years postoperation.     

The characteristics of performing specialized laser keratomileusis after photorefractive keratectomy performed earlier in the correction of myopia

Ninety-four repeated refraction operations were performed by laser specialized keratomileusis (LASIK) after a previous photorefraction keratectomy in order to correct the complications (undercorrection and regression of the refraction result). LASIK operation can be performed no earlier than 12 months after the first operations if subepithelial corneal fleur develops; the fleur severity is to be about 0.5 points and the optimal thickness of corneal section is 180 mu. Causes of complications of reoperations are discussed. The majority of complications are due to corneal epithelium fixation after photorefraction keratectomy. Refraction and visual results of surgery are presented to characterize its efficiency.     

Comparative results evaluation of residual myopia and astigmatism correction after radial keratotomy by photorefraction keratectomy and laser specialized keratomileusis]

The results of correction of residual myopia by photorefraction keratectomy (PRK) (51 eyes) and laser specialized keratomileusis (LASIK) (36 eyes) after radial keratotomy (RK) are compared. The patients were observed for up to 12 months. After PRK, 7.3% patients developed late fleur of the cornea, evaluated by at least 2 points. The incidence of fleur directly depended on the value of residual myopia. After LASIK none of the patients developed such fleur. The best visual acuity (0.5 and higher without correction) was attained in 70.73% after PRK and RK, vs. 100% after LASIK. The results of photorefraction operations and severity of residual myopia after RK correlated. In residual myopia of up to -3 diopters the results of correction by PRK and LASIK were virtually the same. In residual myopia higher than -3 diopters, LASIK is preferable.