Lea Symbols与Tumbling E视力表在学龄前儿童视力检查中的应用

目的比较LeaSymbols视力表与TumblingE视力表在学龄前儿童中视力的检测率、视力值和双眼间视力差异。方法对温州市某幼儿园一小班24名36～50(平均43.2±3.71)个月的儿童以随机顺序先后用LeaSymbols与TumblingE视力表检查单眼视力,视力值用logMAR记录方法来表示,用logMAR单位记录双眼视力差异。结果Leasymbols视力表的检测率为96%,Tum-blingE视力表的检测率为71%,其中33只眼能配合查Leasymbols与TumblingE,TumblingE的视力为0.26±0.10,Leasymbols的视力为0.19±0.10,两者呈线形相关(相关系数r=0.76),两者作配对t检验有显著性差异(t=6.068,p<0.0001),16名儿童用LeaSymbols测得的双眼视力差别为-0.004±0.065,用TumblingE测得的双眼视力差别为-0.019±0.067,两者呈线形相关(相关系数r=0.65),统计学分析两者无显著性差异(p=0.296)。结论Leasymbols视力表检查学龄前儿童视力特别是3～4周岁的儿童检测率高,LeaSymbols与TumblingE视力表一样能够很好地反映双眼间视力的差别,但与TumblingE视力表相比,LeaSymbols视力表存在过高估计视力的可能。视力的测定是个心理物理学过程,对于学龄前儿童,我们不能简单地根据视力小于0.8判断其弱视,而是要从儿童的认知水平来考虑。     

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。     

中山市火炬开发区2019年学龄前儿童视力筛查分析

目的 探讨中山市火炬开发区2019年学龄前儿童视力筛查情况。方法 将2019年中山市火炬开发区所有的52所幼儿园和托儿所2～6岁学龄前儿童应用索维SW-800进行视力筛查,并统计分析其结果。结果 共12586名(25172只眼)学龄前儿童完成视力筛查,把结果统计为视力异常(2619只眼,10.4%)、视力可疑(13478只眼,53.5%)、视力正常(9075只眼,36.1%)。视力异常与视力可疑右左眼比较无统计学意义(P>0.05)。各年龄组(2岁、3岁、4岁、5岁、6岁)的视力异常率接近(分别为11.1%、10.7%、11.3%、9.3%、10.3%),但是比较有统计学意义(P=0.002)。两两比较发现,3岁与5岁组(P=0.012)、4岁与5岁组(P<0.001)视力异常比较有统计学意义;而其他年龄组视力异常没有差异(P>0.05)。各年龄组视力异常中散光占比最高(72.5%);球镜0、-0.25D占比较高(31.5%)。结论 学龄前儿童视力异常、视力可疑、远视储备耗尽的占比均处于较高水平,散光异常较为常见,学龄前儿童视力保健措施很有必要。     

低视力对数视力表评价严重弱视儿童视力的研究

目的应用低视力对数视力表评价严重弱视患儿的疗效。方法研究对象是初诊时矫正视力低于或等于0．1的12例患儿，年龄3—5岁，其中远视性屈光参差性弱视11例，斜视性弱视1例。采用的视力表，是刘晓玲等设计的低视力对数视力表，进行的矫正远视力评价。治疗采用以遮盖和矫正为主的综合治疗。结果12例患儿治疗前矫正视力为0．04～0．08，视功能训练后视力提高2行或2行以上的有10例，其中有3例3眼超过0．1的视力，医师、患儿及家长得到较大的鼓舞，积极参加进一步训练。结论虽然严重弱视的儿童的视力预后比较差，但是使用低视力对数视力表评价以后，使得低于0．1的视力也能够精细测量，短时间的治疗已经证明多数儿童视力有2行的提高，其结果，得到家长理解和儿童的合作。     

学龄前儿童视力及Spot筛查仪屈光筛查结果分析

目的：了解学龄前儿童视力状况及Spot筛查仪在屈光筛查中的应用价值。方法：横断面调查研究。 对北京市海淀区5 866例3～6岁儿童进行视力检查及自然状态下Spot屈光筛查。对视力状况进行似 然比卡方检验。对视力正常儿童的屈光度采用Kruskal-Wallis H检验进行不同年龄组间差异比较,再 用Wilcoxon秩和检验进行组间两两比较。用M（Q1,Q3）描述各屈光度及屈光参差的分布特征,以 百分位数法得到屈光筛查的界值点。结果：按2种视力判定方法得到3～6岁儿童视力低常率分别为 4.25%和17.29%。不同年龄组间的差异均有统计学意义（P<0.05）。视力正常儿童的球镜度、柱镜度 和双眼球镜度参差在不同年龄组间的差异均有统计学意义（P<0.05）。随年龄增长,远视度降低,散 光度降低。等效球镜度（SE）、双眼柱镜度参差和SE参差在不同年龄组间的差异均无统计学意义。 球镜度和SE的P2.5、P97.5分别为0 D、+1.50 D和-0.25 D、+1.00 D。柱镜度的P5为-1.25 D。球镜度 参差和柱镜度参差的P95均为0.75 D。结论：Spot筛查仪屈光筛查数值获取率高,在大规模人群筛查 工作中有一定应用价值,可参考各界值点结合视力等情况给予转诊。     

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．     

Lea Symbols视力表与HOTV视力表在2.5～5.0岁儿童视力发育评价中的研究应用

目的:运用Lea Symbols视力表、HOTV视力表对2.5～5.0岁正常儿童视力发育情况进行探究,并评价2种视力表的应用效果.方法:以随机顺序先后应用Lea Symbols视力表与HOTV视力表对广州地区2所早教中心及3所幼儿园共461例儿童(922只眼)进行单眼视力检查,所有儿童提前1 d行小瞳下检影验光、眼前节...     

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。     

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...     

低视力对数视力表在严重弱视儿童视力评价中的应用价值

目的 :应用低视力对数视力表评价严重弱视患儿的疗效。方法 :研究对象是初诊时矫正视力≤ 0 .1的 12例患儿 ,年龄 3～ 5岁 ,其中远视性屈光参差性弱视 11例 ,斜视性弱视 1例。采用由刘晓玲等设计的低视力对数视力表 ,进行矫正远视力评价。治疗采用以遮盖和矫正为主的综合治疗。结果 :12例患儿治疗前矫正视力为 0 .0 4～ 0 .0 8,视功能训练后视力提高 2行或 2行以上的有 10例 ,只有 3例 3眼视力超过 0 .1。但是 ,医师、患儿及家长由此得到了较大的鼓舞 ,积极参加进一步的训练。结论 :虽然严重弱视儿童的视力预后比较差 ,但是使用低视力对数视力表评价以后 ,低于 0 .1的视力也能够被精细测量 ,短时间的治疗已经证明多数儿童视力有 2行以上的提高 ,且得到家长的理解和儿童的配合     

Visual acuity assessment: a comparison of two tests for measuring children''s vision

PURPOSE: To compare the Kay Picture Test and the logMAR Crowded Test. METHODS: Monocular visual acuity measurement was attempted on 103 paediatric subjects (aged between 2.5 and 16 years) attending eye clinics, using each of the visual acuity tests. RESULTS: The results obtained with the two tests were found to be comparable as confirmed with the Intra-class Correlation Coefficient, which revealed good agreement between the two tests. There was significant correlation between the visual acuity results measured and high conformity in the results from the weaker eye. There was a statistical difference in acuity scores between the tests; the Kay Picture Test gave a lower logMAR score with a mean difference of 0.08 logMAR. This 0.08 difference represents an actual difference of less than one line of acuity measure which can be considered to be clinically insignificant. There was a significant difference in the ability to perform each of the tests under binocular conditions, with more of the 50 children, aged 5 and under, able to perform the Kay Picture Test than the logMAR Crowded Test. CONCLUSIONS: The results obtained with the two tests are comparable. Both tests can be considered to be appropriate for amblyopia detection and the use of picture-based logMAR tests should be considered for younger children.     

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。     

Analysis of Visual Acuity and Refractive Screening Results of the Spot Vision Screener in Preschoolers

Objective: To investigate visual acuity in preschoolers and the application value of refractive screening with the Spot Vision Screener. Methods: In this cross-sectional study, 5 866 preschool children in the Haidian District of Beijing were selected for noncycloplegic visual and refractive examinations. The visual acuity distribution was analyzed by the likelihood-ratio Chi-square test. The refractive results of children with normal vision were tested by a rank sum test. The Kruskal-Wallis H test was used to analyze the differences in refractive values and anisometropia for different age groups. A two-way comparison between any two groups was performed using a Wilcoxon rank test. Medians (Q1, Q3) were used to describe the distribution characteristics of each refraction and anisometropia. The cut-off points for refractive screenings were calculated by percentiles. Results: The respective incidences of visual abnormalities were 4.25% and 17.29% based on the two methods. The differences between different age groups were statistically significant (P<0.05). The differences in spherical values, cylindrical values and spherical anisometropia values in children with normal vision were statistically significant among different age groups (P<0.05).Hyperopia and astigmatism values decreased as age increased. The values of spherical equivalent (SE), cylindrical anisometropia and SE variability were not statistically significant among different age groups (P>0.05). P2.5 and P97.5 of the spherical value and SE were 0 D, +1.50 D, -0.25 D, and +1.00 D, respectively. P5 for the cylinder value was -1.25 D. P95 for spherical and cylindrical anisometropia was 0.75 D. Conclusions: The Spot Vision Screener is considered a useful device in large-scale refractive screening work with children. The cut-off points of refractive screening and visual acuity can be used for referral.     

儿童青少年近视普查中检测设备和设置标准化专家共识（2019）

应对我国近视防控总体要求,中小学校确立为近视防控主体。中小学近视普查成为关键内容和计划之一,基于科学研究和近视普查特点,专家组已经制定出普查的基本内容和规范流程,该规范流程包含了个人资料获取、视力检查和眼屈光度检测,此外,科普宣教贯穿整个过程。     

Stereoacuity and Related Factors in Healthy Preschool Children: The Nanjing Eye Study

Purpose: To assess the distribution of stereoacuity and related factors in healthy preschool children aged 48–60 months in eastern China.

Methods: This cross-sectional study was part of the Nanjing Eye Study, a longitudinal population-based cohort study. In 2016, preschool children without any neurological problems or ophthalmological abnormalities completed comprehensive eye examinations, including visual acuity, ocular alignment and movements, cycloplegic refraction, axial length, interpupillary distance, Titmus stereotest, anterior segment, and fundus examination. Multivariate linear regression model was used to determine the factors associated with stereoacuity score, and logistic regression model was used to determine the factors associated with subnormal stereoacuity (worse than 40 arc-seconds).

Results: Among 942 healthy preschool children (mean age = 55 months), the mean (SD) stereoacuity was 81 (2.3) arc-seconds with majority (76.5%) worse than 40 arc-seconds. In the multivariate analysis, older age (p = 0.001) and better presenting visual acuity (PVA) (p = 0.01) were independently associated with better stereoacuity score. Older age was also associated with low risk of subnormal stereoacuity (odds ratio = 0.37,p < 0.001 for age 57–60 months compared to age 48–51 months).

Conclusions: The maturation of stereopsis has not completed by the age of 48–60 months. Age and PVA should be taken into account when evaluating stereopsis in healthy preschoolers. The significant associations of age and PVA with stereoacuity provide valuable insights into possible intervention for healthy preschool children with poor stereoacuity.     

Validity of Teacher-Based Vision Screening and Factors Associated with the Accuracy of Vision Screening in Vietnamese Children

Purpose: To assess validity of teacher-based vision screening and elicit factors associated with accuracy of vision screening in Vietnam.

Methods: After brief training, teachers independently measured visual acuity (VA) in 555 children aged 12–15 years in Ba Ria – Vung Tau Province. Teacher VA measurements were compared to those of refractionists. Sensitivity, specificity, positive predictive value and negative predictive value were calculated for uncorrected VA (UVA) and presenting VA (PVA) 20/40 or worse in either eye. Chi-square, Fisher’s exact test and multivariate logistic regression were used to assess factors associated with accuracy of vision screening. Level of significance was set at 5%.

Results: Trained teachers in Vietnam demonstrated 86.7% sensitivity, 95.7% specificity, 86.7% positive predictive value and 95.7% negative predictive value in identifying children with visual impairment using the UVA measurement. PVA measurement revealed low accuracy for teachers, which was significantly associated with child’s age, sex, spectacle wear and myopic status, but UVA measurement showed no such associations.

Conclusions: Better accuracy was achieved in measurement of VA and identification of children with visual impairment using UVA measurement compared to PVA. UVA measurement is recommended for teacher-based vision screening programs.     

The Effect of Test Method on Visual Acuity in School Children Aged 4–5

Purpose:This study compared two different methods of testing visual acuity (VA) in children aged 4–5 years (The UK’s school vision screening target age). A conventional vision test method was compared to a reversed presentation order of logMAR, where letters are presented in ascending size order up to vision threshold. Threshold VA, test duration and concentration were compared, to assess the most accurate and efficient method of VA testing in this age group, to determine the most clinically and cost-effective method for vision screening.Methods:Thirty-four participants completed the study (15 males, 19 females, age range 53–65 months, mean age 59 months’ ±3.7 months). VA was measured in logMAR. Keeler Crowded logMAR screening plates determined the starting line on the vision chart to ensure the initial optotype size was either seen or not seen for the conventional and reversed test methods respectively. Test duration was measured in seconds and a concentration score was given by the examiner.Results:The median VA was 0.17 logMAR for each test method. There was no significant difference in the VA outcomes between each test method (p = 0.46). The reversed method was significantly quicker to complete, with a median reduction in test duration of 28 seconds (p = 0.002). There was no difference in concentration levels between the test methods.Conclusion:Both test methods gave the same VA threshold, and are therefore comparable. The reversed method was significantly quicker to complete which could benefit school vision screening services and busy clinical contexts.     

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.     

One-stage vs. two-stage adjustable sutures for the correction of esotropia

BACKGROUND The aim of this study was to evaluate the stability and the level of postoperative consciousness, nausea and vomiting, ocular pain, starting oral intake and activity, and cost-effectiveness in patients undergoing medial rectus recession surgery using an adjustable suture technique that was performed by two different methods. METHOD In this prospective study, we evaluated 78 patients undergoing medial rectus recession surgery. Thirty-eight patients were operated by a one-stage technique in which the whole operation was done under topical anesthesia and adjustment was done on the operating table, while 40 patients were operated by a two-stage technique in which the operation was done under general anesthesia and adjustment was done the following day at the patient’s bedside. The results were recorded and compared according to the parameters given above. A scoring system was used to assess all these parameters except for stability. The stability of the procedures was evaluated according to the degrees of squint immediately after the adjustment and at least three months thereafter. RESULTS There was no significant difference between the procedures with regard to stability and ocular pain. During the early postoperative period, the level of consciousness was better and nausea and vomiting occurred less frequently in the patients operated by the one-stage procedure. Postoperative activity and oral intake returned to normal status more quickly in the one-stage group and the one-stage procedure was cost-effective. CONCLUSION We conclude that although both procedures provide satisfactory and stable results, the one-stage procedure has significant advantages over the two-stage procedure for medial rectus recession surgery in suitable cases.