河北省沧州城区6～14岁学龄儿童眼病现况调查

目的：了解沧州地区学龄儿童眼部多发眼病种类及其相关危险因素,为学龄儿童眼部疾病预防及治疗提供可靠的流行病学依据。 方法：我们对河北省沧州市区及所辖县市单纯随机抽取20所学校作为调查点,抽取调查对象3150例6299眼,一到三年级儿童只接受医生眼部健康状况检查,四到六年级儿童接受医生眼部健康状况检查及眼表疾病指数问卷调查。所有结果资料采用SPSS 16.0进行统计学分析。 结果：视力〉0.9者42.42%,共2672眼;干眼858例,患病率27.24%;睑缘及结膜炎症1423眼,患病率22.59%;斜视189例,患病率6.00%。其他：先天性白内障8眼,患病率为0.13%;先天性上睑下垂78眼,患病率1.90%;下睑倒睫89眼,患病率1.41%;陈旧性眼外伤13眼,先天小视乳头4眼,男性儿童中有1眼为义眼。 结论：学龄期儿童视力〈0.9者比例较高,而低视力中近视所占的比例最高,提示广大眼科医师及家长儿童眼病的防治工作必须从保健入手,从小抓起,早发现、早治疗各种眼病以确保儿童较好的视力。     

北京市密云县学龄前儿童视力状况分析

目的:了解密云县学龄前儿童视力状况,为学龄前儿童眼保健工作提供指导依据和可行性方法。方法:选择密云县具有代表性的三个区域部分学龄前儿童(4～6岁)进行常规远视力检查,对视力结果进行统计分析。结果:学龄前儿童4,5和6岁视力低常率分别为36.29%,24.43%和20.86%;城镇视力低常率为36.76%,城乡结合部为24.35%,农村为17.08%;视力低常者中,轻度84.38%,中度8.99%,重度6.63%。结论:学龄前儿童的视力低常率以4岁组最高,城镇视力低常率明显高于城乡结合部和农村,视力低常者中以轻度低常为主。学龄前儿童视力是儿童眼保健工作的重要内容,结果受多种因素影响,应正确分析对待。     

在社区开展儿童视力保健的探讨

目的 在社区开展小年龄儿童的视力保健，可以早期发现视力异常的患儿，并给予早期治疗。通过早期干预以提高我社区儿童整体健康水平。方法 对2000～2003年期间对在我科进行视力保健的0～5岁1196名社区儿童进行视力观察、视力筛查及常见眼病的诊治等视力保健工作。结果 1196例小年龄儿童中视力异常者79例，视力异常率为6．61％。其中54例确诊为屈光不正，患病率为4．51％。这54例中远视51例，近视3例，合并有弱视者17例，合并有斜视者7例。以上病例均给予专科治疗并取得良好效果。结论 本组视力保健儿童的视力异常率最高，且小年龄儿童的屈光不正以远视为主，提示屈光不正在儿童小年龄时期就可能发生，故早期对小年龄儿童进行视力保健是必要的，对视力异常者早期干预治疗效果显著。     

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。     

云南多民族地区学龄前儿童视功能的干预和保护

儿童处于视觉发育的关键期和敏感期,特别容易受各种因素的影响形成弱视、斜视等眼病,严重者导致终身残疾即低视力和盲。在该时期,只要治疗及时,绝大多数儿童可取得良好的治疗效果。通过开展早期儿童眼保健的干预和保护,同时依靠行政机构、教育机构、医疗机构和儿童家长的通力配合,可以大大降低儿童盲和视觉损害,对保障儿童视觉功能正常发育有重要意义。本文通过从儿童眼的发育特点,学龄前儿童视力及视功能的检测方法,存在的问题和解决措施的角度,总结分析我省儿童眼保健工作的发展与现状。     

视力检查在眼病筛查中的作用

视力检查是许多致盲性眼病基层筛查工作的第一步。目前我国儿童人群视力损伤的初步筛查主要由教育机构中的保健老师完成,一直沿用的是以裸眼远视力检查结果为基础的视力不良标准。但该标准并不符合儿童视力发育规律,且可能导致大量已接受正确屈光矫正的患儿重复筛查、诊断和治疗,不符合筛查试验的基本原理。在成年人群基层眼病筛查工作中仍存在只检查裸眼视力的状况。建议对学龄前儿童的视力筛查界值参考我国新的弱视诊断标准而制订;综合裸眼、日常和矫正视力指标来全面了解儿童视力情况;加速儿童保健专业、小儿眼科和视光学专业在儿童视力检查工作上的并轨。在成年人群中,推行日常生活视力指标进行成年人群视力损伤的筛查,并根据所筛查的特定眼病来确定视力检查的具体方案。     

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。     

江苏省初级眼保健与防盲的调查研究

目的了解江苏省农村基层的眼保健与防盲工作状况。设计横断面调查研究。研究对象江苏省13个全国防盲先进县的34个乡76个村。方法对上述乡、村的防盲治盲人员、职责、业务、设备进行检查、评估,并作统计分析。主要指标按卫生部标准所规定的乡村初级眼保健与防盲的各项指标。结果所有乡、村达到或超过了卫生部颁布标准中有关组织网络、职责、设备指标。约50％的乡、村达到或超过了卫生部颁布标准规定的常见眼病的诊疗技术要求。部分乡、村存在统计报表不准确、白内障手术方法落后等不足。结论江苏省防盲先进地区的农村基层眼保健与防盲工作基本达到了卫生部颁布标准,但业务水平有待提高。(眼科,2006,15：355-358)     

甲状腺相关眼病眼眶减压术的疗效分析

目的：探讨眼眶减压术在甲状腺相关眼病中治疗的价值。方法：回顾性分析中山眼科中心1993－2000年27例（30只眼）经全身和眼部临床检查（视力、视野或视觉诱发电位等）确诊为甲状腺相关眼病患者采用眼眶减压术（一壁、二壁及三壁减压）治疗的临床资料,观察其手术前和手术后患者视力、眼球突出度及眼球运动的变化。术后随访2个月至7年,平均13．7个月。结果：视力：19只眼（63．3％）明显提高;4只眼（13．3％）轻度提高,视力均保持在0．2－0．8;4只眼（13．3％）视力无变化,其中3只眼（10．0％）视力下降。24只眼（80．0％）眼球突出后退≥3．0mm,28只眼（93．3％）眼球突出后退≥2．0mm,平均眼球突出后退3．6mm。结论：眼眶减压术可提高甲状腺相关眼病患者的视力,减轻其眼球突出度。     

中国新生儿眼病筛查的现状和进展

为了最大限度减少儿童以避免盲和视力损害,对儿童眼病的早期干预成为目前儿童保健和社会关注的问题,新生儿眼病筛查越来越受到眼科医生的重视.我国最早的儿童眼病筛查开始于2005年,筛查对象逐渐由高危儿及早产儿扩展到部分地区内所有新生儿,检查的方法由最早的光刺激、眼前节联合红光反射检查逐渐扩展到前节联合间接检眼镜下的视网膜检查,至某些地区目前开展的数字化眼底成像系统.视网膜照相成为新生儿眼病筛查的新的重要工具并有较高的阳性检出率.但目前新生儿眼病筛查中发现的可以治疗的和治疗后可脱盲的眼病比例仍缺乏相关数据.新生儿眼病筛查需要规范和科学的方法和程序,以便有效地消灭儿童可预防盲.     

幼儿家长的儿童视觉保健意识调查

目的调查幼儿家长的儿童视觉保健意识,以便有效制订工作规划及采取科普宣教,达到对幼儿眼病早发现早治疗的目的.方法采用问卷调查方式,非选择抽样调查上海部分幼儿园的幼儿家长共2000人.问卷主要了解家长对小儿视觉的关心情况、就医意识、诊疗依从性及对各种"视觉保健特效药物及仪器"的看法等.结果40%6～50%的家长会有意识地主动关心小儿视觉的情况,12%的家长缺乏就医意识,"散瞳验光"、"戴眼镜治疗"的诊疗依从性为40%～50%,"手术治疗"的依从性为2%.结论要加强科普教育与宣传,增强患儿家长的儿童视觉保健意识.     

Patterns of eye care use and expenditures among children with diagnosed eye conditions.

PURPOSE: Little is known about use and expenditure patterns of children's eye-care services and about possible disparities in care among children. This report describes the use and expenditure patterns of eye care and non-eye care services for children under 18 years old in the United States. METHODS: Levels of use and expenditure were estimated using self-reported information from the nationally representative Medical Expenditure Panel Surveys (1996-2001) for 48,304 subjects under 18 years old from randomly selected households in the United States. Means presented for children with and without diagnosed eye conditions were adjusted for child and family characteristics using generalized linear models. RESULTS: Children with diagnosed eye conditions had higher levels of use and expenditure than children without diagnosed conditions. Families of children with diagnosed eye conditions incurred higher out-of-pocket expenditures. Black children and children living below 400% of the federal poverty level had lower levels of use and expenditure, indicating that they received fewer and less intensive services. CONCLUSIONS: Children with diagnosed eye conditions experienced higher overall use of health care. Some groups of children appear to be underserved. Estimates of use and expenditure patterns, stratified by socioeconomic factors, will be needed to plan for future delivery of children's eye and vision care services and to assess progress toward Healthy People 2010 goals.     

Comparing the effectiveness of vision screenings as part of the school entrance physical examination to comprehensive vision examinations in children ages 3 to 6: an exploratory study.

PURPOSE: The purpose of this exploratory study was to investigate the effectiveness of vision screenings performed during school entrance physical examinations compared with comprehensive vision examinations in the state of Kentucky, which mandates comprehensive eye examinations for children, ages 3 to 6, who are entering the public school system. METHODS AND SUBJECTS: In this exploratory study, 1,386 children had forms submitted from 36 optometrists and 1 ophthalmologist reporting on their vision and eye problems. Vision and eye problems were defined as the presence of strabismus, amblyopia, or a refractive error requiring an optical correction, as determined by the optometrists or ophthalmologist using cycloplegic refraction. Among these 1,386 children, there were 300 diagnosed with vision problems. RESULTS: Sixty-six children were diagnosed with a vision problem who had not previously been to an eye doctor and had received a vision screening at their school entrance physical examination. In 56 of these 66 children, the vision problem was not detected by the vision screening, according to the parents. CONCLUSION: The exploratory study suggests that comprehensive vision examinations may identify some vision problems that were not found in children's preschool physical examinations that included vision screenings. A larger randomized study is needed to determine the most appropriate method of timely diagnosis of vision problems in children that can be corrected with early intervention in order to ensure the vision health and well-being of children entering the public school system.     

Quantitative analysis by reversed-phase high-performance liquid chromatography and retinal neuroprotection after topical administration of moxonidine

AIM: To determine moxonidine in aqueous humor and iris-ciliary body by reversed-phase high performance liquid chromatography (RP-HPLC), and to evaluate the retinal neuroprotective effect after topical administration with moxonidine in a high intraocular pressure (IOP) model. METHODS: The eyes of albino rabbits were administered topically and ipsilaterally with 0.2% moxonidine. A RP-HPLC method was employed for the identification and quantification of moxonidine between 2 and 480min, which presented in the aqueous humor and iris-ciliary body. Flash electroretinography (F-ERG) amplitude and superoxide dismutase (SOD) level were measured between day 1 and day 15 after topical administration with moxonidine in a rabbit model of high IOP. Histological and ultrastructural observation underwent to analyze the changes of retinal morphology, the inner retinal layers (IRL) thickness, and retinal ganglion cell (RGC) counting. RESULTS: Moxonidine was detectable between 2 and 480min after administration, and the peak concentration developed both in the two tissues at 30min, 0.51 μg/mL in aqueous humor and 1.03 μg/g in iris-ciliary body. In comparison to control, F-ERG b-wave amplitude in moxonidine eyes were significantly differences between day 3 and day 15 (P<0.01) in the high IOP model; SOD levels were significantly higher at all time-points (P<0.01) with a maximum level of 20.29 U/mgprot at day 15; and RGCs were significantly higher (P<0.05). CONCLUSION: Moxonidine is a viable neuroprotective agent with application to high IOP model. All layers of retina, including RGC layer, retinal nerve fiber layer and INL, are more preserved after moxonidine administration. SOD plays a neuroprotective role in ocular hypertension-mediated RGC death.     

Legislative issues facing pediatric ophthalmology in 2006

PURPOSE OF REVIEW: There has been a surge in legislative activity concerning children's vision in recent years. This review will summarize and compare newly enacted state statutes and review legislation that has been introduced at both the state and federal level. Detailed reference sites are provided and may be a useful resource for those involved in legislative advocacy. RECENT FINDINGS: The legislative arena has often mirrored the disparate views of ophthalmology and optometry regarding the most appropriate methods for identifying vision problems in young children. While state legislation mandating comprehensive eye examinations for all asymptomatic and risk free children was passed in Kentucky in 2000, no other state since has successfully enacted and implemented similar legislation. In contrast, numerous states, have enacted mandatory preschool vision screening legislation. Federal legislation, introduced separately by ophthalmology and optometry, would provide funds for uninsured children's eye exams, but the two bills have important differences in eligibility requirements. Issues such as eye safety and retinoblastoma detection have also been addressed through the legislative process. SUMMARY: There has been a myriad of state and federal legislative activity in the area of children's vision. The momentum is likely to continue as additional states file new legislation.     

智障儿童眼部筛查结果与分析

目的 通过对温州地区特殊学校就读的智障儿童进行眼部健康筛查,了解智障儿童的眼部健康问题,分析相关因素,以提供相应的视觉矫正和治疗措施,及探索如何为智障儿童的眼部健康提供有效的服务.方法 调查研究.对在温州地区特殊学校就读的342名智障儿童进行眼部健康筛查,内容包括：一般信息、视力检查、眼位检查、色觉检查、眼前段检查、内眼检查以及屈光不正检查.采用Excel软件对数据进行整理、归纳和求百分比.并针对存在的视觉问题作出相应的分析和医学处理.结果 筛查患儿智力残疾为轻度至中度,心理与情绪等适应能力轻度或中度障碍,能参与部分社区活动.眼科检查发现,正视眼占46.6%,屈光不正均以低度屈光不正状态为主,大部分能通过眼镜矫正达到5.0 眼位检查显示正位眼占67.2%,隐斜视占12.9% 色觉正常者占81.9%,色觉存在明显异常者占6.4% 外眼及眼前段检查未发现明显异常者占92.7% 内眼检查未发现明显异常者占81.1%.这些患儿眼部的异常主要是眼球震颤（占50.0%）和白内障（占28.3%）.结论 智障儿童的眼部问题现患率比普通儿童高,但还是以屈光不正、眼球震颤、白内障等为主,大多为可矫正和可康复的,可以通过眼镜、手术或视觉康复等提高视功能.     

Need for optical and low vision services for children in schools for the blind in North India

CONTEXT: Children admitted in blind schools need low vision assessment for improving functional vision (useful residual vision). AIM: To ascertain the need for spectacles and magnifiers as low vision devices (LVD) in children with useful residual vision, attending blind schools. SETTING AND DESIGN: Cross-sectional study conducted in 13 blind schools in Delhi, North India. MATERIALS AND METHODS: Of a total of 703 children (less than 16 years of age) examined, 133 (18.91%) with useful residual vision were refracted and analyzed. High addition plus lenses (range 5-30 diopters) were used as spectacle magnifiers for near LVD assessment. "World health organization (WHO)/ prevention of blindness (PBL) eye examination record for children with blindness and low vision", was used to collect data. SPSS (statistical package for the social science), version 10.0 was used for analysis. RESULTS: Based on the vision of 133 children at initial examination, 70.7% children were blind and 12.0% were severely visually impaired (SVI). 20.3% children improved by at least one WHO category of blindness after refraction. With best correction, 50.4% children were still blind and 13.5% were SVI. Visual acuity in the better eye after refraction in 47 children (35.3%), improved with spectacles. Children with aphakia (17), coloboma (5), refractive error (5) and microphthalmos (4) benefited from spectacles. Of 124 children with low vision but having useful residual vision, 51 (41.1%) were able to read N-10 unaided or with distance spectacles and 30 children (22.6%) improved to N-10 with spectacle magnifiers and were prescribed the same. CONCLUSION: Visually impaired children with aphakia and congenital anomalies of the eye benefit from refraction and low vision services.     

医教结合模式下普及眼保健知识对儿童视觉发育的影响

目的：在幼儿园中应用医教结合模式普及儿童眼保健知识,研究该模式对儿童视觉发育的影响并评价其效果。方法：在南京市雨花区随机抽取3所幼儿园大班儿童（5～6岁）作为试验组,应用医教结合模式普及儿童眼保健知识;另在南京市建邺区随机抽取3所幼儿园大班儿童（5～6岁）为对照组。两组进行为期一学年的对照研究,分析试验组与对照组儿童的视力低常率、屈光偏离转诊率、散光患病率、等效球镜度数均值、生理性远视不足比率等指标有无差异。结果：一学年后,医教结合模式下的试验组儿童视力低常率、屈光偏离转诊率、散光患病率与对照组比较均明显降低,差异具有统计学意义（P＜0．05）,与试验前比较亦有明显降低,差异具有统计学意义（P＜0．05）;试验组儿童等效球镜均值增加,生理性远视不足比率降低,与试验前及对照组比较均有统计学意义（P＜0．05）。结论：应用医教结合模式普及儿童眼保健知识对于促进儿童视觉的正常发育,降低视力不良发生率,延缓近视发生有着积极意义。