学龄前儿童弱视筛查标准研究

目的了解学龄前儿童的视力和屈光发育状况,探讨该年龄段儿童弱视筛查中的视力和屈光度筛选标准。方法横断面调查研究。对海淀区24所幼儿园3~6岁儿童进行视力和屈光度检查。3岁儿童采用图形视力表,4岁以上用标准对数视力表。屈光度检查用SureSight手持式自动验光仪在自然状态下进行。用M（Q1~Q3）描述各年龄组视力和屈光度的分布特征,用秩和检验比较不同年龄组间视力和屈光度分布差异,以百分位数法确定95%参考值范围。结果球镜度M（Q1~Q3）：3岁和4岁均为1.25 D（1.00~1.75 D）,5岁和6岁均为1.50 D（1.00~1.75 D）,3~6岁不同年龄组间球镜度分布差异有统计学意义（χ2=77.60,P<0.01）。柱镜度：各年龄组均为-0.50 D（-0.75~-0.25 D）,不同年龄组间柱镜度分布差异有统计学意义（χ2=60.41,P<0.01）,两两比较3岁和4岁组之间差异有统计学意义（Z=-4.75,P<0.008）,3岁儿童柱镜度较其他组偏小。视力：3岁为0.6（0.6~0.7）,4岁为0.8（0.8~1.0）,5岁和6岁均为1.0（1.0~1.0）,不同年龄组间视力分布差异有统计学意义（χ2=11 323.87,P<0.01）,两两比较各年龄组间差异均有统计学意义（P＜0.008）,随年龄增长视力逐渐提高。视力正常儿童的球镜度P2.5~P97.5：3岁+0.50~+2.75 D,4岁+0.50~+2.50 D,5岁+0.50~+2.75 D,6岁+0.50~+3.00 D,柱镜度P5：3岁-1.50 D,4~6岁-1.25 D;屈光度正常儿童的视力P5分别为3岁和4岁0.6,5岁和6岁0.8。柱镜度数变化对视力的影响较大,球镜度数变化对视力的影响相对较小。结论视力筛选标准：3岁和4岁＜0.6,5岁和6岁＜0.8;球镜度筛选标准：3~6岁球镜≤+0.25 D和≥+3.00 D;柱镜度筛选标准：3岁≤-1.75 D,4~6岁 ≤-1.50 D。自然状态下屈光筛查球镜度范围可适当放宽,柱镜度范围应相对严格。     

北京市海淀区2～3岁幼儿视力和屈光状态筛查结果分析

目的研究北京市海淀区2～3岁儿童远视力、屈光参考范围及异常转诊标准。方法横断面调查研究。通过整群抽样,对随机抽取到的24所海淀区幼儿园托班和小班的3 804名2～3岁儿童进行远视力和屈光度检查。远视力检查使用图形视力表,屈光度检查使用SureSight手持式自动验光仪在自然状态下进行。用中位数和四分位数[M（P25,P75）]描述远视力、球镜度和柱镜度的分布特征。分别将球镜度以每1.00 D、柱镜度以每0.50 D为一个区间各分为7组,观察各组视力分布情况,比较不同度数球镜度组或柱镜度组视力分布是否存在差异。以视力低于0.4为视力异常,比较不同屈光度组视力异常的发生率差异。根据视力不同分为视力正常组（≥0.6）、视力低常组（=0.5）、视力异常组（≤0.4）3组,比较不同视力组屈光异常的发生率。不同屈光度组视力分布的比较使用秩和检验,视力和屈光异常的发生率的比较使用卡方检验。结果3 378例儿童（6 756眼）获得完整视力和屈光度资料。2岁儿童视力为0.6（0.6,0.6）,3岁儿童为0.6（0.6,0.8）,3岁儿童视力明显优于2岁儿童,差异具有统计学意义（Z=-10.10,P<0.01）。2岁和3岁儿童视力参考值下限P5值为0.5。2岁儿童与3岁儿童比较无论球镜度还是柱镜度分布差异均无统计学意义（Z=-2.48、-2.10,P>0.05）。不同球镜度组间视力差异具有统计学意义（χ²=89.22,P<0.01）;-0.25～+0.75 D组视力优于总体样本（Z=1.66,P<0.05）;+1.00～+2.75 D组视力与总体样本比较差异无统计学意义（Z=0.44,P>0.05）;而+3.00D～组的视力低于总体样本（Z=3.53,P<0.01）。不同柱镜度组间视力差异具有统计学意义（χ²=373.73,P<0.01）;0.00～-1.50 D组视力分布与总体样本比较差异无统计学意义（Z=1.02,P>0.05）;当柱镜度等于或超过-1.75D时视力低于总体水平, 并且视力水平随散光度增高而降低,差异具有统计学意义（Z=3.31、4.73、4.97,P<0.01）。远视球镜度等于或高于3.00 D,柱镜度值大于等于1.75 D时视力异常率明显增高（χ²=142.20,P<0.01）。视力异常组屈光异常率亦显著增高（χ²=240.82,P<0.01）。结论对2～3岁儿童的进行屈光筛查,有助于及早发现弱视。远视球镜度等于或高于3.00 D,柱镜度值大于等于1.75 D为屈光异常转诊标准。     

Spot Vision Screener视力筛查仪在儿童视力筛查中的应用分析

目的：通过对Spot Vision Screener视力筛查仪在儿童视力筛查中的应用探讨,寻求一种新型、可靠、方便的儿童屈光状况筛查方法。方法：对我院门诊进行筛查的2~9岁儿童共87例174眼进行屈光检查,并将结果与电脑显然验光结果进行对比。结果：Spot Vision Screener视力筛查仪与电脑显然验光结果对比,除右眼球镜值存在统计学差异外,两种方法测量的左眼球镜值、双眼柱镜值及柱镜轴向、双眼等效球镜值均无统计学差异(P>0.05)。结论：Spot Vision Screener视力筛查仪操作简单易行,儿童配合度好,不失为临床对儿童进行视力筛查的一种新方法。     

高透氧硬性角膜接触镜减少儿童远视屈光不等差异的疗效

目的：探讨在非弱视性远视屈光不等儿童中,使用高透氧硬性角膜接触镜（ rigid gas permeable lens,RGP）矫正高屈光度眼视力,对双眼屈光度等效球镜差值（△SE ）、眼轴差值（△AL ）的影响。方法：选择我院视光门诊远视性屈光不正的6～12岁儿童95例190眼,且双眼屈光度差值（△SE）1D≤△SE＜2．0D和矫正视力不等,但每一眼的矫正视力均在同龄儿童正常范围内,即均非弱视。随机分为两组：A组48例,给屈光度较高眼（视力较差眼）配戴RGP,另一眼不戴镜处理;B组47例,不配镜作为对照组。用1％环戊酮散瞳验光计算等效球镜（SE）,测量眼轴（AL）,并随访1．5a。分别计算A组和B组等效球镜差值（△SE ）、眼轴差值（△AL ）,进行统计学分析。结果：A组双眼之间等效球镜度差值（△SE ）小于B组,差异有统计学意义（F＝18．508,P＝0．002＜0．05）;A组双眼之间眼轴差值（△AL ）小于B组,差异有统计学意义（ F＝1116．765,P＝0．000＜0．05）。结论：在非弱视性远视屈光不等儿童中,用RGP矫正高屈光度眼视力是有必要的,可以明显减少双眼屈光度、矫正视力差异,避免屈光参差所带来的视觉功能异常等一系列问题。     

Spot双目视力筛查仪在儿童屈光筛查中的应用效果分析

目的 探讨Spot双目视力筛查仪在儿童屈光筛查中的临床应用效果。方法 将2021年5月至2022年5月在南通市妇幼保健院眼科门诊就诊的儿童分为两个年龄段,3～6岁和>6岁,每个年龄段150例(300眼),Spot双目视力筛查仪屈光筛查和睫状肌麻痹检影验光,四格表计算Spot双目视力筛查仪的判读结果灵敏度、特异度和准确度。秩和检验计算两者测量数值差异,线性回归分析两者相关性。Bland-Altman方法评估两者一致性。结果 Spot双目视力筛查仪在3～6岁组灵敏度、特异度和准确度分别为74.32%、94.74%、84.67%,>6岁组分别为78.23%、80.77%、78.67%。3～6岁组Spot双目视力筛查仪较检影验光低估了球镜值(Z=-13.735,P<0.01)及等效球镜(Z=-14.232,P<0.01),高估了柱镜值(Z=-8.562,P<0.01)。在>6岁组Spot双目视力筛查仪较检影验光低估了等效球镜(Z=-4.172,P<0.01),高估了球镜值(Z=-4.051,P<0.01)及柱镜值(Z=-13.193,P<0...     

Spot视觉筛查仪在学龄前儿童屈光筛查中的应用

目的探讨Spot在学龄前儿童屈光筛查中的可配合性、屈光数值的准确性及在屈光性弱视危险因素筛查中的筛查效率。方法前瞻性研究。144例1～5岁儿童先后进行Spot及眼科检查,Spot数值与睫状肌麻痹后视网膜检影结果进行配对t检验。数据的相关性采用Pearson相关分析,以2013年美国斜视与小儿眼科协会（AAPOS）规定的视觉筛查转诊指南作为金标准来评估Spot在屈光性弱视危险因素筛查中的敏感性、特异性、阳性预测值及阴性预测值。结果入组144例儿童中96.5%的儿童[平均年龄（3.0±1.2）岁]能配合Spot检查,打印出的报告全部有屈光、眼位结果及评估建议,与睫状肌麻痹后检影比较,Spot表现为低估远视或高估近视（-1.32 D）,高估散光（+0.39 D）。Pearson相关系数表示Spot球镜度、柱镜度与睫状肌麻痹检影值均高度相关（r=0.884、0.728,P<0.01）。Spot在屈光性弱视危险因素筛查中敏感性为90.9%,特异性为82.1%,阳性预测值为48.8%,阴性预测值为98%。结论大多数学龄前儿童可配合Spot的检查,Spot可同时评估双眼的屈光状态,与检影结果有较高的一致性,同时在屈光性弱视危险因素的筛查中具有一定的临床应用价值。     

无屈光参差近视患者双眼周边屈光度分布

目的探讨双眼无屈光参差近视患者的周边屈光度分布状态。方法自身对照研究。选取2015年1-4月拟行准分子激光矫治的屈光状态稳定且无屈光参差的成年近视患者153例,睫状肌麻痹下使用Grand Seiko WAM5500型红外验光仪测量视网膜中心凹0°以及鼻颞侧15°、30°、45°的屈光度。采用配对t检验进行各项数据分析。结果无屈光参差近视患者右、左眼球镜度、柱镜度、等效球镜度（SE）在视网膜中心凹0°以及鼻颞侧15°、30°、45°各对应部位差异均无统计学意义（P>0.05）;右、左眼鼻侧15°的球镜度和SE与颞侧15°比较,差异有统计学意义（右眼：t=5.31、4.51,P<0.05;左眼：t=3.39、2.54,P<0.05）,并且颞侧45°的柱镜度明显大于鼻侧45°的柱镜度（t=4.95、3.74,P<0.05）,其他各对应部位差异均无统计学意义（P>0.05）;右、左眼鼻侧15°与视网膜中心凹0°球镜度、柱镜度、SE差异无统计学意义（P>0.05）,而其他部位屈光度与视网膜中心凹0°差异均有统计学意义（t=2.32~8.70,P<0.05）,越到周边,球镜度和SE出现远视性离焦,柱镜度逐渐增大。结论无屈光参差近视患者周边屈光度的分布在右、左眼相对应部位具有对称性;旁中心部,颞侧视网膜远视性离焦;越到周边部,远视性离焦程度越高;颞侧周边散光度明显大于鼻侧。     

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。     

屈光参差儿童单眼配戴角膜塑形镜的临床效果

目的：评估屈光参差儿童单眼配戴角膜塑形镜控制近视、矫正屈光参差的临床效果。方法：回顾性自身对照病例研究。收集2014 年1 月至2016 年12 月在温州医科大学附属眼视光医院单眼接受角膜塑形镜治疗的屈光参差儿童40 例,年龄9～15 岁,随访时间1 年。双眼根据是否配戴角膜塑形镜分为配戴角膜塑形镜眼组（戴镜眼组）和未配戴角膜塑形镜眼组（未戴镜眼组）。戴镜眼组40眼,等效球镜度（-2.51±0.95）D;未戴镜眼组40眼,等效球镜度（0.10±0.52）D。双眼屈光度数差异范围1.00～4.38 D,平均（2.61±1.04）D。观察戴镜前及戴镜1 年后的双眼裸眼视力（UCVA）、屈光度数、眼轴、前房深度及角膜形态参数等变化,并对数据进行配对t检验和Pearson相关分析。结果：单眼配戴角膜塑形镜1年后,双眼UCVA（LogMAR）差值由0.77±0.29下降至0.17±0.22（t=-15.865,P < 0.001）,双眼屈光度数的差值由（2.61±1.04）D下降至（2.07±1.05）D（t=-7.366,P < 0.001）,双眼眼轴的差值由（0.97±0.66）mm降至（0.67±0.63）mm（t=-5.995,P < 0.001）,双眼前房深度的差值由（0.47±0.11）mm下降至（0.01±0.13）mm（t=-2.704,P=0.027）。相关性分析发现戴镜后屈光参差减少量仅与双眼眼轴差值变化量、双眼UCVA差值变化量具有相关性（r=0.539、0.418,P < 0.001）。结论：单眼配戴角膜塑形镜对屈光参差儿童是一种安全、有效的控制近视进展、矫正屈光参差的临床方法。     

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。     

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.     

甘肃省兰州市城关区学龄前儿童视力与屈光状态调查

目的对兰州市城关区学龄前儿童的视力及其屈光状态进行调查,以发现超出生理范围的视力异常及屈光异常。方法横断面调查研究。采用整群抽样的方法对兰州市城关区10所幼儿园的2 841例3～6岁学龄前儿童进行裸眼远视力及Suresight屈光筛查仪检查,实际受检2 754例（5 508眼）,计量资料采用t检验或方差分析,分类资料采用卡方检验或线性趋势检验。结果兰州市城关区学龄前儿童视力异常检出率为13.9%,不同年龄组间视力异常检出率存在差异（?字２=31.80,P＜0.05）,且随着年龄增长视力异常检出率呈下降趋势（?字２lineartrend=31.59,P＜0.05）。屈光异常占检查总人数的13.13%,随着年龄增加,复性远视散光人数和单纯远视人数均逐渐减少（?字２lineartrend,复性远视散光=16.01,P＜0.05;?字２lineartrend,单纯远视=9.11,P＜0.05）。结论兰州市城关区3～6岁的学龄前儿童视力异常随着年龄增长呈下降趋势,提示视力随年龄增加逐步升高;屈光异常以单纯远视为主,远视屈光度向远视减小方向发展,符合儿童视力及眼屈光发育的规律。     

调节性内斜视儿童双眼屈光差值的变化趋势及其对立体视的影响

目的研究调节性内斜视患者屈光差值的变化趋势和立体视的发展变化。方法回顾性研究。对有完整病历资料的屈光调节性内斜视儿童进行回顾性研究和总结。根据初始双眼屈光差值分为低度屈光差异组（双眼SE差≤1.0 D）、中度屈光差异组（1.0 D<双眼SE差<2.5 D）和高度屈光差异组（双眼SE差≥2.5 D）;根据初始视力情况分为双眼视力相等组和弱视组。对初始视力与初始屈光差值的关系进行独立样本t检验,对初始屈光差值随戴镜治疗时间的变化采用重复测量混合线性模型进行分析,对初始屈光差值与末次立体视进行卡方检验。结果在平均（6.8±2.8）年后,末次随访时87例（82.1%）屈光差值为低度,14例（13.2%）为中度,5例（4.7%）为高度。①不同视力组别间屈光差值差异有统计学意义（t=9.787,P<0.05）;②不同的屈光差异组间的末次立体视差异有统计学意义（χ2=18.785,P<0.01）;③戴镜后,随着年龄的增加3组屈光差值均有下降的趋势（F=142.913,P<0.01）。结论初始就诊时,调节性内斜视伴远视性屈光差异者,初始屈光差值越大,初始弱视眼视力越差,末次随访时获得的立体视越差。随戴镜时间增加,双眼屈光差值逐渐趋减。     

Validation of Peek Acuity application in pediatric screening programs in Paraguay

AIM: To validate the Peek Acuity mobile phone application in pediatric populations and compare its utility, both economic and diagnostic, against conventional screening methods using a pediatric ophthalmologist examination as the gold standard. METHODS: A cohort of 393 subjects from Fernando de la Mora, Paraguay (ages 6-16y) were enrolled in the study. Subjects were randomly assigned a starting screening modality among: Peek Acuity, a single line of tumbling E optotypes set at 20/40, and Spot Vision Screener. Once completing the first screening modality, the subjects completed the two remaining techniques. Referral criteria were established based on the most current American Association of Pediatric Ophthalmology and Strabismus (AAPOS) recommendations: 20/40 for Peek Acuity and the tumbling E, and refractive error detection for the Spot Vision Screener. Subjects that failed to achieve the cut-off for any of the three screening techniques or subjects that passed the screening but were randomly selected to perform a comprehensive eye exam to determine the false negative rate, were evaluated by a pediatric ophthalmologist. This evaluation was considered the gold standard, and included vision assessment by a Snellen chart, strabismus evaluation, and cycloplegic refraction with dilated fundoscopy. RESULTS: We obtained 48% sensitivity, 83% specificity, 43% positive predictive value, and 86% negative predictive value for Peek Acuity''s ability to refer compared to evaluation by a pediatric ophthalmologist, failing to achieve a desired sensitivity for implementation. Peek Acuity trended to overestimate the subject''s visual acuity, providing a higher visual acuity that would not indicate referral for a comprehensive eye examination. However, its high specificity accurately predicted a significant number of children who did not need further evaluation. When comparing the three screening methods, no single screening modality outperformed the others. Peek Acuity represented a technology that was economically feasible compared to other screening modalities in low income settings, due to the prevalence of cell phone use. CONCLUSION: Peek Acuity represents an efficient tool that has potential for implementation in school screenings with different strategies aimed at pediatric populations due to its low cost and high specificity. An increase in sensitivity would improve detection of children with refractive errors.     

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。     

Assessment of stereopsis in pediatric and adolescent spectacle-corrected refractive error – A cross-sectional study

Purpose:To assess the level of stereopsis in school children with spectacle-corrected refractive errors using Titmus fly and Randot stereo tests, evaluate the factors associated with the level of stereopsis, and determine the level of agreement between the two tests.Methods:A cross-sectional study was done on 5- to 18-year-old school-children wearing spectacles for at least 1-month duration. Visual acuity was assessed using Snellen’s visual acuity chart, and their spectacle correction being used currently was measured using an auto lensmeter. The level of stereopsis was assessed using Randot and Titmus fly stereo tests. Data were entered using Microsoft Excel and analyzed using IBM-SPSS version 20, Chicago, IL. The associations between stereopsis and type of refractive error, visual acuity, age, and gender were analyzed. An agreement between Randot and Titmus fly test was done using Kappa statistics.Results:A total of 222 children (101 boys and 121 girls; mean age 13 years) were assessed. Astigmatism was the most prevalent refractive error (60.4%), followed by myopia (24.8%) and hypermetropia (1.4%). Thirty children (13.5%) had anisometropia. All hyperopes had normal stereopsis. Children with spherical myopia had better stereopsis, followed by astigmatism and anisometropia in the same order (P = 0.036). Children with anisometropia ≤1.5 D had better stereopsis than anisometropia more than 1.5 D. Stereopsis was also found to have no correlation with the age and visual acuity at the time of testing or the age at which the child first started wearing spectacles. Stereopsis values obtained from Randot and Titmus fly stereo tests showed moderate agreement with Kappa value 0.581.Conclusion:Anisometropia and astigmatism are the most critical factors determining the level of stereopsis in refractive errors.     

不同程度近视性屈光参差患者双眼间调节参数的差异性分析

目的：探讨近视性屈光参差患者双眼间调节力差异与屈光参差程度间的关系。方法：横断面研究。收集2019年11月至2021年6月在山东第一医科大学附属青岛眼科医院就诊的近视患者123例（246眼），年龄8~21岁。根据双眼间等效球镜度（SE）差值分为屈光不正组（SE差值≤0.25D）29例、低度屈光参差组（1.00D≤SE差值<2.50D）62例及高度屈光参差组（SE差值≥2.50D）32例3组。所有患者符合双眼最佳矫正视力（BCVA）≥0.8且各项原始数据较为完善。使用综合验光仪测量3组患者的单眼调节幅度（AMP）、单、双眼负相对调节（NRA）、正相对调节（PRA）、调节反应（AR）及调节灵活度（AF）在睫状肌麻痹下验光后确定双眼间屈光度数，分析3组间双眼调节相关参数及单眼调节参数差差值（双眼间调节参数差值＝近视屈光度较高眼调节数值-近视屈光度较低眼调节数值）之间的差异。对3组间调节参数比较采用单因素方差分析；对屈光参差程度与双眼调节参数值及双眼间调节参数差值间的关系分析选择Spearman相关分析。结果：3组间双眼NRA、PRA、AR、AF值及单眼间NRA、AF差值比较差异均无统计学意义。3组AR差值分别为-0.03±0.25、0.20±0.30、0.26±0.36，差异有统计学意义（F=7.36，P<0.001）；3组PRA差值分别为0.04±0.27、0.34±0.72、0.66±0.63，差异有统计学意义（W=7.47，P<0.001）；3组AMP差值分别为0.41±0.86、-1.07±1.53、-1.02±2.18，差异有统计学意义（W=9.25，P<0.001）。事后多重比较显示，屈光不正组与低度屈光参差组和高度屈光参差的AR差值、PRA差值、AMP差值比较差异均有统计学意义（均P<0.05）。相关性分析显示，SE差值与AR差值、AMP差值存在低强度的正相关性（r=0.22，P=0.014；r=0.36，P<0.001）。结论：不同程度近视性屈光参差患者双眼间调节参数差值不同，且双眼间AR差值、AMP差值与双眼间屈光度差异程度存在一定相关性。     

Distribution of refractive error in healthy infants

PURPOSE: Few data exist regarding the upper limits of refractive error distributions in healthy infants; the data that do exist are biased because they were selected from the records of pediatric ophthalmology practices. We sought to obtain these data to validate examination failure criteria for vision screening. METHODS: We reviewed records from all children age birth to 5 years seen at the Tennessee Lions Eye Center at Vanderbilt Children's Hospital with a billing diagnosis of nasolacrimal duct obstruction and no comorbid ocular diagnoses except for refractive error. This was to avoid referral bias for any condition that could have influenced refractive error. All patients received a complete eye examination and cycloplegic refraction. Cumulative probability distribution (CPD) plots and means for spherical and cylindrical refractive error and anisometropia were prepared. RESULTS: One hundred thirty patients were studied; mean age was 15.5 +/- 9.9 months (range, 2 days to 66 months). The mean refractive error (spherical equivalent) was +1.4 D +/- 1.1 D. CPD plot analysis showed 95% of hyperopia to be < +3.25 D. Two children had myopia +1.00 D in one eye. CPD plot analysis showed 95% of astigmatism to be < +1.50 D and 95% of meridional anisometropia to be < 1.50 D. Six children had anisometropia >/=1.50 D, and 3 children had anisometropia > 3.00 D. CONCLUSIONS: At least 95% of children have hyperopia < +3.25 D, astigmatism < +1.50 D, and anisometropia < 1.50 D. This information will prove useful in identifying the natural history and prevalence of amblyogenic factors identified during preschool vision screening.