可调节度数眼镜验光与传统验光法在社区老年人眼保健中的应用比较

背景 中国老年人屈光不正矫正需求巨大,亟待寻求适宜的新型屈光不正矫正技术. 目的 探讨可调节度数眼镜作为验光和矫正视力的方法应用于社区老年人初级眼保健筛查的可行性. 方法 采取前瞻性横断面研究方法,在上海市普陀区白玉社区6个居委会55岁以上老年人初级眼保健筛查现场用ETDRS LogMAR视力表检查视力,纳入任一眼日常生活视力＜0.5的受检者作为调查对象,进行自主可调节度数眼镜（Eyejusters眼镜）验光和矫正视力检查,并由专业视光医师行传统电脑自动验光和主觉验光法矫正视力,与Eyejusters眼镜验光和矫正视力结果进行比较.对纳入的受检者进行眼科检查,确定影响视力的原因;对自主调节验光矫正视力低于主觉验光最佳矫正视力（BCVA）2行及以上的影响因素进行分析.结果 参加社区日常生活视力检查者727人,日常生活视力任一眼＜0.5者338人,其中自愿验光者294人,占87.0％,平均年龄（70.4±177;8.6）岁,女性占64.3％.日常生活视力较好眼≥0.5者145人,占49.3％,经自主调节验光和主觉验光矫正视力后,人数分别增至230人（占78.2％）和258人（占87.8％）.日常生活视力＜0.5的443眼中,自主调节验光矫正视力≥主觉验光矫正视力的眼数为233眼（占52.6％）,低于1行的眼数为82眼（占18.5％）,低于2行及以上的眼数为128眼（占28.9％）.Logistic回归分析发现,自主调节验光矫正视力低于主觉验光2行及以上的影响因素为相对高的球镜和柱镜度数的绝对值,OR值分别为1.11 （95％ CI：1.02 ～1.20）和1.34（95％ CI：1.02 ～ 1.77）.自主调节验光矫正视力作为视力损伤判定指标的受试者工作特征（ROC）曲线下面积为0.941 （95％ CI：0.907 ～0.965）,最佳阳性界值为＜0.5,灵敏度为94.4％ （95％ CI：81.3％ ～99.2％）,特异度为88.4％ （95％ CI：83.8％ ～92.0％）.在自主可调节眼镜屈光范围内（自动电脑验光SE为-5.50～＋4.50 D）自主调节验光与主觉验光所得SE的Spearman相关系数为0.68（95％CI：0.59～0.76）,Bland-Altman分析发现,两者95％一致性界限为-3.4～＋2.6 D,相差幅度±0.50 D以内者占18.1％,相差±1.00 D以内者占47.0％,相差在±1.50D以内者占68.5％. 结论 老年人采用可调节度数眼镜矫正视力的结果可作为定性判定未矫正屈光不正简便、易行的指标,但可调节度数眼镜尚不宜作为验光工具定量检测屈光度.

Comparison of adjustable spectacles and traditional optometry for elderly refractive correction in community-based primary eye care service

Background There is a large amount of elderly population with uncorrected refractive error in China.To seek a new and suitable correction technology is very urgent for public health.Objective This survey was to investigate the feasibility of adjustable spectacles for optometry and vision correction in community-based eye disease screening.Methods A prospective cross-sectional survey was performed.Random cluster sampling 6 blocks were included from 13 blocks in Baiyu community Putuo district of Shanghai eye disease screening site.The subjects with visual acuity （ETDRS LogMAR） 〈0.5 of either eye was included in the survey,and visual acuity was corrected with adjustable spectacles by trained volunteers,the corrected vision and optometry results were compared with ones of traditional autorefraction and subjective optometry procedure conducted by opometrists.General eye examinations were performed on the subjects to determine the causes of low visual acuity,and the affecting factors were analyzed.Writen informed consent was obtained from each subject prior to any medical examination.Results The optometry examination was carried out in 294 participants with the mean age of （70.4±8.6） years,and female were 64.3%.The subjects with visual acuity ≥ 0.5 in the better eye were 145 （49.3%）.After self correction with adjustable spectacles and traditional subjective optometry procedure,the number of subjects with visual acuity ≥ 0.5 increased to 230 （78.2%） and 258 （87.8%）,respectively.In 443 eyes with visual acuity 〈0.5,233 （52.6%） eyes had a better or equal vision after self correction in comparison with subjective optometry,and 82 eyes （18.5%） had a worse vision with one-line decline of eye chart.Logistic regression analysis revealed that relatively high spherical （high myopia,hyperopia） and cylinder （astigmatism） degrees were responsible for the eyes of vision being worse two or more lines of eye chart after self correction than that of subjective optometry （OR =1.11,95% CI：1.02-1.20 ; OR=1.34,95% CI：1.02-1.77）.When self correction vision result was used as diagnosing indicator for visual impairment,the area under the ROC curve was 0.941 （95% CI：0.907-0.965）,with the best positive value 〈0.5,sensitivity 94.4% （95% CI：81.3%-99.2%） and specificity 88.4% （95% CI：83.8%-92.0%）.The self correction diopter ranged from-5.63 D to ＋4.13 D,and those of subjective optometry and autorefraction were from -22.25 D to ＋ 10.25 D and from-22.00 D to ＋ 5.63 D,respectively,showing a statistically significant difference between them（P〈0.001）.In range of self correction （-5.50 D to ＋4.50 D）,the spherical equivalent showed a positive correlation between self correction and subjective optometry （r =0.68,95% CI：0.59-0.76）.Bland-Altman analysis showed that 95% agreement limits between the two results was from-3.4 D to ＋2.6 D with the difference within ±0.50 D in 18.1% subjects,within ±1.00 D in 47.0% subjects,within ±1.50 D in 68.5% subjects.Conclusions In the old population,the self correction spectacles for visual acuity is a simple indicator for determination of uncorrected refractive error and eye disease screening,but it is uncompatible for a quantitative determination of diopter.