屈光相对安全儿童青少年裸眼视力生长曲线研究

  目的  分析3~18岁屈光相对安全范围儿童青少年裸眼视力分布，为研制不同年龄段儿童青少年裸眼视力的生长曲线和参考值范围、制定视力异常转诊界值提供参考。  方法  通过整群抽样的方法，选取上海市9 146名3~18岁儿童青少年进行裸眼视力、散瞳验光、裂隙灯等眼科检查，采用LMS法拟合屈光相对安全范围儿童青少年裸眼视力的百分位数和生长曲线，同时分析各年龄组裸眼视力筛查屈光异常的ROC曲线下面积及不同界值的灵敏度和特异度。  结果  儿童青少年裸眼视力呈偏态分布，中位数为4.8。其中屈光相对安全范围儿童青少年4 675名，裸眼视力中位数为4.9。LMS拟合曲线显示，裸眼视力在低年龄段随年龄增长而提高，6~10岁时逐渐稳定至最佳水平。P₅₀在3~4岁为4.8，5~8岁为4.9，≥9岁均为5.0。裸眼视力预测屈光异常的ROC曲线下面积随年龄的增加而提高，3岁时仅为0.55(95%CI=0.50~0.61)，12~18岁时最高0.95(95%CI=0.94~0.96)]。3~6岁以P₂₅为转诊界值时约登指数最高，7岁及以上以P₁₀为界值时约登指数最高。随着界值的增加，灵敏度提高，特异度降低。  结论  裸眼视力随年龄增长先提升，6~10岁后逐渐稳定至视力最佳水平。年龄越大，裸眼视力指标筛查屈光异常的效果越好。建议根据年龄设置儿童青少年裸眼视力异常转诊界值，各年龄段可根据筛查目的选择P₂₅~P₇₅为转诊界值。

Study on the growth curve of uncorrected visual acuity of children and adolescents with relative safe refractive range

  Objective  To analyze the distribution of uncorrected visual acuity in children and adolescents aged 3-18 years with relative safe refractive range, and to develop the growth curve and reference range of uncorrected visual acuity in children and adolescents of different ages, so as to provide reference for formulating the referral threshold for myopia screening practice.   Methods   Using cluster sampling method, 9 146 children and adolescents aged 3-18 years old in Shanghai were selected for uncorrected visual acuity, cycloplegic refraction, slit lamp and other ophthalmic examinations, and the percentiles and growth curve of uncorrected visual acuity of children and adolescents in the relative safe refractive range were fitted by LMS method. Besides, the area under the ROC curve and the sensitivity and specificity of different cut-off values were analyzed.  Results  The uncorrected visual acuity was skewed, with a median of 4.8. There were 4 675 individuals with safe refraction, the median of uncorrected visual acuity in which was 4.9. The LMS curve showed that the uncorrected visual acuity increased with age in the lower age group, and gradually stabilized to the best level at the age of 6-10. P₅₀ was 4.8 in 3-4 years old, 4.9 in 5-8 years old, 5.0 in 9 years old and above. The area under ROC curve of uncorrected visual acuity predicting refractive abnormality increased with age, with the lowest value of 0.55(95%CI=0.50-0.61) at 3 years old and the highest value of 0.95 (95%CI=0.94-0.96) at 12-18 years old. The Youden index was the highest for P₂₅ at 3-6 years old, and the highest for P₁₀ at 7 years old and above. With the increase of the cut-off value, the sensitivity increased and the specificity decreased.  Conclusion  The uncorrected visual acuity increases gradually with age, and reaches the best level after 6-10 years old. The screening effect of uncorrected visual acuity predicting refractive abnormality increased with age. It is suggested that the referral threshold of children and adolescents with abnormal uncorrected visual acuity should be set according to their ages, and P₂₅-P₇₅ can be selected according to the screening purposes.