基于非散瞳验光结果评价儿童青少年近视风险的研究

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摘要目的通过分析山东某县中小学生屈光检查数据,获得单纯依据等效球镜度数预测儿童青少年近视风险的参考界值,为预测近视发生及进展、开展近视防控提供科学依据。方法 2019年3—5月山东某县对全县中小学生开展了标准化视力普查,视力检查工具包括标准对数视力表和自动电脑验光仪,检查内容包括裸眼远视力、球镜度数和柱镜度数等指标。参考《中小学生屈光不正筛查规范》,本研究将近视定义为:受检学生任意一侧眼的裸眼远视力低于5.0,且在非散瞳状态下等效球镜度数<-0.500 D。本研究在描述年龄别近视患病率的基础上,假定调查对象等效球镜度数在相应年龄组所处百分位数随时间推移维持相对稳定,据此获得标识各年龄组近视发生及进展风险的等效球镜度数参考界值。结果研究共纳入43 059名中小学生,小学一年级(7岁)近视患病率为12.9%,高中二年级(17岁)近视患病率为89.0%,其他年级患病率介于两者之间且随着年龄增加而上升。7岁学生等效球镜度数第12.9百分位数为-1.250 D、17岁学生第89.0百分位数为-1.625 D,据此可将-1.250 D和-1.625 D作为单纯依据等效球镜度数判定7岁学生和17岁学生近视的参考界值;7岁学生第89.0百分位数为0.250 D,17岁学生第12.9百分位数为-7.125 D,表明对于7岁时等效球镜度数为0.250 D的学生,到17岁时等效球镜度数可能会进展到-1.625 D,而对于7岁时等效球镜度数为-1.250 D的学生,到17岁时等效球镜度数可能会进展到-7.125 D;相应地对于7岁时等效球镜度数大于0.250 D的学生到17岁时等效球镜度数可能大于-1.625 D,即不会发生近视。根据前述规则,研究给出了标识7~17岁学生近视发生及进展风险的等效球镜度数参考界值并绘制了相应的等效球镜度数演化曲线。结论研究地区中小学生近视患病率随年级升高而升高,本研究给出了标识7~17岁学生近视发生及进展风险的等效球镜度数参考界值并绘制了相应的等效球镜度数演化曲线,预期能为科学预测近视的发生及进展、针对高危群体开展近视防控提供参考依据。

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	张丁元
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	李宏田
	张勇
	刘建蒙

关键词 ：儿童青少年, 近视, 非散瞳验光, 风险预测

Abstract：Objective To obtain reference cut-off values for predicting the risk and progression of myopia based on noncycloplegic refraction among primary and secondary students in a county in Shandong province of China. Methods A standardized visual acuity screening was conducted among primary and secondary students in a county in Shandong province from March to May 2019(Third grade high school students and some fourth grade middle school students did not participate in the screening) by using a standard logarithmic visual acuity chart(LogMAR) and an automatic computerized optometry, in which uncorrected visual acuity and the spherical and cylindrical indicators were collected. Myopia was defined as an uncorrected visual acuity less than 5.0 and spherical equivalent refraction <-0.500 D under the noncycloplegic state in either eye according to the national standard of China for screening ametropia among primary and secondary students. Based on the age-specific prevalence of myopia and the quantile distribution of the spherical equivalent refraction in the corresponding age group, a reference cut-off value of the spherical equivalent refraction for identifying the onset and progression of myopia in each age group was obtained with the assumption that the quantile distribution of the spherical equivalent refraction remained relatively stable over time. Results A total of 43,059 primary and secondary students were involved in the study, including 22,570(52.4%) boys and 20,489(47.6%) girls. The prevalence of myopia was 12.9% among the first grade primary school students(age 7), which increased linearly with age and reached 89.0% among the second grade high school students(age 17). The corresponding 12.9^th percentile of spherical equivalent refraction for the 7-year-olds was -1.250 D and the 89.0^th percentile for the 17-year-olds was -1.625 D. As a result, the values -1.250 D and -1.625 D could be used as the reference cut-off values for determining myopia for 7-year-olds and 17-year-olds, respectively, if myopia was determined solely based on spherical equivalent refraction. The 89.0^th percentile of 7-year-old students was 0.250 D and the 12.9^th percentile of 17-year-old students was -7.125 D, indicating that a spherical equivalent refraction of 0.250 D at age 7 would progress to -1.625 D by age 17, while a spherical equivalent refraction of -1.250 D at age 7 would progress to -7.125 D by age 17. Similarly, for students with spherical equivalent refraction greater than 0.250 D at age 7, the spherical equivalent refraction may be greater than -1.625 D by age 17, i.e., myopia would not occur by age 17. Following this principle, reference cut-off values on the spherical equivalent refraction for identifying the risk of myopia onset and progression in students aged 7 to 17 years were provided and the corresponding spherical equivalent refraction progression curve was plotted. Conclusions The study obtained the reference cut-off values of spherical equivalent refraction for the assessment of myopia risk in students aged 7-17 years, which may be used a tool for predicting the onset and progression of myopia to facilitate health education on the prevention and control of myopia.

Key words： children and adolescents myopia noncycloplegic refraction risk prediction

收稿日期: 2022-04-10

ZTFLH:

R17

基金资助:中央高校基本科研业务费资助(BMU2021RCZX029)

通讯作者: 李宏田(lihongtian@pku.edu.cn);穆英超(1319094858@qq.com)

引用本文:

张丁元, 穆英超, 程志浩, 任浩然, 封康, 李宏田, 张勇, 刘建蒙. 基于非散瞳验光结果评价儿童青少年近视风险的研究[J]. 中国生育健康杂志, 2023, 34(5): 433-439. ZHANG Dingyuan, MU Yingchao, CHENG Zhihao, REN Haoran, FENG Kang, LI Hongtian, ZHANG Yong, LIU Jianmeng. Study on the evaluation of risks of myopia in children and adolescents based on noncycloplegic refraction. Chinese Journal of Reproductive Health, 2023, 34(5): 433-439.

链接本文:

http://cjrh.bjmu.edu.cn/CN/ 或 http://cjrh.bjmu.edu.cn/CN/Y2023/V34/I5/433

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