摘要
目的比较几种常用小学生近视筛查方法(裸眼远视力、小瞳孔电脑验光、轴率比、散瞳验光)评估近视的准确性,提出适合于群体近视筛查的视觉指标。设计以人群为基础的横断面研究。研究对象以河北省肃宁县学区小学生为研究对象,发放《散瞳验光知情同意书》,签字同意并排除眼病后共计232例学生,年龄6～12岁,男性123例,女性109例。方法采用标准对数视力表测量裸眼远视力(UCDVA),低于1.0为视力不良;采用电脑验光仪(日产RM-8000)进行小瞳孔验光,≤-0.50 D为近视阳性界值;相干光生物测量仪(IOL Master)测量眼轴及角膜曲率,计算轴率比(眼轴/平均角膜曲率半径,AL/CR),>3为可疑近视。采用1%盐酸环喷脱酯点眼行睫状肌麻痹,瞳孔充分散大后行电脑验光,以等效球镜≤-0.50 D为近视诊断标准,并与散瞳验光结果比较,分析各方法在群体近视筛查中的灵敏度、特异度和Youden指数,评估其诊断近视的准确性。主要指标UCDVA、小瞳孔下屈光度、AL/CR与散瞳后屈光度相比对诊断近视的灵敏度、特异度、Youden指数。结果裸眼远视力筛查近视的灵敏度为86.8%,特异度为59.3%,Youden指数为0.46;小瞳孔验光筛查近视的灵敏度为94.3%,特异度为66.6%,Youden指数为0.61。轴率比筛查近视的灵敏度为90.6%,特异度为81.3%,Youden指数为0.72。结论在散瞳验光难以实施的大规模小学生近视筛查中,轴率比是一个相对客观、准确的评估指标。
Objective To compare the accuracy of common visual indexes, uncorrected distant visual acuity （UCDVA）, axial length/mean corneal redius （AL/CR）, refractive state with cycloplegia and non-cycloplegia in school-age large sample myopia for screening, and to put forward a suitable method to replace cycloplegic refractometry. Design Cross-sectional study based on school-age children. Participants School-age children in Suning Country, Hebei Province were selected. Those students who had the informed consent and had no ocular diseases took part in this study. There were 232 children （123 boys and 109 girls）, aging from 6 to 12 years old enrolled. Methods All the students received examinations including UCDVA with standard logarithmic visual acuity chart, 〈0.9 defined as visual impairment; axial length （AL） and corneal redius （CR） with Optical coherence biological measuring instrument （IOL Master）, AL/CR〉3 defined as suspicious of myopia; refractometry with automatic refractor （Nissan RM-8000） both in the condition of cycloplegia and non-cycloplegia（≤0.50 D defined as myopia）. 1% cyclopentolate was applied for cycloplegic refraction. The sensitivity, specificity and Youden index of each method was analyzed using the cycoplegic refractometry as gold standard. Main Outcome Measures UCDVA, AL/CR, diopter by refraction with cycloplegia and non-cycloplegia; sensitivity, specificity and Youden index. Results The sensitivity, specificity and Youden Index of UCDVA and non-cycloplegic refractometry in myopia screening was 86.8%, 59.3%, 0.46, and was 94.3%, 66.6%, 0.61 respectively, while those of AL/CR were 90.6%, 81.3%, and 0.72. Conclusion In a large-scale myopia screening, AL/CR could be used as an effective and accurate method instead of cycolplegic refractometry.
出处
《眼科》
CAS
2012年第5期327-330,共4页
Ophthalmology in China
