摘要
目的分析儿童青少年常见快速视力筛查方法的准确性,探讨视力筛查的最佳方案。方法选取2021年云南省3个市/县各2所小学2~4年级学生进行标准对数视力表远视力筛查、非睫状肌麻痹下使用电脑验光仪验光,对裸眼视力<5.0或电脑验光等效球镜(SE)≤-0.50D且未佩戴眼镜无眼病的168名(336只眼)小学生进行散瞳获得散瞳后屈光度,作为屈光度金标准,比较散瞳前和散瞳后的电脑验光屈光度。依据远视力检查和电脑验光仪验光结果,按照以下4种方案分析比较近视患病率、灵敏度、特异度及约登指数。4种方案分别是:单独满足裸眼视力<5.0即为近视和电脑验光仪验光等效球镜(SE)≤-0.50D即为近视的2个方案,及同时满足2个条件及满足2个条件之一的2个方案。结果与散瞳前比较,散瞳后屈光度右眼从(-1.34±1.15)下降到(-0.85±1.06)、左眼从(-1.12±1.15)下降到(-0.61±1.29),差异均有统计学意义(t=5.91、7.89,均P<0.05)。睫状肌麻痹后出现大量的假性近视,右眼电脑验光后近视146只眼,假性近视29只眼,混合性近视32只眼,左眼假性近视性率为19.86%,混合性近视率为21.92%;左眼睫状肌麻痹电脑验光后近视135只眼,假性近视31只眼,混合近视21只眼,左眼假性近视率为22.96%,混合性近视率为15.56%。金标准即睫状肌麻痹后的电脑验光,近视221只眼,近视率为65.8%,方案一、方案二、方案三及方案四近视率分别为91.1%(306只眼)、83.0%(279只眼)、80.1%(269只眼)及94.6%(318只眼),其中方案三最接近于金标准,方案四中近视率最高。4种方案与金标准比较,差异均有统计学意义(χ^(2)=51.12、111.65、132.95及25.24,均P<0.05)。4种方法的灵敏度均较高,均高于98.0%;4种方法的特异度均较低。方案三的阳性预测值和阴性预测值分别为80.7%和94.0%,与金标准比较,约登指数在4种方案中最高,即方案三准确性最高。结论目前未散瞳的快速筛查方法对近视患病率存在一定程度高估,但是当不具备散瞳条件时,可以结合远视力筛查和电脑验光,提高视力筛查方案准确性。
Objective To analyze the accuracy of common rapid vision screening methods for children and adolescents,and explore the best vision screening program.Methods In 2021,students from grade 2 to grade 4 of two primary schools in three cities/counties in Yunnan Province were selected for standard logarithmic visual acuity screening,and computer optometry was used for optometry without cili-ary muscle paralysis.168 pupils(336 eyes)with naked eye vision<5.0 or computer optometry equivalent spherical lens(SE)≤-0.50D and no eye disease without glasses were dilated to obtain post-mydriasis diopter,which was used as the gold standard of diopter.The comput-er optometry diopter before and after mydriasis was compared.The prevalence,sensitivity,specificity and Yoden index of myopia were ana-lyzed and compared according to the results of far-vision examination and computer optometry.The four schemes are respectively:two schemes that meet the naked eye vision<5.O,namely myopia,and two schemes that meet the two conditions and one of the two conditions simultaneously.Results Compared with that before mydriasis,the diopter of the right eye decreased from(-1.34±1.15)to(-0.85±1.06)after mydriasis,and that of the left eye decreased from(-1.12±1.15)to(-0.61±1.29).The difference was statistically signifi-cant(t=5.91,7.89,all P<0.05).A large number of pseudomyopia appeared after cycloplegia.146 eyes were pseudomyopia after com-puter optometry in the right eye,29 eyes were pseudomyopia,32 eyes were mixed myopia,the rate of pseudomyopia in the left eye was 19.86%,and the rate of mixed myopia was 21.92%;After computer optometry,135 eyes were myopia,31 eyes were pseudomyopia,and 21 eyes were mixed myopia.The rate of pseudomyopia in the left eye was 22.96%,and the rate of mixed myopia was 15.56%.The golden standard refers to computer optometry after cycloplegia.221 eyes are nearsighted,with a myopia rate of 65.8%.The myopia rates of scheme 1,scheme 2,scheme 3 and scheme 4 are 91.1%(306 eyes),83.0%(279 eyes),80.1%(269 eyes)and 94.6%(318 eyes),re-spectively.Scheme 3 is the closest to the golden standard,and scheme 4 has the highest myopia rate.The difference between the four schemes and the gold standard is statistically significant(X^(2)=51.12,111.65,132.95 and 25.24,all P<0.05).The sensitivity of the four methods is higher than 98.0%;The specificity of the four methods is low.The positive predictive value and negative predictive value of scheme 3 are 80.7%and 94.0%respectively.Compared with the gold standard,the Yoden index is the highest among the four schemes,that is,scheme 3 has the highest accuracy.Conclusion At present,the rapid screening method without mydriasis overestimates the prevalence of myopia to a certain extent,but when the condition for mydriasis is not available,the accuracy of vision screening program can be improved by combining distant vision screening and computer optometry.
作者
马子雪
常利涛
谢雪妮
张金娇
黄达峰
李茜茜
肖洁
罗筱
黄莹
MA Zi-xue;CHANG Li-tao;XIE Xue-ni;ZHANG Jin-jiao;HUANG Da-feng;LI XI-xi;XIAO jie;LUO Xiao;HUANG Ying(School of Public Health,Kunming Medical University,Kunming,Yunnan 650500,China)
出处
《中国妇幼保健》
CAS
2023年第12期2172-2176,共5页
Maternal and Child Health Care of China
基金
国家自然科学基金项目(81960593)。
关键词
视力筛查
散瞳
金标准
假性近视
Vision screening
Mydriasis
Gold standard
Pseudomyopia
