481例6周龄婴儿屈光状态的筛查及其检测结果的临床研究
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摘要
目的探讨6周龄婴儿的屈光状态及影响因素,评价使用SureSight视力筛查仪对低龄婴儿进行屈光筛查的可行性和有效性。方法本研究为回顾性研究。收集2015年4月至2016年8月在首都医科大学附属北京同仁医院出生的481例(962只眼)婴儿的病例资料。所有婴儿均于出生后6周龄左右时使用SureSight视力筛查仪进行屈光检查,其中对超出视力筛查仪测量范围的婴儿采用视网膜检影法检查。同时收集婴儿出生时的基本情况,包括出生体重、出生身长、性别、眼别、分娩方式、是否早产以及父母是否有高度近视眼。采用Pearson相关系数分析出生体重、出生身长和屈光状态之间的关系,采用独立样本t检验比较眼别、性别、分娩方式、足月儿和早产儿之间等效球镜度的差异。结果 481例(962只眼)婴儿中,共有16例(32只眼),占3.3%,超出SureSight视力筛查仪检测范围。除1例(1只眼)因玻璃体积血使用视网膜检影法亦无法测出结果外,其余480例(961只眼)眼等效球镜度为(+3.632±1.272) D,最大值为+8.00 D,最小值为-3.25 D。其中,有9例(11只眼)小于0 D,5例(10只眼)大于+6.00 D。出生体重和出生身长与等效球镜度之间均无相关性(r=-0.017,-0.003;P>0.05)。男婴和女婴等效球镜度分别为(+3.568±1.334) D和(+3.704±1.196) D;右眼和左眼等效球镜度分别为(+3.631±1.273) D和(+3.634±1.272) D;剖宫产和顺产等效球镜度分别为(+3.711±1.194) D和(+3.574±1.325) D;足月儿和早产儿等效球镜度分别为(+3.634±1.276) D和(+3.599±1.255) D;眼别、性别、分娩方式、足月儿和早产儿之间等效球镜度的差异无统计学意义(t=-1.656, 0.038,-1.662, 0.348;P>0.05)。有高度近视眼家族史和无高度近视眼家族史的婴儿眼等效球镜度分别为(+3.346±1.214) D和(+3.689±1.276) D。有高度近视眼家族史的婴儿眼等效球镜度低于无高度近视眼家族史的婴儿,差异有统计学意义(t=-3.112,P<0.05)。结论 6周龄婴儿屈光状态以远视为主,屈光状态与父母是否有高度近视眼有关,与出生体重、出生身长、性别、眼别、分娩方式及是否早产无关。使用SureSight视力筛查仪对婴儿进行屈光筛查方便有效,有助于早期监测和干预婴儿的视力发育。
Objective The aim of this study was to investigate refractive status of infants at 6-week-old and evaluate feasibility and effectiveness of using SureSight vision screener to screen infants′ refractive status. Methods A retrospective research involved 481 infants(962 eyes) who were born in Beijing Tongren Hospital from Apr. 2015 to Aug. 2016. Infants aged 6 weeks around were underwent refractive screening using SureSight vision screener. Retinoscopy optometry were applied when refractive value were exceeded the measurement range of the equipment. Basic information of newborns was collected, including birth weight, birth length, gender, laterality, delivery methods, pre-term or not, and family history of high myopia. Results Among of 481 infants(962 eyes), refractive power cannot be measured in 16 infants(32 eyes, 3.3%) using SureSight vision screener. One infant(1 eye) with vitreous hemorrhage cannot be detected either by SureSight vision screener or by retinoscopy optometry. The rest of 480 infants(961 eyes) were included. Spherical equivalent power was(+3.632±1.272) D. The maximum power was +8.00 D and the minimal power was-3. 25 D. Nine infants( 11 eyes) were under 0 D and 5 infants( 10 eyes) were more than + 6. 00 D. Spherical equivalent power did not related to birth weight or birth length( r =-0. 017,-0. 003; P > 0. 05). Spherical equivalent power of male and female infants were( + 3. 568± 1. 334) D and( + 3. 704 ± 1. 196) D; spherical equivalent power of right and left eyes of infants were( + 3. 631 ± 1. 273) D and( + 3. 634 ± 1. 272) D; spherical equivalent power of spontaneous labor and cesarean section infants were( + 3. 711 ± 1. 194) D and( + 3. 574 ± 1. 325) D; spherical equivalent power of premature and mature infants were( + 3. 634 ± 1. 276) D and( + 3. 599 ± 1. 255) D. There were no statistically differences in spherical equivalent between right and left eyes,male and female,spontaneous labor and cesarean section,premature and mature infants( t =-1. 656,0. 038,-1. 662,0. 348; P >0. 05). Spherical equivalent powers of family high myopia history and without family history infants were( + 3. 346 ± 1. 214) D and( + 3. 689 ± 1. 276) D. Spherical equivalent powers were lower in infants with family high myopia history than those without family history( t =-3. 112,P < 0. 05). Conclusions Most infants at 6-week-old were hyperopia. Refractive status was related to family history of high myopia,and was not related to birth weight,birth length,gender,laterality,delivery mode,or premature. Using SureS ight vision screener for infants refraction screening is convenient and effective,which can help to monitor and intervene vision development at an early age.
Objective The aim of this study was to investigate refractive status of infants at 6-week-old and evaluate feasibility and effectiveness of using SureSight vision screener to screen infants′ refractive status. Methods A retrospective research involved 481 infants(962 eyes) who were born in Beijing Tongren Hospital from Apr. 2015 to Aug. 2016. Infants aged 6 weeks around were underwent refractive screening using SureSight vision screener. Retinoscopy optometry were applied when refractive value were exceeded the measurement range of the equipment. Basic information of newborns was collected, including birth weight, birth length, gender, laterality, delivery methods, pre-term or not, and family history of high myopia. Results Among of 481 infants(962 eyes), refractive power cannot be measured in 16 infants(32 eyes, 3.3%) using SureSight vision screener. One infant(1 eye) with vitreous hemorrhage cannot be detected either by SureSight vision screener or by retinoscopy optometry. The rest of 480 infants(961 eyes) were included. Spherical equivalent power was(+3.632±1.272) D. The maximum power was +8.00 D and the minimal power was-3. 25 D. Nine infants( 11 eyes) were under 0 D and 5 infants( 10 eyes) were more than + 6. 00 D. Spherical equivalent power did not related to birth weight or birth length( r =-0. 017,-0. 003; P > 0. 05). Spherical equivalent power of male and female infants were( + 3. 568± 1. 334) D and( + 3. 704 ± 1. 196) D; spherical equivalent power of right and left eyes of infants were( + 3. 631 ± 1. 273) D and( + 3. 634 ± 1. 272) D; spherical equivalent power of spontaneous labor and cesarean section infants were( + 3. 711 ± 1. 194) D and( + 3. 574 ± 1. 325) D; spherical equivalent power of premature and mature infants were( + 3. 634 ± 1. 276) D and( + 3. 599 ± 1. 255) D. There were no statistically differences in spherical equivalent between right and left eyes,male and female,spontaneous labor and cesarean section,premature and mature infants( t =-1. 656,0. 038,-1. 662,0. 348; P >0. 05). Spherical equivalent powers of family high myopia history and without family history infants were( + 3. 346 ± 1. 214) D and( + 3. 689 ± 1. 276) D. Spherical equivalent powers were lower in infants with family high myopia history than those without family history( t =-3. 112,P < 0. 05). Conclusions Most infants at 6-week-old were hyperopia. Refractive status was related to family history of high myopia,and was not related to birth weight,birth length,gender,laterality,delivery mode,or premature. Using SureS ight vision screener for infants refraction screening is convenient and effective,which can help to monitor and intervene vision development at an early age.
引文
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[26] 褚仁远,赵家良.儿童青少年屈光不正诊治应以睫状肌麻痹下验光结果为基准[J].中华眼科杂志,2019,55(2):86-88.
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[2] Wen G,Tarczy-Hornoch K,McKean-Cowdin R,et al.Prevalence of myopia,hyperopia,and astigmatism in non-Hispanic white and Asian children:multi-ethnic pediatric eye disease study[J].Ophthalmology,2013,120(10):2109-2116.
[3] Dirani M,Chan YH,Gazzard G,et al.Prevalence of refractive error in Singaporean Chinese children:the strabismus,amblyopia,and refractive error in young Singaporean Children(STARS) study[J].Invest Ophthalmol Vis Sci,2010,51(3):1348-1355.
[4] 汪芳润.近视眼研究的现状与存在问题[J].中华眼科杂志,2003,39(6):381-383.
[5] Matsumura H,Hirai H.Prevalence of myopia and refractive changes in students from 3 to 17 years of age[J].Surv Ophthalmol,1999,44 Suppl 1:S109-S115.
[6] Fan DS,Lam DS,Lam RF,et al.Prevalence,incidence,and progression of myopia of school children in Hong Kong[J].Invest Ophthalmol Vis Sci,2004,45(4):1071-1075.
[7] Singh NK,James RM,Yadav A,et al.Prevalence of Myopia and Associated Risk Factors in Schoolchildren in North India[J].Optom Vis Sci,2019,96(3):200-205.
[8] Harrington SC,Stack J,O′Dwyer V.Risk factors associated with myopia in schoolchildren in Ireland[J].Br J Ophthalmol,2019.pii:bjophthalmol-2018-313325.
[9] French AN,Morgan IG,Burlutsky G,et al.Prevalence and 5-to 6-year incidence and progression of myopia and hyperopia in Australian schoolchildren[J].Ophthalmology,2013,120(7):1482-1491.
[10] Zadnik K.The Glenn A.Fry Award Lecture(1995).Myopia development in childhood[J].Optom Vis Sci,1997,74(8):603-608.
[11] He M,Zeng J,Liu Y,et al.Refractive error and visual impairment in urban children in southern China[J].Invest Ophthalmol Vis Sci,2004,45(3):793-799.
[12] Ip JM,Huynh SC,Robaei D,et al.Ethnic differences in refraction and ocular biometry in a population-based sample of 11-15-year-old Australian children[J].Eye(Lond),2008,22(5):649-656.
[13] Murthy GV,Gupta SK,Ellwein LB,et al.Refractive error in children in an urban population in New Delhi[J].Invest Ophthalmol Vis Sci,2002,43(3):623-631.
[14] Sapkota YD,Adhikari BN,Pokharel GP,et al.The prevalence of visual impairment in school children of upper-middle socioeconomic status in Kathmandu[J].Ophthalmic Epidemiol,2008,15(1):17-23.
[15] Gao Z,Meng N,Muecke J,et al.Refractive error in school children in an urban and rural setting in Cambodia[J].Ophthalmic Epidemiol,2012,19(1):16-22.
[16] 董彦会,刘慧彬,王政和,等.2005—2014年中国7～18岁儿童青少年近视流行状况与变化趋势[J].中华预防医学杂志,2017,51(4):285-289.
[17] 黄立红,顾芳.摄影验光法在学龄前儿童弱视普查中的意义[J].中国斜视与小儿眼科杂志,2001,9(4):177-179.
[18] 张佩斌,杨翎,吴海霞,等.学龄前儿童17129例视力筛查结果分析[J].中国儿童保健杂志,2016,24(8):856-858.
[19] 曹敏辉,杨夏敏,安琪,等.莫廷视力筛查仪对264例婴幼儿视力屈光参数纵向监测的结果分析[J].中国儿童保健杂志,2016,24(10):1073-1076.
[20] 赵堪兴,史学锋.重视婴幼儿视力异常的筛查[J].中华眼科杂志,2013,49(7):577-579.
[21] 袁莉萍.小瞳视网膜检影在学龄前儿童屈光不正筛查中的使用[J].浙江临床医学,2018,20(9):1573-1574.
[22] 李丽红,许江涛.视网膜检影镜在儿童眼屈光状态评估中的应用[J].中华全科医师杂志,2007,6(9):572-573.
[23] Adams RJ,Dalton SM,Murphy AM,et al.Testing young infants with the Welch Allyn SureSight non-cycloplegic autorefractor[J].Ophthalmic Physiol Opt,2002,22(6):546-551.
[24] Büchner TF,Schnorbus U,Grenzebach UH,et al.Examination of preschool children for refractive errors.First experience using a handheld autorefrator[J].Ophthalmologe,2003,100(11):971-978.
[25] 童梅玲,张桂英,吴兴香,等.Suresight手持式自动验光仪检测婴幼儿屈光状态对早期弱视筛查价值的探讨[J].中国儿童保健杂志,2007,15(5):474-475.
[26] 褚仁远,赵家良.儿童青少年屈光不正诊治应以睫状肌麻痹下验光结果为基准[J].中华眼科杂志,2019,55(2):86-88.
[27] 中华医学会眼科学分会斜视与小儿眼科学组.中国儿童睫状肌麻痹验光及安全用药专家共识(2019年)[J].中华眼科杂志,2019,55(1):7-12.
[28] Edwards M.The refractive status of Hong Kong Chinese infants[J].Ophthalmic Physiol Opt,1991,11(4):297-303.
[29] Kuo A,Sinatra RB,Donahue SP.Distribution of refractive error in healthy infants[J].J AAPOS,2003,7(3):174-177.
[30] 陈洁.0—3岁婴幼儿屈光状态发展规律的研究[D].温州:温州医学院,2012:10-12.
[31] 唐忠鲁,郝小波,王桂红,等.571例新生儿屈光状态分析[J].中国实用眼科杂志,1994,12(11):668-670.
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