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中华眼科医学杂志(电子版) ›› 2019, Vol. 09 ›› Issue (02) : 71 -76. doi: 10.3877/cma.j.issn.2095-2007.2019.02.002

论著

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
马燕1, 邓光达1, 麻婧1, 刘敬花1, 李松峰1, 卢海1,†()   
  1. 1. 100730　北京，首都医科大学附属北京同仁医院眼科　北京同仁眼科中心　北京市眼科学与视觉科学重点实验室
  • 收稿日期:2018-11-12 出版日期:2019-04-28
  • 通信作者: 卢海
  • 基金资助:
    首都临床特色应用研究(Z141107002514029); 首都医科大学附属北京同仁医院扬帆计划(TRZDYXZY201703)

Clinical research of screening and analysis of refractive status in 481 infants at the age of 6 weeks

Yan Ma1, Guangda Deng1, Jing Ma1, Jinghua Liu1, Songfeng Li1, Hai Lu1,†()   

  1. 1. Department of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2018-11-12 Published:2019-04-28
  • Corresponding author: Hai Lu
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引用本文：

马燕, 邓光达, 麻婧, 刘敬花, 李松峰, 卢海. 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[J]. 中华眼科医学杂志(电子版), 2019, 09(02): 71-76.

Yan Ma, Guangda Deng, Jing Ma, Jinghua Liu, Songfeng Li, Hai Lu. Clinical research of screening and analysis of refractive status in 481 infants at the age of 6 weeks[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2019, 09(02): 71-76.

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。

关键词: 婴儿, 屈光状态, 筛查, 危险因素
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 SureSight vision screener for infants refraction screening is convenient and effective, which can help to monitor and intervene vision development at an early age.

Key words: Infants, Refractive status, Screening, Risk factor
图1 婴儿屈光状态检查体位示意图　图A示检查者通过窥视孔，将十字靶对准婴儿的瞳孔中心，仪器会发出声音及灯光闪烁吸引婴儿注意。图B~D示检查时使仪器与婴儿视线保持一致，检查者和婴儿距离35 cm左右，被检查的婴儿可以取平卧位，或趴于家长肩上，或坐靠于家长怀中
图2 等效球镜度频率直方图　图示等效球镜度的分布符合正态分布，偏向于远视，峰值在+4.00 D
[1]
中华人民共和国卫生部. 儿童弱视防治技术服务规范[J]. 中国斜视与小儿眼科杂志，1994, 2(2)：49-51.
[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.
[32]
潘勇，葛军，张松，等. 低龄婴儿100例屈光状态分析[J]. 中国实用眼科杂志，2005, 33(10)：1162-1164.
[33]
Wood IC, Hodi S, Morgan L. Longitudinal change of refractive error in infants during the first year of life[J]. Eye(Lond), 1995, 9(Pt 5): 551-557.
[34]
严双琴，顾春丽，刘明芳，等. 6个月龄儿童眼屈光状况及其影响因素[J]. 中国妇幼保健，2008, 23(16)：2302-2304.
[35]
Fledelius HC. Pre-term delivery and growth of the eye. An oculometric study of eye size around term-time[J]. Acta Ophthalmol Suppl, 1992, 70(204): 10-15.
[36]
Varghese RM, Sreenivas V, Puliyel JM, et al. Refractive status at birth: its relation to newborn physical parameters at birth and gestational age[J]. PLoS One, 2009, 4(2): e4469.
[37]
Becker R, Krzizok T, Wassill H, 等. 双眼视觉功能缺乏的患者体位对眼球旋转位的影响[J]. 世界核心医学期刊文摘：眼科学分册，2006(6)：30-31.
[38]
French AN, Morgan IG, Mitchell P, et al. Risk factors for incident myopia in Australian schoolchildren: the Sydney adolescent vascular and eye study[J]. Ophthalmology, 2013, 120(10): 2100-2108.
[39]
Ip JM, Saw SM, Rose KA, et al. Role of near work in myopia: findings in a sample of Australian school children[J]. Invest Ophthalmol Vis Sci, 2008, 49(7): 2903-2910.
[40]
Rose KA, Morgan IG, Ip J, et al. Outdoor activity reduces the prevalence of myopia in children[J]. Ophthalmology, 2008, 115(8): 1279-1285.
[41]
Pacella R, McLellan J, Grice K, et al. Role of genetic factors in the etiology of juvenile-onset myopia based on a longitudinal study of refractive error[J]. Optom Vis Sci, 1999, 76(6): 381-386.
[42]
Kurtz D, Hyman L, Gwiazda JE, et al. Role of parental myopia in the progression of myopia and its interaction with treatment in COMET children[J]. Invest Ophthalmol Vis Sci, 2007, 48(2): 562-570.
[43]
Kaur S, Ramli NI, Narayanasamy S. Heredity factor in myopia development among a sample in Klang Valley, Malaysia[J]. Chin Med J(Engl), 2012, 125(19): 3522-3525.
[44]
Xiang F, He M, Morgan IG. The impact of parental myopia on myopia in Chinese children: population-based evidence[J]. Optom Vis Sci, 2012, 89(10): 1487-1496.
[45]
张宁，陶晗，张春丽，等. 237例6~12月婴儿屈光分析[J]. 中外医疗，2008, 27(35)：190-191.
[46]
钟瑞英，王燕，李志英，等. 近视儿童屈光度与体质分析[J]. 中华中医药杂志，2019(1)：387-390.
[47]
陈琰. 屈光矫正联合注视训练改善儿童弱视视力水平的效果分析[J]. 中国妇幼保健，2019, 34(1)：97-99.
[48]
杨晓玮，张少斌. 近视相关影响因素的研究进展[J]. 国际眼科杂志，2017, 17(10)：1871-1873.
[49]
胡岚君，赵金荣，张金英. 坐位及仰卧位人眼屈光状态的改变[J]. 眼科，2008, 17(5): 311-312.
[50]
于淑娟. 儿童屈光不正正视化及近视化大样本长期观察及在临床治疗中的指导意义[D]．青岛：青岛大学，2005.
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