上海市北新泾街道老年人高度近视眼的流行病学调查

Epidemiological investigation of senile high myopia in Shanghai Beixinjing community

目的了解上海市北新泾街道60岁及以上老年人高度近视眼患病率、高度近视眼视网膜脉络膜病变的患病率及其相关影响因素。方法采用整群随机分层抽样法，对上海市北新泾街道的4153位60岁及以上老年人进行人群普查，受检者3851例，受检率为92．73％。现场调查内容为问卷调查及全面的眼科检查，包括视力、屈光度、裂隙灯显微镜、直接检眼镜检查和眼底照相等。屈光不正用等效球镜度数（SE）表示。若受检者SE〉-6．00D，眼底表现有后巩膜葡萄肿、漆纹样裂纹、Fuchs斑、近视弧形斑等近视性视网膜脉络膜萎缩病灶则诊断为高度近视眼视网膜脉络膜病变。小孔视力按照WHO视力损伤分级：最佳矫正视力≥0．05但＜0．3为低视力，＜0．05为盲。结果受检者中，高度近视跟207例，占5．37％。其中，183例表现高度近视性视网膜脉络膜病变，占88．40％。随年龄的增长，高度近视眼视网膜脉络膜病变的患病率显著下降（X^2=19．21，P〈0．01），但男女之间患病率差异无统计学意义（X^2=1．83，P〉0．05）。Logistic回归分析显示，不同年龄、不同文化程度、有无高度近视跟家族史人群的患病率差异均有统计学意义（X^2=19．21，32．08，960．68；P＜0．01）。受检者中，双眼盲29例，单眼盲96例，双眼低视力104例，单眼低视力562例。183例高度近视眼视网膜脉络膜病变患者中，111例存在明显的视力损伤，占60．65％，其中，双眼盲、单眼盲、双眼低视力、单眼低视力的患者分别为10例、11例、31例和59例，分别占总受检人群中视力损伤者的34．48％、11．46％、29．81％和10．50％。结论上海市北新泾地区老年人高度近视眼的患病率较高。年龄、文化程度、高度近视眼家族史是影响高度近视眼视网膜脉络膜病变的重要因素。

Objective To investigate the prevalence of high myopia, the prevalence and risk factors of high myopia associated with chorioretinopathy in residents aged 60 years or over in Beixinjing community, Shanghai, China. Methods A cluster stratified random sampling method was used to screen 4153 people aged 60 and over in Beixinjing community. There were 3851participants in total with a 92. 73% response rate. Participants were invited to complete a questionnaire and received a comprehensive eye examination including visual acuity, refraction, slit-lamp microscopic examination, direct ophthalmoscopy and fundus photography and so on. Spherical equivalent （SE） was used to determine the degree of refractive errors. The diagnosis of high myopic chorioretinopathy was made if SE〉- 6.00 D and myopic chorioretinal atrophy lesions were presented such as posterior scleral staphyloma, lacquer cracks, Fuchs spot and myopic arc spots. The degree of visual acuity impairment was determined according to the World Health Organization （WHO） classification as low vision （the best corrected visual acuity ≥0.05, but 〈0.3） or blindness （the best corrected visual acuity〈0.05）. Results There were 207/3851 （5.37%） high myopia patients, in which 183/207 （88.40%） patients were associated with myopic chorioretinopathy. The prevalence of myopic chorioretinopathy decreased while age increased （X^2 = 19.21, P〈0.01）, but statistically there was no gender difference （X^2 = 1.83, P〉0.05）. Logistic regression analysis showed that there were significant differences in the prevalence of high myopia between people with different age, educational levels and family history （X^2 = 19.21,32.08,960.68; P〈0.01）. There were 29 cases of bilateral blindness, 96 cases of unilateral blindness, 104 cases of bilateral low vision and 562 cases of unilateral low vision in those participants. In 183 cases of high myopic chorioretinopathy patients, 111（60.65 %）cases had an obvious visual impairment, including 34.48%（10 cases） of bilateral blindness, 11.46% （11 cases） of unilateral blindness, 29.81%（31 cases）of bilateral low vision and 10.50% （59 cases） of unilateral low vision. Conclusions The prevalence of high myopia of residents aged ≥60 years in Beixinjing community, Shanghai, China is relatively high. Age, education level and family history are the most important factors affecting the occurrence of chorioretinopathy in high myopia patients.