广州地区3～6岁学龄前儿童视力发育及屈光状态流行病学调查

Epidemiological study of the development of refraction and visual acuity in preschoolers aged 3 to 6 in the Guangzhou area

目的 了解广州地区3～6岁学龄前儿童的屈光状况及视力发育情况.方法 随机选取广州市不同行政区的10所幼儿园,对其中3～6岁学龄前儿童的屈光状态及视力进行检查.使用1%环戊酮麻痹睫状肌后,进行电脑验光检查,并用带状光检影复查;48 h后使用EDTRS视力表行主觉验光,记录最佳矫正视力.最后按年龄分组,对屈光及视力资料进行one-way ANOVA及Bonferroni统计学分析.结果 共2480名儿童完成检查,其中,3岁组男201例,女172例;4岁组男434例,女384例;5岁组男437例,女410例;6岁组男238例,女204例.各组的平均年龄分别为（43.3±2.8）个月、（53.8±3.3）个月、（65.5±3.4）个月及（75.1±2.6）个月.各年龄组的等效球镜度分别为（1.66±0.70）D、（1.67±0.80）D、（1.59±0.81）D及（1.48±0.72）D,4组之间等效球镜度的差异存在统计学意义（F=12.39.P=0.000）;以Bonferroni法进行两两比较发现,除3岁组与4岁组以及3岁组与5岁组之间差异无统计学意义（P〉0.008）外.其余各组间差异均有统计学意义（P〈0.008）.3岁组、4岁组、5岁组及6岁组的LogMAR视力分别为0.26±0.14、0.18±0.10、0.13±0.08及0.10±0.08,4组之间视力的差异存在统计学意义（F=406.2,P=0.000）;以Bonferroni法进行两两比较发现,任意两组间的差异均有统计学意义（P=0.000）.结论 对于3～6岁学龄前儿童,眼球屈光度向远视减小方向发展符合正视化过程的规律,他们的生理性远视的等效球镜度相差不大,都接近＋1.50 D;同时,视力随年龄增加而逐步提高,提示在弱视诊断时,应该将正常视力发育状况作为参考.

Objective To investigate the refractive error and best corrective visual acuity of preschoolers aged 3 to 6 years. Methods Ten kindergartens were randomly selected from different districts in the Guangzhou area. Refractive error and best corrected visual acuity of the preschoolers were measured. Refractive error was determined by an autorefractor, which was rechecked by cycloplegic retinoscopy with cyclopentolate. Best corrected visual acuity was measured with an EDTRS vision chart. Data was analyzed with one-way ANOVA using Bonferroni correction. Results Two thousand four hundred and eighty children were examined in the study. There were 201 boys and 172 girls in the 3-year-old group and 434/384, 437/410, 238/204 in the 4-, 5- and 6-year-old groups, respectively. The mean ages in months were 43.3±2.8, 53.8±3.3, 65.5±3.4 and 75.1 ±2.6, respectively. The spherical equivalent refractions of the corresponding age groups were （1.66±0.70）D, （1.67±0.80）D, （1.59±0.81）D and （1.48±0.72）D, respectively. And the differences among the groups were statistically significant （P=0.000）. The Bonferroni multiple comparisons showed that the difference between any pair of groups was statistically significant, except for that between the 3-year-old and 4-year-old groups, and between the 3-year-old and 5-year-old groups. The best corrected visual acuities on the LogMAR scale for the corresponding age groups were 0.26±0.14, 0.18±0.10, 0.13± 0.08 and 0.10±0.08, respectively. The difference among groups was statistically significant （P=0.000）. The Bonferroni multiple comparisons between any pair of groups were also statistically significant （P=0.000）. Conclusion Hyperopic refractive error gradually decreases with an increase of age during the 3rd to 6th years. The norms of the best corrected visual acuity shows a slow rise during this period, which indicates that age is an indispensable factor in making a diagnosis of amblyopia in children.