上海市学龄儿童屈光与立体视锐度的调查

A survey of refractive status and stereopsis in school-aged children in the city of Shanghai

目的 探讨学龄儿童屈光状态和立体视的分布特征以及立体视锐度、屈光状态与年龄、眼轴长度之间的关系.方法 横断面调查研究.采用整群抽样,随机抽取上海市8所小学,对抽取到的学校的所有学生进行问卷调查和视力、立体视、电脑验光、眼轴长度等眼科检查.根据年龄（6岁组、7岁组、8岁组、9岁组及10岁组）及屈光状态（正视组、轻度近视组、中高度近视组、轻度远视组及中高度远视组）分组.对计数资料组间比较采用卡方检验,计量资料中正态分布的数据组间比较采用单因素方差分析,非正态分布的数据采用非参数检验.并采用等级相关分析变量之间的相关性.结果 学龄期儿童随年龄的增长,近视的检出率有上升的趋势,远视的检出率有下降的趋势,经等级相关分析,近视的检出率与年龄呈正相关（r=0.427,P＜0.01）,远视的检出率与年龄呈负相关（r=-0.269,P＜0.01）.不同年龄组裸眼视力正常儿童的立体视锐度差异具有统计学意义（Kruskal Wallis检验,x2=88.867,P＜0.01）,其中6岁组与7岁组立体视锐度差异有统计学意义（Z=2.584,P＜0.01）,7岁组与8岁组、8岁组与9岁组、9岁组与10岁组间差异无统计学意义.不同屈光状态儿童立体视异常检出率差异具有统计学意义（x2=57.294,P＜0.01）.不同屈光状态立体视锐度组间差异具有统计学意义（Kruskal Wallis检验,x2=67.428,P＜0.01）,其中中高度远视组（Z=2.584,P＜0.01）、中高度近视组（Z=2.138,P＜0.01）及轻度远视组（Z=1.819,P＜0.01）立体视锐度与屈光正常组比较,差异均有统计学意义,而轻度近视组与屈光正常组比较差异无统计学意义.眼轴长度有随年龄而增长的趋势,不同年龄组眼轴长度差异具有统计学意义（F=115.248,P＜0.01）,各组间两两比较差异均具有统计学意义（P＜0.01）.结论 学龄儿童眼球存在由远视到正视再到近视的发展过程;立体视发育成熟年龄在7～8岁,远视及中高度近视对学龄儿童立体视的建立影响较大;学龄儿童眼轴长度随年龄增长逐渐增加.

Objective To explore the relative contribution of refractive status and stereopsis in a school population and to determine the associations between refractive status and stereoacuity,age,and axial length.Methods Subject data were sampled from the materials of a population-based cluster sampling of children in 8 primary schools in Shanghai in this cross-sectional investigation.According to the standards established for this study,a table was created based on a questionnaire and the examination of vision,stereopsis and axial length of the subjects.SPSS 20 software was used to analyze the data for the different ages （6,7,8,9 and 10 years of age） and refractive status （emmtropia,mild myopia,severe myopia,mild hyperopia and severe hyperopia）.A x2 test was used to compare groups.An ANOVA was used to compare the normal distribution measurement data among groups.For non-normal distributions data,nonparametric tests were used throughout.Results ①The trend for the incidence of myopia increased and for the incidence of hyperopia decreased with an increase in age.There was a positive correlation between the prevalence of myopia and increased age （r=0.427,P＜0.01）,and a negative correlation between the prevalence of hyperopia and increased age （r=0.269,P＜0.01）.There was a significant difference in stereopsis with normal uncorrected vision （Kruskal Wallis,x2=88.867,P＜0.01）.There was a statistically significant difference in stereopsis between ages 6 and 7 （Kolmogorov-Smirnov,Z=2.584,P＜0.01）,but no difference between ages 7 and 8,8 and 9,and 9 and 10 （P＞0.05）.The difference in the detection rate of anomalous stereopsis was statistically significant for different refractive states （x2=57.294,P＜0.01）.Stereoacuity also differed significantly among different refractive groups （Kruskal Wallis,x2=67.428,P＜0.01）.The differences were statistically significant between severe hyperopia （Z=2.584,P＜0.01）,severe myopia （Z=2.138,P＜0.01）,and mild hyperopia （Z=1.819,P＜0.01） and normal groups respectively.The mean value of axial length gradually increased with an increase in age and the differences were significant among age groups （F=115.248,P＜0.01）.The differences were significant when all age groups were compared to each other （P＜0.01）.Conclusion ①The results suggest that the prevalence of myopia increases with age,but the prevalence of hyperopia decreases with age in school-aged children.The eye in school-aged children goes from farsightedness to myopia.②Stereopsis reaches maturity at 7 to 8 years of age.③Mild and severe hypermetropia obviously influenced the development and establishment of stereopsis.④The mean axial length of the eye gradually increased with age.