学习新版临床指南进一步规范弱视诊断治疗

Learn new version of Preferred Practice Pattern to further standardize the diagnosis and treatment of amblyopia

眼科临床指南（PPP）的引入,使我国眼科医师有机会接触和了解国际眼科PPP的制定原则、方法和应用价值,对快速提高我国眼科临床的诊疗水平,推动我国眼科临床诊疗规范化,促进国际交流起到了显著作用.由赵家良教授主译的PPP中译本第2版于2013年11月正式出版.新版PPP弱视分册采用了最新的证据分级和推荐意见标准,在循证基础上突出实用性;在弱视的定义方面,根据近年来国际研究的最新进展增加了新的解释;在弱视的诊断标准方面,对不同年龄段双眼弱视的最佳矫正视力标准有了新的界定;在弱视的检查方面,提供了从视力的定性评估方法、视力表的选择到睫状肌麻痹剂的使用等全面而实用的建议;在弱视的治疗方面,不仅根据最新的多中心临床随机对照试验的研究成果给出了强烈的建议,而且也明确地指出某些治疗措施尚缺乏足够证据支持;强调了停止弱视治疗后仍然需要定期随诊的必要性;在弱视的预防方面,指出了开展弱视的早期筛查的重要性,明确健康保健保险计划应当覆盖弱视的筛查、治疗和监察复发.本文就新版PPP弱视内容进行择要解读,以期与国内眼科同道一起进一步促进我国弱视诊断治疗的规范化.

The introduction of Preferred Practice Patterns （PPP） into China has given ophthalmologists in China more opportunities to acquaint themselves with international clinical guidelines for eye care,including its developing principles,methods and the application value.It had brought significant effects on the fast improvement of clinical eye care and standardization of diagnosis and treatment of eye diseases in China,and promoted the international academic exchanges.The 2nd Chinese version of PPPs translated by Prof.Jialiang Zhao was officially published in November,2013.The new version of PPP for amblyopia adopted the newest standard for grading of evidence strength and recommendation assessment,and emphasizes the practicability based on evidence.New explanations of the definition of amblyopia are added according to the recent research progresses in amblyopia.The diagnostic criteria of best visual acuity for bilateral amblyopia at different ages is given with new specifications.Comprehensive and practical suggestions on the examination methods for amblyopia are provided from the qualitative assessment of visual acuity,the choice of eye chart,to the use of cycloplegic agents.In the aspect of the treatment of amblyopia,based on the findings of recent multi-central random controlled clinical trials,not only strong recommendations are provided,but also the insufficiency of evidence supporting for some choices of therapy is pointed out.The necessity of the follow-up evaluation after the cessation of the treatment of amblyopia is emphasized too.In the aspect of the prevention of amblyopia,the new amblyopia PPP points out the importance of the early-period screening of amblyopia,and that the healthcare insurance plans should cover timely screening,treatment,and monitoring for recurrence of amblyopia.This article deciphers the essential contents of the new version of Chinese PPP for amblyopia,and aims to promote the standardization of the diagnosis and treatment of amblyopia with our ophthalmic colleagues in China.