SureSight手持验光仪在3～6岁儿童屈光不正筛查中的应用

The use of SureSight for vision screening in preschool children

目的 探讨SureSight手持验光仪在3～6岁儿童屈光不正筛查中的应用价值.方法 横断面研究.对徐汇区康健街道内321例经初步筛查后视力可疑低常儿童,进行非睫状肌麻痹下SureSight手持式验光仪及睫状肌麻痹下Topcon台式验光仪检查.将所得检测结果进行Bland-Altman相关性检验,并利用ROC曲线计算SureSight屈光不正筛选标准以进行诊断性试验评价.结果 非睫状肌麻痹下SureSight验光测得的球镜度、柱镜度及SE均与睫状肌麻痹下Topcon验光仪所测得相应度数差异有统计学意义,在测量结果上两者有中度（球镜度：r=0.59,P＜0.05;SE：r=0.54,P＜0.05）到高度（柱镜度：r=0.89,P＜0.05）相关性.进一步以散瞳后Topcon测量值为金标准作ROC曲线,发现当SureSight SE测量值≤＋1.13 D时,可划定为可疑近视,SE测量值≥＋1.44 D时,划定为可疑远视,散光测量值≥0.88 D时,划定为可疑散光.散光、近视及远视的Youden指数分别为0.679、0.298及0.270.结论 3～6岁儿童非睫状肌麻痹下SureSight检测结果在散光的筛查中具有一定的临床意义,可协助划定可疑参考值范围,操作方便.但用于近视以及远视的筛查界定有一定的局限性。

Objective To assess the value of the hand-held autorefractor SureSight in screening refractive errors in children 3 to 6 years old.Methods In a cross-sectional study,321 children with lower visual acuity than normal participated in the SureSight and Topcon examinations,under cycloplegic and non-cycloplegic conditions respectively.Data were evaluated with Bland-Altman and ROC based on the prevalence study.Results In the comparison,it was found that the differences in spherical diopter,cylinder diopters and spherical equivalent （SE） between non-cycloplegia with SureSight （S1） and cycloplegia with Topcorn （T2） were significant.The correlation between S1 and T2 ranged from moderate （spherical diopter：r=0.59,P〈0.05; SE：r=0.54,P〈0.05） to high （cylinder diopter：r=0.89,P〈0.05）.The ROC curve found that myopia,hyperopia and astigmatism suspects with S1 were ≤＋1.13 D,≥＋1.44 D and ≥ 0.88 D when compared to T2.The Yonden index also showed better sensitivity and specificity for astigmatism （0.679） than myopia （0.298） and hyperopia （0.270）.Conclusion As a vision screening technique to detect refractive errors in preschool children,SureSight can help identify suspected astigmatism,but had limitations for myopia and hyperopia.