阅读时戴低度凸透镜对小学生近视干预效果评价

Evaluation of the effect of wearing low-degree convex spectacle when reading on myopia prevention among school students

目的 评价阅读时戴低度凸透镜对小学生近视的干预效果。 设计 前瞻性队列研究。 研究对象 594例1-5年级的近视高危（双眼裸眼视力≥4.7，－1.0 D≤双眼等效球镜值≤2.0 D）的小学生。阅读时戴低度凸透镜者286例为干预组，平均年龄（7.81±1.48）岁；未戴低度凸透镜者308例为对照组，平均年龄（8.44±1.59）岁。方法 2010年底（基线）和2011年底（终线）分别对594例1-5年级的小学生行屈光度检查。根据终线时的检查结果（取右眼数据），以近视进展情况（终线右眼等效球镜－基线右眼等效球镜）、近视发病情况作为结局指标，分别采用多重线性回归分析和logistic回归分析评价干预效果，并且按照性别和年级（1-3年级VS 4-5年级）进行分层分析。主要指标 右眼等效球镜度数。结果 干预前后干预组右眼等效球镜变化（-0.35±0.76）D，较对照组（-0.56±0.71）D少（P=0.004）。女生干预组较对照组有效（P=0.003），男生干预组与对照组无统计学差异（P=0.317）。1-3年级干预组较对照组有效（P〈0.001），而4-5年级干预组与对照组无统计学差异（P=0.678）。终线时，干预组和对照组近视发病率分别为14.3%和29.5%。与对照组相比，干预组近视发病的OR值为0.593（95%CI=0.371-0.946）；按性别分层，男生和女生干预组近视发病的OR值分别为0.704 （95%CI=0.358-1.385）和0.450（95%CI=0.227-0.894）；按年级分层，1-3年级和4-5年级干预组近视发病的OR值分别为0.440（95%CI=0.238-0.813）和1.143（95%CI=0.478-2.731）。结论 阅读时戴低度凸透镜，尤其是女学生和低年级学生，可以减缓近视发展的进程，降低近视发病率，对小学生近视防治起到积极的作用。（眼科，2016, 25：294－298）

Objective To evaluate the effect of wearing low-degree convex spectacle when reading on myopia prevention among school students. Design Prospective cohort study. Participants The high risk students （1-5 grade） with uncorrected visual acuity ≥ 4.7 and -1.0D ≤ the spherical equivalent refraction of right eye ≤ 2.0D. 286 students were selected as Intervention group to wear low-degree convex spectacle when reading. 308 students with no intervention were selected as the control group. The average age for the two groups were （7.81±1.48） and （8.44±1.59） years old, respectively. Methods 594 cases of school students were measured twice （at the end of 2010 and 2011） for refractive error. According to the examination results （data of the right eye）, outcome indicators were the variation of spherical equivalence in the right eye and incidence of myopia. Multiple linear regression and logistic regression were used to evaluate the effect of wearing low-degree convex spectacle when reading on myopia prevention. Subgroup analysis by gender and grade （1-3 grade versus 4-5 grade） were also conducted. Main Outcome Measures Spherical equivalence in the right eye. Results The changed values of spherical equivalence in the intervention group were （-0.35±0.76）D, significantly lower than（-0.56±0.71）D in the control group（P=0.004）. Results from the subgroup analysis showed the intervention was significant among girls （P=0.003） and among students of 1-3 grade （P〈0.001）. At the end of 2011, the incidence of myopia was 14.3% for intervention group and 29.5% for control group, respectively. Compared to control group, the OR value of the incidence of myopia in the intervention group was 0.593 （95%CI=0.371-0.946）. According to the gender stratification, the OR value of the incidence of myopia in the intervention group was 0.704 （95%CI=0.358-1.385） for boys and 0.450 （95%CI=0.227-0.894） for girls. According to the grade stratification, the OR value of the incidence of myopia in the intervention group was 0.440 （95%CI=0.238-0.813） for students of 1-3 grade and 1.143 （95%CI=0.478-2.731） for students of 4-5 grade. Conclusion Wearing low-degree convex glasses when reading, especially for girls and for lower grade students, can slow the exacerbation of myopia and reduce the incidence of myopia. （Ophthalmol CHN, 2016, 25： 294-298）