儿童青少年近视筛查3种方案比较

A comparative study of 3 types of myopia screening methods among children and adolescents

目的评价3种近视筛查方案筛查儿童青少年近视的真实值、预测值,为有效筛查近视提供最佳方案。方法在江苏省12个县(市、区)共选取36所中小学,对其中7 441名一至十二年级中小学生进行眼科体检,包括远视力检查裸眼远视力<5.0(方案A)、非睫状肌麻痹下计算机验光等效球镜值(SE)<-0.5 D(方案B)以及两者的结合(方案C),以睫状肌麻痹验光数据为金标准,使用ROC曲线下面积及灵敏度、特异度、阳性预测值等指标进行比较评价。结果方案C的ROC曲线下面积最为接近1,为0.91;95%CI=0.90~0.92,灵敏度、特异度、约登指数、诊断符合率、阳性预测值、阴性预测值分别为92.4%,89.5%,0.82,91.1%,91.3%,90.8%,但此指标小学低年级均较低。七至十二年级学生方案A筛查的视力不良率与近视诊断率最为接近。结论裸眼远视力<5.0且非睫状肌麻痹计算机验光等效球镜值(SE)<-0.5 D可作为中小学生近视筛查方案;在无计算机验光的条件下,中学生可考虑裸眼远视力<5.0代替近视率;小学生群体建议使用睫状肌麻痹后验光。

Objective This study aimed to evaluate the validity and predictive value of different methods for myopia screening, and to provide the most effective method of myopia screening. Methods A total of 7 441 students of grade 1-12 selected from 36 primary and middle schools in 12 counties in Jiangsu Province were enrolled in this study for ophthalmological examination, and uncorrected visual acuity(UCVA, Plan A), noncycloplegic autorefraction(NCAR, Plan B) and combination of UCVA and NCAR(Plan C) were included in the examination. Receiver operating characteristics(ROC) curve was performed to determine the cut-off values(The gold standard is cycloplegic refraction: SE≤0.5 D), and positive predictive value, sensitivities, specificities and other indicators of three screening tests were compared and calculated. Results The AUC of the combination test for uncorrected visual acuity(UCVA) and noncycloplegic autorefraction(NCAR) was nearly 1(0.91, 95%CI=0.90-0.92), and the sensitivity, specificity, Yoden index, diagnostic coincidence rate, positive predictive value and negative predictive value were 92.4%,89.5%,0.82,91.1%,91.3%,90.8%, respectively, but the index of the younger pupils in primary schools was relatively low. The result of screening plan A for students of middle and high school students was the closest to that of myopia diagnosis. Conclusion Combination test, which was recommended by China National Health Commission, can be a practical solution for school students for myopic screening. Under the condition of no mydriatic refraction, Plan A could be considered for myopia screening especially for middle and high school students. For the younger pupils, it is suggested to use the internationally recommended myopia screening strategy, that is, SE ≤ 0.50 D after mydriasis.