拥挤Kay图片视力表在学龄前儿童视力筛查中的应用

The Use of the Kay Picture Test Linear Crowded Book for Vision Screening in Preschool Children

目的: 采用拥挤Kay图片视力表检测学龄前儿童视力, 并和标准对数视力表检测结果进行比较, 探讨2种视力表检测结果是否具有一致性, 以补充不能完成标准对数视力表检测的学龄前儿童的视力筛查。方法: 前瞻性自身对照研究。于2021年1—5月随机选取济南市章丘区某幼儿园152名学龄前儿童进行全面眼科筛查, 分别使用拥挤Kay图片视力表及标准对数视力表对其进行视力检测, 并采用Wilcoxon检验进行2种视力差异性的比较, Spearman秩相关分析及Bland-Altman分析进行相关性及一致性分析。结果: 152名儿童参与筛查, 其中129名儿童屈光状态正常且能配合2种视力表检测。129名儿童中男74名, 女55名, 年龄为(52.3±7.0)个月;拥挤Kay图片测得LogMAR视力为0.10(0.09, 0.10), 标准对数视力表视力为0.10(0.10, 0.22);2种视力检查方法有较好的相关性(r=0.436, P<0.001), 拥挤Kay视力表检测结果略高于标准视力表约0.04 LogMAR, 差异有统计学意义(Z=-6.124, P<0.001), Bland-Altman散点图显示98.4%的点均在一致性范围内;参与筛查儿童Kay图片视力检查配合度更高(χ^(2)=18.007, P<0.001)。不同月龄拥挤Kay图片视力检测结果差异有统计学意义(H=13.791, P=0.003), 随年龄增长, 视力呈递增趋势。结论: 拥挤Kay图片视力表用于学龄前儿童视力检测, 患儿配合程度高, 其结果与标准对数视力表相比有较好的一致性, 但Kay图片视力表所检查的视力结果高于标准视力表约0.04 LogMAR, 在参考视力结果时应相应调整视力标准。

Objective:To evaluate the consistency between the Kay Picture Test Linear Crowded Book and the standard logarithmic visual acuity chart in preschool children's vision screening and to help the children who could not complete the standard logarithmic visual acuity chart.Methods:A prospective self-controlled study design was performed.One hundred fifty-two preschool children were enrolled from January 2021 to May 2021,who had completed a comprehensive ophthalmological examination and vision test with the Kay Picture Test Linear Crowded Book and the standard logarithmic visual acuity chart.The Wilcoxon sign rank test,Spearman rank correlation analysis and Bland-Altman were used for analysis.Results:One hundred fifty-two preschool children participated in the screening and 129 children who were without refractive errors and who completed the 2 visual acuity tests were included.There were 74 males and 55 females among the 129 children with a mean age of 52.3±7.0 months.Acuities were 0.1(0.09,0.1)LogMAR measured by the Kay Picture Test Linear Crowded Book and were 0.1(0.1,0.22)LogMAR for the standard logarithmic visual acuity chart.There was a good correlation between the two charts(r=0.436,P<0.001).The visual acuity level measured by the Kay Picture Test Linear Crowded Book was higher by 0.04 LogMAR than with the other chart(Z=-6.124,P<0.001).Bland and Altman scatter plots showed that 98.4%of the points were within the 95%limits of agreement.The degree of cooperation for the Kay Picture Test Linear Crowded Book was higher than for the standard logarithmic visual acuity chart(χ^(2)=18.007,P<0.001).The visual acuities measured by the Kay Picture Test Linear Crowded Book were significantly different for different ages groups(H=13.791,P=0.003),with a trend that increased with age.Conclusions:The Kay Picture Test Linear Crowded Book can be used for vision screening in preschool children with a good measurement consistency and higher completion rate compared to the standard logarithmic visual acuity chart.The visual acuity level measured by the Kay Picture Test Linear Crowded Book is higher by 0.04 LogMAR than measurements by the other visual acuity chart,so visual acuity standards should be adjusted appropriately.