孤独症谱系障碍合并智力障碍患儿视功能特征分析

Characteristics of visual function in children with autism complicated with mental retardation

目的探讨孤独症谱系障碍(ASD)合并智力障碍患儿的视功能及眼部疾病特点。方法横断面研究。于2022年1至3月纳入北京市朝阳区7所特殊教育学校的292例(584只眼)ASD合并智力障碍患儿资料,其中男性235例,女性57例;年龄2~18岁。检查所有患儿主观远、近视力、近立体视、客观视力、屈光度数、眼前节和眼底。另纳入健康幼儿及学生300人作为对照,年龄2~18岁,检查主、客观视力和屈光度数。对ASD合并不同智力障碍程度患儿进行分析,视力结果转换为最小分辨角的对数进行计量分析,不同性别、不同年龄的患儿数据比较采用Mann-Whitney U检验或Kruskal-Wallis H检验。结果ASD合并智力障碍患儿的584只眼中,屈光不正272只眼(47.22%),散光260只眼(45.14%),远视29只眼(5.03%),近视10只眼(1.74%),弱视危险因素47只眼(8.16%)。292例患儿中斜视20例(6.85%),色弱3例(1.03%),外眼异常4例(1.37%)。211例患儿完成了近立体视检查,其中100″及以内者54例(25.59%),200″~900″者157例(74.41%)。272只屈光不正眼中,157只眼(57.72%)需矫正而未矫正。患儿主观、客观视力分别为0.22(0.10,0.35)和0.10(0.00,0.22);不同性别的ASD合并轻度或中度智力障碍患儿远近视力、客观视力、屈光度数、近立体视的差异均无统计学意义(P>0.05);不同年龄段ASD合并轻度智力障碍患儿差异有统计学意义(H=21.453,P<0.001),合并中度智力障碍患儿主观远、近视力的差异有统计学意义(Z=-3.508,-4.503;P<0.001),客观视力、屈光度数、近立体视的差异无统计学意义(P>0.05)。健康儿童的主观远视力和客观视力分别为0.10(0.00,0.22)和0.00(0.00,0.10),屈光度数为0.25(-0.25,0.50)D,与ASD合并智力障碍患儿比较,主观远视力及客观视力差异有统计学意义(Z=-8.527,-10.393;P<0.001),屈光度数的差异无统计学意义(Z=-1.274,P=0.203)。结论ASD合并智力障碍患儿的主、客观视力均低于健康儿童,屈光不正、斜视、弱视等眼病的患病率和未矫正率均明显高于健康儿童,其所患的屈光不正中以散光为主,且矫正和治疗率较低。

Objective To explore the characteristics of visual function and eye diseases in children with autism spectrum disorder(ASD)and mental retardation.Methods It was a cross-sectional study.Two hundred and ninety-two cases(584 eyes)of children with ASD combined with mental retardation from 7 special education schools in Chaoyang District of Beijing,including 235 males(80.48%)and 57 females(19.52%);The age ranged from 2 to 18 years old.Subjective far and near vision,near stereoacuity,objective vision,diopter,anterior segment and fundus were examined.In addition,300 students with normal intelligence level,aged 2 to 18 years,were included as controls.LogMAR was used to record vision examination.Subjective,objective vision and diopter were examined.Mann Whitney U test or Kruskal Wallis H test was used for the data of children with different genders,different age.Results Among 584 eyes of children with ASD and mental retardation,272 eyes(47.22%)were ametropia,260 eyes(45.14%)were astigmatism,29 eyes(5.03%)were hyperopia,10 eyes(1.74%)were myopia,and 47 eyes(8.16%)were amblyopia risk factors.Among 292 children,there were 20 cases of strabismus(6.85%),3 cases of color weakness(1.03%),and 4 cases of external eye abnormalities(1.37%).Two hundred and eleven children completed near stereopsis examination,of which 54(25.59%)were within 100″and 157(74.41%)were within 200″to 900″.Two hundred and seventy-two eyes with ametropia,157 eyes(57.72%)needed correction but did not.The median and quartile of subjective and objective logMAR visual acuity were 0.22(0.10,0.35),0.10(0.00,0.22),respectively;There were no significant differences in far visual acuity,near visual acuity,objective visual acuity,diopter,and near stereoacuity between different genders of ASD children with mild or moderate mental retardation(all P>0.05);There was a statistically significant difference in ASD children with mild mental retardation at different age rangs(H=21.453,P<0.001).There was a statistically significant difference in subjective tests such as far visual acuity and near visual acuity,for children with moderate mental retardation(Z=-3.508,-4.503;P<0.001).There was no statistically significant difference in objective visual acuity,diopter and near stereo acuity(all P>0.05).There are 300 healthy children as the control group,with LogMar′s subjective far vision is 0.10(0.00,0.22),and the objective vision is 0.00(0.00,0.10),diopter 0.25(-0.25,0.50)D.Compared with healthy children,ASD children with mental retardation had a significant difference in subjective far vision and objective vision(Z=-8.527,-10.393;P<0.001).There was no significant difference in diopter(Z=-1.274,P=0.203).Conclusions The subjective and objective visual acuity of children with ASD combined with mental retardation was lower than that of healthy children.The prevalence and uncorrected rate of refractive errors,strabismus,amblyopia and other eye diseases were significantly higher than those of healthy children.Their refractive errors were mainly astigmatism,and the rates of correction and treatment were low.