7种儿童常用近视筛查方案的准确性比较

Comparison of the Effectiveness of 7 Common Types of Myopia Screening Methods among Children

目的:以睫状肌麻痹验光作为近视诊断金标准,比较常用的近视筛查方案及其不同组合用于儿童近视筛查的准确性。方法:系列病例研究。连续选取2021年12月至2022年11月期间,在马鞍山市妇幼保健院初次就诊的儿童543例,年龄6~8岁,检查并记录儿童裸眼远视力(UCDVA)、眼轴长度(AL)、平均角膜曲率半径(CR)、自然瞳孔下电脑验光屈光度(PR)及睫状肌麻痹验光后等效球镜度(SE)。以PR≤-0.50 D作为近视阳性界值;UCDVA<5.0为视力不良;轴率比(AL/CR)>3视为可疑近视;以睫状肌麻痹验光后SE≤-0.50 D为近视诊断金标准。筛查方案共7种,分别为:UCDVA、PR、AL/CR、UCDVA+PR、UCDVA+AL/CR、PR+AL/CR、以及UCDVA+PR+AL/CR。筛查方案评价指标包括灵敏度、特异度、约登指数、阳性预测值、阴性预测值、诊断符合率和ROC曲线下面积等。不同近视筛查方案间阳性检出率比较采用χ^(2)检验。结果:当使用单一指标筛查近视时,PR方案准确性最好,其灵敏度(100.0%)、特异度(89.2%)、约登指数(0.89)、阳性预测值(64.7%)、阴性预测值(100.0%)、诊断符合率(0.732)和ROC曲线下面积(0.95)均最高。当使用2种指标组合筛查近视时,UCDVA+PR方案和PR+AL/CR方案准确性较接近(约登指数分别为0.91、0.92),均比UCDVA+AL/CR方案准确性好(约登指数为0.87)。当使用3种指标组合,即UCDVA+PR+AL/CR方案筛查近视时,仅特异度(96.2%)、阳性预测值(83.3%)和诊断符合率(0.861)相较UCDVA+PR和PR+AL/CR方案稍有提升,其余准确性及可靠性指标均有所下降。结论:在大规模儿童近视筛查中,如果只使用单一指标筛查近视,可考虑使用PR;如果可以联合2种指标筛查近视,可考虑使用UCDVA+PR或PR+AL/CR;当3种指标全部联合筛查近视时,筛查效能提升有限。

Objective:To evaluate the accuracy of common types of myopia screening methods among children with the results of cycloplegic refraction as the gold standard for the diagnosis of myopia.Methods:In this case series study,a total of 543 children aged 6-8 years old who visited Maternal and Child Health Care Center of Ma'anshan from December 2021 to November 2022 were enrolled.Uncorrected distance visual acuity(UCDVA),axial length(AL),mean corneal radius(CR),pre-cycloplegia refraction(PR),and cycloplegic refraction were assessed and recorded.PR≤-0.50 D,UCDVA<5.0,and AL/CR>3 were defined as myopia-positive boundary value,respectively.And the results of cycloplegic refraction were defined as the gold standard for the diagnosis of myopia.In this study,there were 7 screening methods:UCDVA,PR,AL/CR,UCDVA+PR,UCDVA+AL/CR,PR+AL/CR,and UCDVA+PR+AL/CR.The evaluation indicators of the screening methods included sensitivity,specificity,Youden index,positive predictive value,negative predictive value,diagnostic coincidence rate,and area under ROC curve.The Chi-square test was used to compare the positive detection rate among different myopia screening methods.Results:When a single index was used for myopia screening,PR had the best effect,with the highest sensitivity(100.0%),specificity(89.2%),Youden index(0.89),positive predictive value(64.7%),negative predictive value(100.0%),diagnostic coincidence rate(0.732),and area under ROC curve(0.95).When two indexes were combined for myopia screening,the effectiveness of UCDVA+PR and PR+AL/CR were similar(Youden index were 0.91 and 0.92,respectively),and both were greater than UCDVA+AL/CR(Youden index was 0.87).When UCDVA+PR+AL/CR was used for myopia screening,only specificity(96.2%),positive predictive value(83.3%),and diagnostic coincidence rate(0.861)were slightly improved,compared with UCDVA+PR and PR+AL/CR,while other accuracy and reliability indexes were decreased.Conclusions:In the large-scale screening of myopia in children,if only a single index was used to screen myopia,PR can be considered.If two indexes could be combined to screen myopia,the PR combined with UCDVA or AL/CR can be considered.When all three indexes combined to screen myopia,the improvements of screening accuracy were limited.