北京市2023年幼儿和小学生近视辅助筛查方法研究

Auxiliary screening for myopia in kindergarten and primary school students in Beijing,2023

目的分析2023年北京市幼儿和小学生散瞳验光等眼视光检查数据,为科学选择学生人群近视辅助筛查方法提供参考。方法2023年春季学期,在北京市1个城区和1个郊区,采用多阶段整群随机抽样的方法抽取幼儿园和小学,城区选取2所幼儿园和2所小学,使用0.5%复方托吡卡胺滴眼液散瞳后验光1191名学生;郊区选取66所幼儿园和6所小学,散瞳验光3555名学生。检查项目包括散瞳前后验光、眼轴长度、角膜曲率、身高等。结果在各个学段,幼儿和小学生轴率比的ROC曲线下面积(幼儿园:AUC=0.89,小学低年级:AUC=0.91,小学高年级:AUC=0.89)均高于筛查性近视(幼儿园:0.87,小学低年级:0.90,小学高年级:0.89),但差异均无统计学意义(P值均>0.05);眼轴长度的AUC值均最低(0.74,0.82,0.83),均低于轴率比AUC值,差异有统计学意义(χ^(2)值分别为22.43,59.04,20.13,P值均<0.05)。裸眼视力加上轴率比后,幼儿园幼儿AUC值由0.83(95%CI=0.78~0.88)增加至0.93(95%CI=0.89~0.97),小学低年级学生AUC值由0.89(95%CI=0.86~0.91)增加至0.96(95%CI=0.95~0.97),小学高年级学生AUC值由0.91(95%CI=0.89~0.92)增加至0.96(95%CI=0.95~0.97),前后置信区间均无交叉,差异均有统计学意义(P值均<0.05)。结论轴率比对幼儿和小学生近视辅助筛查有重要意义,应重视轴率比在相关人群近视辅助筛查中的应用。

Objective To analyze cycloplegic refraction data of kindergarten and primary school students in Beijing in 2023,so as to provide scientific reference for selecting auxiliary methods for students myopia screening.Methods In the spring semester of 2023,a multi-stage cluster sampling method was used to select kindergartens and primary schools in one urban and one suburban district of Beijing.Two kindergartens and two primary schools were selected in the urban district,with 1191 students undergoing cycloplegic refraction examination.And the suburban district included 66 kindergartens and 6 primary schools,with 3555 students undergoing cycloplegic refraction examination.The examination items included pre-and post-cycloplegia optometry,axial length(AL),corneal curvature and height.Results In each academic stage,the area under the ROC curve(AUC)for the axial length/corneal radius of curvature(AL/CR)(Kindergarten:AUC=0.89,Lower primary school students:AUC=0.91,Upper primary school students:AUC=0.89)were higher than that of screening myopia,but the difference were not statistically significant(P>0.05).The AUC for axial length was the lowest(0.74,0.82,0.83)and lower than that for AL/CR with statistically significant difference(χ^(2)=22.43,59.04,20.13,P<0.05).After combining naked eye vision and AL/CR,kindergarten students showed an increased AUC from 0.83(95%CI=0.78-0.88)to 0.93(95%CI=0.89-0.97),and lower primary school students exhibited an increase from 0.89(95%CI=0.86-0.91)to 0.96(95%CI=0.95-0.97).In higher primary school students,AUC increased from 0.91(95%CI=0.89-0.92)to 0.96(95%CI=0.95-0.97).There was no overlap in the confidence intervals before and after combinations,and the differences were statistically significant(P<0.05).Conclusion AL/CR plays a significant role in assisting with myopia screening among kindergarten and primary school students.Attention should be paid to the application of AL/CR in assisting myopia screening in kindergarten and primary school students.