基于人群的6岁龄儿童屈光参差和双眼散光不等的患病率及其关联性研究

Aim:To study the distribution of anisometropia and anisoa-stigmatismin young Australian children,togetherwith clinical and ocular biometry relations.Method:The Sydney Myopia Study examined 1765 predominantly 6 year old children from 34 randomly selected Sydney schools during 2003-4.Keratometry,cycloplegic autorefraction,and questionnaire data were collected.Results:Spherical equivalent(SE)anisometropia(≥ 1 dioptre)prevalence was 1.6%(95% confidence interval(CI)-1.1% to 2.4%).Aniso-astigmatism(≥ 1D)prevalence was 1.0%(CI:0.6% to 1.6%).Both conditions were significantly more prevalent among moderately hyperopic(SE ≥ 2.0D)thanmildly hyperopic(SE 0.5-1.9D)children.Myopic children(SE ≤-0.5D)had higher anisometropia prevalence.Neither condition varied by age,sex,or ethnicity.In multivariate analyses,anisometropia was significantly associated with amblyopia,odds ratio(OR)29,(CI:8.7 to 99),exotropia(OR 7.7,CI:1.2 to 50),and neonatal intensive care unit(NICU)admission(OR 3.6,CI:1.1 to 12.6).Aniso-astigmatism was significantly associated with amblyopia(OR 8.2,CI:1.4 to 47),maternal age > 35 years(OR 4.0,CI:1.3 to 11.9),and NICU admission(OR 4.6,CI:1.2 to 17.2).Anisometropia resulted from relatively large interocular differences in axial length(p < 0.0001)and anterior chamber depth(p=0.0009).Aniso-astigmatism resulted from differences in corneal astigmatism(p < 0.0001).Conclusion:In this predominantly 6 year old population,anisometropia and aniso-astigmatism were uncommon,had important birth and biometry associations,and were strongly related to amblyopia and strabismus.

12岁澳大利亚儿童人群的可矫正和不可矫正视觉障碍的研究

Purpose:To document the prevalence of correctable and noncorrectable visual impairment in a representative sample of Australian children,predominantly age 12 years.Design:Population-based cross-sectional study.Methods:Logarithm of the minimum angle of resolution(logMAR)visual acuity was measured in both eyes unaided,with spectacles if worn,and after subjective refraction if required,in 2353 children,examined during 2004 to 2005.Cycloplegic autorefraction(using cyclopentolate)and dilated fundus examination were performed.Using a cut-off of 0.3 logMAR units(< 20/40),presenting visual impairment was defined using unaided visual acuity if spectacles were not worn or with usual correction if spectacles were worn.Impairment not eliminated by refraction was considered non-correctable;any difference between this and presenting impairment was defined as correctable impairment.Myopia was defined as spherical equivalent refraction(SER)≤-0.50 diopters(D),hyperopia as SER ≥ + 2.0 diopters,anisometropia as SER difference ≥ 1.00 diopters,and astigmatism as cylinder ≥ 1.0 diopters.Amblyopia was defined as corrected visual acuity< 0.3 logMAR not attributable to an underlying structural eye or visual pathway abnormality.Results:Visual impairment was found in the worse eye of 117 children(5.0%)and comprised correctable(82%)and non-correctable impairment(18%).Correctable impairmentwas due to myopia in 67(69.8%),hyperopia in 11(11.5%)and astigmatism in 32 subjects(33.3%).Causes of non-correctable impairment were:amblyopia 66.7%,congenital glaucoma 9.5%,optic nerve hypoplasia 9.5%,congenital nystagmus 4.8%,and cortical blindness 4.8%.Conclusions:Visual impairment had a relatively low prevalence in this older childhood population,a large proportion of which was correctable by refraction alone.

肾脏损害能否作为白内障发病率或白内障手术的预测指标:基于人群研究的发现

Purpose: To explore the relationship between creatinine clearance, an estimate of glomerular filtration rate, and5- year incidence of cataract and cataract surgery. Design: Population- based cohort study. Participants: Of the 3654 participants (aged 49 years or older) of the Blue Mountains Eye Study (BMES I) baseline examination (during 1992 to 1994), 2334 (75% )were reexamined after5 years from 1997 to 1999 (BMES II). Method: Risk factor data were collected for all participants at baseline (BMES I). Assessment of renal function was based on estimated creatinine clearance (CCr) calculated with the Cockcroft- Gault formula, adjusted for body surface area, and expressed in ml/minute/1.73 m2. Cataract incidence was determined from graded photographs. The association between renal function and incidence of cataract and cataract surgery was analyzed by logistic regression. Main OutcomeMeasures: Incidence of nuclear, cortical, and posterior subcapsular cataract, and cataract surgery. Results: Mean CCr± standard deviation was 60± 13 ml/minute/1.73 m2. The overall5- year incidence of nuclear, cortical, and posterior subcapsular cataract was 35.7% (417 of 1167 participants at risk), 16.7% (274 of 1641), and4.3% (77 of 1790), respectively. Cataract surgery was performed in 6.8% (144 of 2123) of participants. There were no significant associations of renal function with incident nuclear (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.99- 1.02), cortical (OR, 1.0; CI, 0.98- 1.01), and posterior subcapsular cataract (OR, 1.0; CI, 0.99- 1.04) after adjusting for multiple risk factors. After adjusting for age, gender, and dark brown iris color, moderate or worse renal impairment (CCr <60 ml/minute/1.73 m2) compared with normal or mildly impaired function (CCr ≥ 60 ml/minute/1.73 m2) was significantly associated with incident cataract surgery (P< 0.05), but the effect depended on age. Participants younger than 60 years of age with moderate to severe renal impairment had increased odds of incident cataract surgery (OR, 2.75; CI, 1.06- 7.14), but this OR decreased with age. In participants 80 years old or older, the OR was 0.34 (CI, 0.11- 1.10). Conclusions: There were no significant effects of renal function on the incidence of cataract of any type. The effect of moderate or worse renal impairment on incident cataract surgery depended on age. However, the interpretation of this effect is uncertain because of additional factors that may be involved in patients having surgery.