屈光相对安全儿童青少年裸眼视力生长曲线研究

王菁菁; 杜林琳; 谢辉; 杨金柳行; 陈军; 朱剑锋; 邹海东; 许迅; 何鲜桂

doi:10.16835/j.cnki.1000-9817.2021.06.022

屈光相对安全儿童青少年裸眼视力生长曲线研究

doi: 10.16835/j.cnki.1000-9817.2021.06.022

王菁菁¹,
杜林琳¹,
谢辉¹,
杨金柳行¹,
陈军¹,
朱剑锋¹,
邹海东^{1, 2},
许迅^{1, 2},
何鲜桂^{1, 2, ,}

1.
上海市眼病防治中心/上海市眼科医院/上海市视觉健康中心/上海市儿童青少年近视防治技术中心, 200040
2.
上海交通大学附属第一人民医院/上海市眼底病重点实验室/国家眼部疾病临床医学研究中心

基金项目:

2020年度上海市卫生健康委标准预研制项目计划 2020WB13

上海市公共卫生优秀学科带头人培养计划 GWV-10.2-XD09

2019年上海市卫生健康委员会科研课题 20194Y0308

详细信息

作者简介:
王菁菁(1991-)，女，江苏泰州人，硕士，医师，主要研究方向为儿童青少年近视防控

通讯作者:
何鲜桂, E-mail: xianhezi@163.com

中图分类号: R 179 R 778.11
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- 被引次数: 0
出版历程
- 收稿日期: 2021-01-14
- 修回日期: 2021-02-17
- 网络出版日期: 2021-06-22
- 刊出日期: 2021-06-25

Study on the growth curve of uncorrected visual acuity of children and adolescents with relative safe refractive range

WANG Jingjing¹,
DU Linlin¹,
XIE Hui¹,
YANG Jinliuxing¹,
CHEN Jun¹,
ZHU Jianfeng¹,
ZOU Haidong^{1, 2},
XU Xun^{1, 2},
HE Xiangui^{1, 2
, ,}

1.
Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital/Shanghai Vision Health Center and Shanghai Children Myopia Institute, Shanghai(200040), China

摘要

摘要: 目的分析3~18岁屈光相对安全范围儿童青少年裸眼视力分布，为研制不同年龄段儿童青少年裸眼视力的生长曲线和参考值范围、制定视力异常转诊界值提供参考。方法通过整群抽样的方法，选取上海市9 146名3~18岁儿童青少年进行裸眼视力、散瞳验光、裂隙灯等眼科检查，采用LMS法拟合屈光相对安全范围儿童青少年裸眼视力的百分位数和生长曲线，同时分析各年龄组裸眼视力筛查屈光异常的ROC曲线下面积及不同界值的灵敏度和特异度。结果儿童青少年裸眼视力呈偏态分布，中位数为4.8。其中屈光相对安全范围儿童青少年4 675名，裸眼视力中位数为4.9。LMS拟合曲线显示，裸眼视力在低年龄段随年龄增长而提高，6~10岁时逐渐稳定至最佳水平。P₅₀在3~4岁为4.8，5~8岁为4.9，≥9岁均为5.0。裸眼视力预测屈光异常的ROC曲线下面积随年龄的增加而提高，3岁时仅为0.55(95%CI=0.50~0.61)，12~18岁时最高[0.95(95%CI=0.94~0.96)]。3~6岁以P₂₅为转诊界值时约登指数最高，7岁及以上以P₁₀为界值时约登指数最高。随着界值的增加，灵敏度提高，特异度降低。结论裸眼视力随年龄增长先提升，6~10岁后逐渐稳定至视力最佳水平。年龄越大，裸眼视力指标筛查屈光异常的效果越好。建议根据年龄设置儿童青少年裸眼视力异常转诊界值，各年龄段可根据筛查目的选择P₂₅~P₇₅为转诊界值。
- 屈光, 眼 /
- 生长和发育 /
- ROC曲线 /
- 儿童 /
- 青少年
Abstract: Objective To analyze the distribution of uncorrected visual acuity in children and adolescents aged 3-18 years with relative safe refractive range, and to develop the growth curve and reference range of uncorrected visual acuity in children and adolescents of different ages, so as to provide reference for formulating the referral threshold for myopia screening practice. Methods Using cluster sampling method, 9 146 children and adolescents aged 3-18 years old in Shanghai were selected for uncorrected visual acuity, cycloplegic refraction, slit lamp and other ophthalmic examinations, and the percentiles and growth curve of uncorrected visual acuity of children and adolescents in the relative safe refractive range were fitted by LMS method. Besides, the area under the ROC curve and the sensitivity and specificity of different cut-off values were analyzed. Results The uncorrected visual acuity was skewed, with a median of 4.8. There were 4 675 individuals with safe refraction, the median of uncorrected visual acuity in which was 4.9. The LMS curve showed that the uncorrected visual acuity increased with age in the lower age group, and gradually stabilized to the best level at the age of 6-10. P₅₀ was 4.8 in 3-4 years old, 4.9 in 5-8 years old, 5.0 in 9 years old and above. The area under ROC curve of uncorrected visual acuity predicting refractive abnormality increased with age, with the lowest value of 0.55(95%CI=0.50-0.61) at 3 years old and the highest value of 0.95 (95%CI=0.94-0.96) at 12-18 years old. The Youden index was the highest for P₂₅ at 3-6 years old, and the highest for P₁₀ at 7 years old and above. With the increase of the cut-off value, the sensitivity increased and the specificity decreased. Conclusion The uncorrected visual acuity increases gradually with age, and reaches the best level after 6-10 years old. The screening effect of uncorrected visual acuity predicting refractive abnormality increased with age. It is suggested that the referral threshold of children and adolescents with abnormal uncorrected visual acuity should be set according to their ages, and P₂₅-P₇₅ can be selected according to the screening purposes.
- Refraction, ocular /
- Growth and development /
- ROC curve /
- Child /
- Adolescent

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图 1 各年龄组儿童青少年裸眼视力筛查异常的ROC曲线

Figure 1. ROC curve analysis of uncorrected visual acuity screening for abnormal refraction in different age groups

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表 1 屈光相对安全范围儿童青少年裸眼视力分布

Table 1. Distribution of uncorrected visual acuity in children and adolescents with relative safe refraction

年龄/岁	人数	P₃	P₁₀	P₂₅	P₅₀	P₇₅	P₉₀	P₉₇	均值
3	225	4.6	4.6	4.7	4.8	4.8	4.9	5.0	4.8
4	377	4.6	4.7	4.8	4.8	4.9	4.9	5.0	4.8
5	411	4.6	4.8	4.8	4.9	4.9	4.9	5.0	4.9
6	803	4.7	4.8	4.8	4.9	4.9	5.0	5.0	4.9
7	828	4.7	4.8	4.9	4.9	5.0	5.0	5.0	4.9
8	711	4.8	4.8	4.9	4.9	5.0	5.0	5.1	5.0
9	544	4.8	4.9	4.9	5.0	5.0	5.0	5.1	5.0
10	309	4.8	4.8	4.9	5.0	5.0	5.0	5.1	5.0
11	184	4.8	4.9	4.9	5.0	5.0	5.0	5.1	5.0
12	104	4.8	4.9	4.9	5.0	5.0	5.0	5.1	5.0
13	75	4.8	4.9	5.0	5.0	5.0	5.1	5.1	5.0
14	43	4.8	4.9	4.9	5.0	5.0	5.1	5.1	5.0
15	26	4.8	4.8	4.9	5.0	5.0	5.0	5.1	5.0
16~18	35	4.8	4.8	5.0	5.0	5.0	5.1	5.1	5.0

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表 2 基于LMS法拟合的屈光相对安全范围儿童青少年各年龄段裸眼视力百分位数值

Table 2. Percentiles of uncorrected visual acuity among children and adolescents with relative safe refraction in different age groups based on LMS method

年龄/岁	人数	P₃	P₁₀	P₂₅	P₅₀	P₇₅	P₉₀	P₉₇
3	225	4.6	4.7	4.7	4.8	4.8	4.9	4.9
4	377	4.6	4.7	4.8	4.8	4.9	4.9	5.0
5	411	4.7	4.8	4.8	4.9	4.9	5.0	5.0
6	803	4.7	4.8	4.8	4.9	4.9	5.0	5.0
7	828	4.7	4.8	4.9	4.9	5.0	5.0	5.1
8	711	4.7	4.8	4.9	4.9	5.0	5.0	5.1
9	544	4.8	4.8	4.9	5.0	5.0	5.1	5.1
10	309	4.8	4.9	4.9	5.0	5.0	5.1	5.1
11	184	4.8	4.9	4.9	5.0	5.0	5.1	5.1
12	104	4.8	4.9	4.9	5.0	5.0	5.1	5.1
13	75	4.8	4.9	4.9	5.0	5.0	5.1	5.1
14	43	4.8	4.9	4.9	5.0	5.0	5.1	5.1
15	26	4.8	4.9	4.9	5.0	5.0	5.1	5.1
16~18	35	4.8	4.9	4.9	5.0	5.0	5.1	5.1

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表 3 不同年龄组屈光相对安全范围儿童青少年分性别裸眼视力分布的敏感性分析

Table 3. Analysis of the distribution of uncorrected visual acuity in children and adolescents with relative safe refractive range in different genders

年龄/岁	男生							女生
年龄/岁	P₃	P₁₀	P₂₅	P₅₀	P₇₅	P₉₀	P₉₇	P₃	P₁₀	P₂₅	P₅₀	P₇₅	P₉₀	P₉₇
3	4.6	4.7	4.7	4.8	4.8	4.9	4.9	4.6	4.7	4.7	4.8	4.8	4.9	4.9
4	4.6	4.7	4.8	4.8	4.9	4.9	5.0	4.6	4.7	4.8	4.8	4.9	4.9	5.0
5	4.6	4.8	4.8	4.9	4.9	5.0	5.0	4.7	4.7	4.8	4.9	4.9	5.0	5.0
6	4.7	4.8	4.9	4.9	4.9	5.0	5.0	4.7	4.8	4.8	4.9	4.9	5.0	5.0
7	4.7	4.8	4.9	4.9	5.0	5.0	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
8	4.7	4.8	4.9	5.0	5.0	5.0	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
9	4.7	4.8	4.9	5.0	5.0	5.1	5.1	4.8	4.8	4.9	5.0	5.0	5.0	5.1
10	4.7	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1
11	4.7	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1
12	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1
13	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1
14	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1
15	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1
16~18	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1

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表 4 各年龄组不同屈光定义下儿童青少年裸眼视力分布的敏感性分析

Table 4. Analysis of uncorrected visual acuity distribution of children and adolescents under different refractive definitions

年龄/岁	SE[0, 1]D							SE[0.5, 2]D							SE[-0.5, 0.5]D
年龄/岁	P₃	P₁₀	P₂₅	P₅₀	P₇₅	P₉₀	P₉₇	P₃	P₁₀	P₂₅	P₅₀	P₇₅	P₉₀	P₉₇	P₃	P₁₀	P₂₅	P₅₀	P₇₅	P₉₀	P₉₇
3	4.6	4.7	4.7	4.8	4.8	4.9	4.9	4.6	4.7	4.7	4.8	4.8	4.9	4.9	4.5	4.6	4.7	4.8	4.8	4.9	4.9
4	4.6	4.7	4.8	4.8	4.9	4.9	4.9	4.6	4.7	4.8	4.8	4.9	4.9	5.0	4.5	4.7	4.7	4.8	4.9	4.9	4.9
5	4.7	4.8	4.8	4.9	4.9	4.9	5.0	4.7	4.8	4.8	4.9	4.9	5.0	5.0	4.6	4.7	4.8	4.8	4.9	4.9	5.0
6	4.7	4.8	4.9	4.9	4.9	5.0	5.0	4.7	4.8	4.8	4.9	4.9	5.0	5.0	4.6	4.7	4.8	4.9	4.9	5.0	5.0
7	4.7	4.8	4.9	4.9	5.0	5.0	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1	4.6	4.8	4.8	4.9	5.0	5.0	5.0
8	4.7	4.8	4.9	5.0	5.0	5.0	5.1	4.7	4.8	4.9	5.0	5.0	5.0	5.1	4.6	4.8	4.9	4.9	5.0	5.0	5.1
9	4.8	4.9	4.9	5.0	5.0	5.0	5.1	4.8	4.8	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
10	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
11	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
12	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
13	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
14	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
15	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1
16~18	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.8	4.9	4.9	5.0	5.0	5.1	5.1	4.7	4.8	4.9	4.9	5.0	5.0	5.1

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表 5 各年龄组儿童青少年裸眼视力筛查屈光异常的ROC曲线下面积及不同界值的灵敏度和特异度分析

Table 5. Area under ROC curve as well as the sensitivity and specificity analysis of different cut-off values of uncorrected visual acuity for screening abnormal refraction in different age groups

年龄/岁	曲线下面积(95%CI)	≤P₁₀				≤P₂₅				≤P₅₀				≤P₇₅				≤P₉₀
年龄/岁	曲线下面积(95%CI)	界值	灵敏度/%	特异度/%	约登指数/%	界值	灵敏度/%	特异度/%	约登指数/%	界值	灵敏度/%	特异度/%	约登指数/%	界值	灵敏度/%	特异度/%	约登指数/%	界值	灵敏度/%	特异度/%	约登指数/%
3	0.55(0.50~0.61)	4.7	44.68	64.89	9.57	4.7	44.68	64.89	9.57	4.8	91.49	12.89	4.38	4.8	91.49	12.89	4.38	4.9	96.81	6.67	3.48
4	0.67(0.63~0.71)	4.7	40.71	80.37	21.08	4.8	87.14	37.67	24.81	4.8	87.14	37.67	24.81	4.9	97.86	5.57	3.43	4.9	97.86	5.57	3.43
5	0.69(0.65~0.73)	4.8	72.55	57.66	30.21	4.8	72.55	57.66	30.21	4.9	98.04	7.06	5.10	4.9	98.04	7.06	5.10	5.0	100.00	0.00	0.00
6	0.72(0.70~0.75)	4.8	64.60	72.35	36.95	4.8	64.60	72.35	36.95	4.9	92.34	20.55	12.89	4.9	92.34	20.55	12.89	5.0	100.00	1.25	1.25
7	0.81(0.78~0.83)	4.8	67.33	81.28	48.61	4.9	91.67	38.53	30.20	4.9	91.67	38.53	30.20	5.0	100.00	1.57	1.57	5.0	100.00	1.57	1.57
8	0.86(0.83~0.88)	4.8	73.80	87.34	61.14	4.9	90.39	48.10	38.49	4.9	90.39	48.10	38.49	5.0	99.34	4.50	3.84	5.0	99.34	4.50	3.84
9	0.89(0.87~0.91)	4.8	72.73	94.30	67.03	4.9	89.39	64.34	53.73	5.0	98.86	6.25	5.11	5.0	98.86	6.25	5.11	5.1	100.00	0.55	0.55
10	0.91(0.89~0.93)	4.9	91.90	62.14	54.04	4.9	91.90	62.14	54.04	5.0	99.45	5.50	4.95	5.0	99.45	5.50	4.95	5.1	100.00	0.32	0.32
11	0.94(0.91~0.95)	4.9	92.46	71.20	63.66	4.9	92.46	71.20	63.66	5.0	99.50	8.15	7.65	5.0	99.50	8.15	7.65	5.1	100.00	1.09	1.09
12~18	0.95(0.94~0.96)	4.9	94.50	72.79	67.29	4.9	94.50	72.79	67.29	5.0	99.37	10.25	9.62	5.0	99.37	10.25	9.62	5.1	99.94	1.06	1.00

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