Prevalence of myopia and consistency evaluation of three myopia assessment methods among children and adolescents
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摘要:
目的 评价筛查性近视、非睫状肌麻痹客观验光近视以及睫状肌麻痹客观验光近视3种方法界定儿童青少年近视检出率及其一致性，为探讨不同界定方法一致性的影响因素提供参考。 方法 纳入2020年9月山东省一项基于学校的横断面研究中7所学校3 868名6~17岁的儿童青少年，分析筛查性近视、非睫状肌麻痹客观验光近视以及睫状肌麻痹客观验光近视在不同年龄和总体儿童青少年中的检出率，以睫状肌麻痹后等效球镜≤-0.50 D为近视金标准，采取Kappa检验和ROC曲线下面积对一致性进行评价。 结果 儿童青少年睫状肌麻痹客观验光近视率和筛查性近视率分别为36.7%和38.3%。非睫状肌麻痹客观验光近视率为62.4%，且该方法测试的小学和初中的近视率高于筛查性和睫状肌麻痹客观验光。3 868名受试者中，筛查性近视、非睫状肌麻痹客观验光近视与近视金标准结果一致的人数分别有3 628(93.8%)和2 862名(74.0%)，受试者与近视金标准结果一致，Kappa值分别为0.87和0.51，ROC曲线下面积分别为0.94(95%CI=0.93~0.95)和0.79(95%CI=0.78~0.81)；与其他亚组相比，8~17岁、初中和高中、居住在城市、日常生活视力足矫、散光度≤1.50 D的儿童青少年应用筛查性近视的一致性较高(P值均＜0.05)。 结论 筛查性近视与睫状肌麻痹客观验光近视的一致性较高，非睫状肌麻痹客观验光近视的一致性较低。 Abstract:Objective To evaluate the prevalence and consistency of screening myopia, non-cycloplegic myopia and cycloplegic myopia in children and adolescents, and to provide references for exploring the factors affecting the consistency of different definition methods. Methods A total of 3 868 children and adolescents aged 6 to 17 years from seven schools were included in a school-based cross-sectional study in Shandong Province in September 2020. The prevalence of screening myopia, non-cycloplegic refraction, and cycloplegic refraction at different ages and all children and adolescents were analyzed. With cycloplegic spherical equivalent ≤-0.50 D as the gold standard for myopia, and Kappa test and area under the ROC curve were used to evaluate the consistency. Results The prevalence of cycloplegic myopia and screening myopia were 36.7% and 38.3% among children and adolescents. The prevalence of non-cycloplegic myopia was 62.4%, which was significantly higher than screening myopia and cycloplegic myopia two methods in primary and junior high schools. Among 3 868 subjects, there were 3 628 (93.8%) subjects with screening myopia and 2 862 (74.0%) subjects with non-cycloplegic myopia who were consistent with the gold standard for myopia. The Kappa values of screening myopia and non-cycloplegic myopia were 0.87 and 0.51, and the area under the ROC curve was 0.94 (95%CI=0.93-0.95) and 0.79 (95%CI=0.78-0.81). Compared with other groups, children and adolescents aged 8 to 17 years, in junior or high school, urban residence, better presenting distance visual acuity, and astigmatism ≤1.50 D had a higher consistency in the application of screening myopia (P < 0.05). Conclusion The consistency between screening myopia and cycloplegic myopia is high, and the consistency between non-cycloplegic objective myopia is low. -
Key words:
- Myopia /
- Prevalence /
- Vision screening /
- Child /
- Adolescent
1) 利益冲突声明 所有作者声明无利益冲突。2) 徐梓航与胡媛媛为共同第一作者。 -
图 1 不同年龄组儿童青少年3种方法界定近视检出率
Figure 1. The prevalence of myopia according to three methods in different age
表 1 3种方法界定不同组别儿童青少年近视的一致性分析
Table 1. Analysis of consistency of three methods in defining myopia in children and adolescents with different groups
组别 选项 人数 筛查性近视 非睫状肌麻痹客观验光近视 一致率/% Kappa值 一致率/% Kappa值 性别 男 1 949 94.10 0.87 74.55 0.52 女 1 919 93.49 0.87 73.42 0.50 年龄/岁 6 546 93.22 0.31 67.40 0.07 7 596 94.63 0.74 67.62 0.26 8 554 93.68 0.81 66.97 0.36 9 450 94.00 0.84 68.44 0.41 10 373 92.49 0.85 75.87 0.54 11 320 92.50 0.85 72.50 0.45 12 301 92.69 0.84 81.06 0.52 13 205 93.17 0.82 85.85 0.53 14 252 94.44 0.83 86.91 0.48 15 103 99.03 0.95 94.18 0.60 16 87 94.25 0.75 93.10 0.54 17 81 98.77 0.88 97.53 0.85 学段 小学 2 542 93.71 0.80 68.73 0.37 初中 1 070 93.18 0.85 81.40 0.51 高中 256 97.27 0.84 95.31 0.63 居住地 城市 2 000 95.00 0.90 77.65 0.57 农村 1 868 92.51 0.83 70.08 0.45 日常生活视力 欠矫 1 283 88.54 0.65 88.54 0.65 足矫 2 585 96.40 0.87 66.77 0.34 散光度/D ≤1.50 3 666 94.41 0.88 73.62 0.51 >1.50 202 82.67 0.63 80.69 0.57 注：P值均<0.01。 
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[1] DOLGIN E. The myopia boom[J]. Nature, 2015, 519(7543): 276-278. doi: 10.1038/519276a [2] HOLDEN B A, FRICKE T R, WILSON D A, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050[J]. Ophthalmology, 2016, 123(5): 1036-1042. doi: 10.1016/j.ophtha.2016.01.006 [3] CHIA A, CHUA W H, CHEUNG Y B, et al. Atropine for the treatment of childhood myopia: safety and efficacy of 0.5%, 0.1%, and 0.01% doses (Atropine for the Treatment of Myopia 2)[J]. Ophthalmology, 2012, 119(2): 347-354. doi: 10.1016/j.ophtha.2011.07.031 [4] SANKARIDURG P, HE X, NADUVILATH T, et al. Comparison of noncycloplegic and cycloplegic autorefraction in categorizing refractive error data in children[J]. Acta Ophthalmol, 2017, 95(7): e633-e640. doi: 10.1111/aos.13569 [5] 郭振, 谢森, 杜显丽, 等. 中国七省份小学生筛查性近视影响因素分析[J]. 中国学校卫生, 2020, 41(12): 1872-1875. doi: 10.16835/j.cnki.1000-9817.2020.12.027GUO Z, XIE S, DU X L, et al. Analysis of influencing factors of screened myopia in primary school students in seven provinces[J]. Chin J Sch Health, 2020, 41(12): 1872-1875. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2020.12.027 [6] 赵堪兴, 杨培增. 眼科学[M]. 8版. 北京: 人民卫生出版社, 2013: 38.ZHAO K X, YANG P Z. Ophthalmology[M]. 8 ed. Beijing: People's Medical Publishing House, 2013: 38. (in Chinese) [7] 中华人民共和国疾病预防控制局. 《儿童青少年近视防控适宜技术指南(更新版)》及解读[EB/OL]. (2021-10-11)[2022-10-10] http://www.nhc.gov.cn/jkj/s5899tg/202110/65a3a99c42a8 4e3f8a11f392d9fea91e.shtml .Bureau of Disease Control and Prevention of the PRC. Guidelines on Appropriate Technology for Prevention and Control of Myopia in Children and Adolescents (updated version) and its interpretation[EB/OL]. (2021-10-11)[2022-10-10].http://www.nhc.gov.cn/jkj/s5899tg/202110/65a3a99c42a8 4e3f8a11f392d9fea91e.shtml .(in Ch-inese)[8] 张凤云, 张锡彦, 杨婕, 等. 儿童青少年近视筛查3种方案比较[J]. 中国学校卫生, 2019, 40(10): 1542-1544. doi: 10.16835/j.cnki.1000-9817.2019.10.029ZHANG F Y, ZHANG X Y, YANG J, et al. A comparative study of 3 types of myopia screening methods among children and adolescents[J]. Chin J Sch Health, 2019, 40(10): 1542-1544. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2019.10.029 [9] FLITCROFT D I, HE M, JONAS J B, et al. IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): M20-M30. doi: 10.1167/iovs.18-25957 [10] FOZAILOFF A, TARCZY-HORNOCH K, COTTER S, et al. Prevalence of astigmatism in 6-to 72-month-old African American and Hispanic children: the multi-ethnic pediatric eye disease study[J]. Ophthalmology, 2011, 118(2): 284-293. doi: 10.1016/j.ophtha.2010.06.038 [11] FANG Y T, CHOU Y J, PU C, et al. Prescription of atropine eye drops among children diagnosed with myopia in Taiwan from 2000 to 2007: a nationwide study[J]. Eye (Lond), 2013, 27(3): 418-424. doi: 10.1038/eye.2012.279 [12] ZHAO J, MAO J, LUO R, et al. Accuracy of noncycloplegic autorefraction in school-age children in China[J]. Optom Vis Sci, 2004, 81(1): 49-55. doi: 10.1097/00006324-200401000-00010 [13] 陈露. 上海市少年儿童屈光发育现状及进展的纵向调查研究[D]. 上海: 复旦大学, 2012.CHEN L. The study of refractive development status and longitudinal changes of children and juveniles in Shanghai[D]. Shanghai: Fudan University, 2012. (in Chinese) [14] ANSTOCE N S, JACOBS R J, SIMKIN S K, et al. Do picture-based charts overestimate visual acuity? Comparison of Kay pictures, Lea symbols, HOTV and Keeler logMAR charts with Sloan letters in adults and children[J]. PLoS One, 2017, 12(2): e0170839. doi: 10.1371/journal.pone.0170839 [15] 中华医学会眼科学分会眼视光学组, 中国医师协会眼科医师分会眼视光专业委员会, 中国非公立医疗机构协会眼科专业委员会视光学组, 等. 近视管理白皮书(2022)[J]. 中华眼视光学与视觉科学杂志, 2022, 24(9): 641-648.Chinese Optometric Association of Chinese Ophthalmological Society, Ophthalmology and Optometry Committee of Ophthalmologists Association of Chinese Doctor Association, Ophthalmology and Optometry Group of Ophthalmologic Committee of Chinese Non-government Medical Institutions Association, et al. Expert consensus on myopia management white paper (2022)[J]. Chin J Optom Ophthalmol Vis Sci, 2022, 24(9): 641-648. (in Chinese) [16] 陈艳艳, 王巍, 刘常明, 等. 小学一、五年级学生视力及屈光状态构成对比分析[J]. 中国斜视与小儿眼科杂志, 2012, 20(1): 14-17. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXS201201005.htmCHEN Y Y, WANG W, LIU C M, et al. Comparative analysis of visual acuity and refractive status structure in pupils of grade 1 and grade 5[J]. Chin J Strabismus Pediatr Ophthalmol, 2012, 20(1): 14-17. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXS201201005.htm [17] 何鲜桂, 朱剑锋, 陆丽娜. 远视力联合小瞳计算机验光法在8岁儿童近视筛查中的应用[J]. 中国学校卫生, 2010, 31(8): 960-962. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201008034.htmHE X G, ZHU J F, LU L N. Combined use of uncorrected visual acuity and noncycloplegic autorefraction for myopia screening in children[J]. Chin J Sch Health, 2010, 31(8): 960-962. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201008034.htm -
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