Optimising non-cycloplegic screening strategies for early detection of pre-myopia and myopia in young children.

IF 2.8 3区 医学 Q1 OPHTHALMOLOGY
Síofra Harrington, Michael Moore, James Loughman, Ian Flitcroft, Veronica O'Dwyer
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引用次数: 0

Abstract

Purpose: Early detection of myopia is essential to delay its onset and progression. Pre-myopia, defined by an inadequate hyperopic reserve, increases myopia risk in childhood. However, effective screening methods remain limited. This study aimed to develop practical non-cycloplegic screening methods for pre-myopia and myopia in 6- to 7-year-olds to support earlier interventions.

Methods: This cross-sectional study of 621 Irish schoolchildren (mean age: 7.12 ± 0.45 years; 51.8% boys) assessed uncorrected distance visual acuity (UDVA). Cycloplegic spherical equivalent refraction (SER) classified refractive status (myopia: SER ≤ -0.50D; pre-myopia: SER > -0.50 ≤ 0.75D). Pre- and post-cycloplegic SER were measured using the Welch Allyn Spot Vision Screener and Dong-Yang Rekto-ORK 11, respectively. Axial length (AL) and corneal radius (CR) were measured with the Zeiss IOLMaster and parental myopia history via questionnaire. Logistic regression and ROC curves evaluated non-cycloplegic screening methods.

Results: Pre-myopia prevalence was 24.3% (95% confidence intervals (CI): 29.3-36.2), and myopia prevalence was 3.3% (CI: 2.5-5.5). UDVA screening had an area under the curve (AUC) (CI) = 0.72 (0.59-0.86) and 0.42 (0.36-0.47) for detecting myopia and pre-myopia, respectively. For pre-myopia discrimination, non-cycloplegic SER, AL, AL/CR and parental myopia had AUCs of 0.67 (0.62-0.72), 0.67 (0.62-0.72), 0.69 (0.64-0.74) and 0.59 (0.53-0.64), respectively. The best method combined non-cycloplegic SER and AL/CR (AUC = 0.72 (0.67-0.76)). Including UDVA or parental myopia did not improve results. For myopia detection, AUCs were non-cycloplegic SER:0.84 (0.72-0.97), AL:0.88 (0.82-0.95), AL/CR:0.84 (0.75-0.94) and parental myopia:0.62 (0.48-0.75). The best method combined AL and non-cycloplegic SER 0.94 (0.90-0.99). Adding parental myopia did not improve the AUC = 0.93 (0.87-0.99) but adding UDVA achieved an AUC = 0.95 (0.90-0.99).

Conclusion: While UDVA alone provided acceptable discrimination for myopia, it was insufficient for screening pre-myopia. Non-cycloplegic SER alone had relatively poor discrimination for pre-myopia, but its performance improved when combined with the AL/CR ratio. The best results for myopia discrimination were achieved by combining non-cycloplegic SER, axial length and UDVA measures.

优化非睫状体麻痹筛查策略,早期发现幼儿近视前期和近视。
目的:早期发现近视对延缓其发生和发展至关重要。近视前期,定义为远视储备不足,增加儿童近视风险。然而,有效的筛查方法仍然有限。本研究旨在开发实用的非睫状体麻痹筛查方法,以支持6- 7岁儿童近视前期和近视的早期干预。方法:对621名爱尔兰学龄儿童进行横断面研究(平均年龄:7.12±0.45岁;51.8%男孩)评估未矫正距离视力(UDVA)。单眼瘫痪球等效屈光(SER)分类屈光状态(近视:SER≤-0.50D;近视眼前期:SER > -0.50≤0.75D)。分别用Welch Allyn斑点视力筛检仪和Dong-Yang Rekto-ORK 11测量眼瘫前后SER。使用蔡司IOLMaster测量眼轴长(AL)和角膜半径(CR),并通过问卷调查父母近视史。Logistic回归和ROC曲线评价非独眼瘫痪筛查方法。结果:近视前期患病率为24.3%(95%可信区间(CI): 29.3 ~ 36.2),近视患病率为3.3% (CI: 2.5 ~ 5.5)。UDVA筛查检测近视和准近视的曲线下面积(AUC) (CI)分别为0.72(0.59 ~ 0.86)和0.42(0.36 ~ 0.47)。非睫状体麻痹性SER、AL、AL/CR和父母近视的auc分别为0.67(0.62-0.72)、0.67(0.62-0.72)、0.69(0.64-0.74)和0.59(0.53-0.64)。非睫状体瘫痪SER与AL/CR联合的最佳方法(AUC = 0.72(0.67 ~ 0.76))。包括UDVA或父母近视并没有改善结果。对于近视的检测,auc分别为:非睫状体麻痹性SER:0.84 (0.72-0.97), AL:0.88 (0.82-0.95), AL/CR:0.84(0.75-0.94),父母近视:0.62(0.48-0.75)。AL与非独眼瘫痪患者联合使用的最佳方法是SER 0.94(0.90 ~ 0.99)。增加父母近视没有改善AUC = 0.93(0.87 ~ 0.99),但增加UDVA使AUC = 0.95(0.90 ~ 0.99)。结论:单纯UDVA对近视的鉴别效果尚可,但不足以用于近视前期的筛查。单用非单眼截瘫性SER对前近视的辨别能力较差,但结合AL/CR比值时,其辨别能力有所提高。结合非独眼性SER、眼轴长度和UDVA测量,近视识别效果最佳。
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来源期刊
CiteScore
5.10
自引率
13.80%
发文量
135
审稿时长
6-12 weeks
期刊介绍: Ophthalmic & Physiological Optics, first published in 1925, is a leading international interdisciplinary journal that addresses basic and applied questions pertinent to contemporary research in vision science and optometry. OPO publishes original research papers, technical notes, reviews and letters and will interest researchers, educators and clinicians concerned with the development, use and restoration of vision.
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