基于防控的北京市学龄儿童近视眼早期预警指标的筛选及干预研究

How to intervene the onset and progression of myopia in school-age children early and effective is an important project which needs to be solved urgently. In terms of public health economics, we have to explore the parameters with high sensibility and specificity for myopia control except central refraction，which can only presents the degree of myopia, but cannot predict the onset and progression of myopia in early stage. The present study will conduct an epidemic survey to investigate 1000 primary student aimed to myopia control. Eye examinations contain visual acuity, central refraction, peripheral refraction, ocular biometry and fundus photograph. Questionnaire includes regular items, nearwork, social-economic information, outdoor activity, et al. By verifying the associations between refraction, ocular biometry, outdoor activity and parapapillary atrophy in order to explore the early-warning parameter of myopia through the baseline and follow-up study. The present study aims to screen the children who have the tendency of myopia from comprehensive ocular biometry combined with subject items. Then targeted intervention measurements can be taken to control myopia. In our precious survey, it is found that nonmyopia has a higher level of outdoor activity than myopia and inferred a protective effect against myopia engagement in outdoor activity. However, the intervention study was lacking in China and abroad. The present study aims to validate the effectiveness by increasing outdoor activity during 3 years follow up, which has huge social and economic benefits and provides more powerful evidence for the formulation of myopia control policy.

如何早期、有效的对学龄儿童进行近视干预是亟待解决的重要课题，从卫生-经济学的角度讲，近视防控首先要找到敏感性、特异性都较高的评价指标，而不能仅仅局限于屈光度，其只能显示近视的严重性而无法早期预示近视倾向及发展。本研究以近视防控为目的，通过视力、屈光度测定、眼球生物参数测量、问卷调查、眼底视盘旁萎缩弧分析等手段，经过基线调查以及干预随访，找出学龄儿童近视的早期预警信号，在其屈光度未改变前筛选出具有近视倾向的儿童，从而进行更有针对性的干预。通过前期调查发现，近视儿童的户外活动时间明显低于非近视儿童，推测户外活动对近视具有潜在的保护作用，但目前国内外尚缺乏户外活动的干预研究。本课题将增加户外活动时间作为干预手段，通过三年的随访，进一步验证其有效性，达到近视防控的目的。因此，该研究具有重大的社会、经济效益，可为我国近视防控政策的制定提供更有利的证据

近视眼是全世界尤其是我国患病率最高的屈光不正，是影响青少年成长的重大问题之一。本课题通过对学龄儿童的流行病学随访，用全面的眼球生物参数代替单一的屈光度，期望找出近视早期预警指标，筛选出近视发生的高危人群。结果显示学龄儿童β区萎缩弧发生率44.5%， 5年累计发生率为37.1%。其主要出现在视盘颞侧，面积平均为0.17±0.29mm2，最宽处平均长度为0.11±0.15mm。β区萎缩弧的面积与较长的室内学习时间、较长的眼轴、较高的屈光度明显相关。β区萎缩弧的患病率、发病率明显升高，与青少年近视流行趋势一致，颞侧宽度的增加可能与视盘扭转相关，提示在眼球的轴性增长过程中视盘受到颞侧周边巩膜的牵拉力。倾斜视盘的发生率与较大年龄、较大的β区萎缩弧面积、较小的柱镜屈光度相关。北京儿童的倾斜视盘发生率6.6%明显高于成人、及澳大利亚同年龄段儿童，而低于悉尼同年龄儿童，与近视发病趋势相同，同时与视盘旁萎缩弧面积具有良好相关性。2011年基线黄斑视盘距离平均为4.98±0.3mm，2016年为6.11±0.5mm。城区、郊区黄斑视盘距离的增长分别为1.24±0.34 mm和0.99±0.26 mm。黄斑视盘距离的增加与较大的屈光度进展、较长的眼轴增长、较大的β区萎缩弧宽度增加以及较多的室内学习时间相关。黄斑视盘距离在屈光度进展、眼轴增长中起重要作用，为眼球近视化机制提供了更多的证据。随访发现，男性、女性儿童眼轴长度的增长分别为1.15±0.56 mm和1.10±0.63mm。郊区、城区儿童眼轴长度的增长分别为0.84±0.56 mm和1.32 ± 0.54mm。眼轴增长与较少的户外活动时间、较多的室内学习时间、父亲近视相关。近视累计发病率为35.1%。等效球镜度增加−0.92±1.51D。户外活动时间、近距离用眼时间和父母近视情况在儿童屈光度进展、眼轴增长、轴率比增长方面起重要作用。视盘旁萎缩弧、倾斜视盘、视盘黄斑距离等眼底形态学参数及其变化与眼轴增长、近视发病率、屈光度进展明确相关，可以作为防控近视的客观评价指标。