文章來源：安研社馬英妍

研究俗觀

通過研究學(xué)齡前兒童屈光及屈光參數(shù)的一年變化，上海市眼病預(yù)防中心趙海東、許昕、何先溪、馬英淵、林林等聯(lián)合澳大利亞李安摩根教授、阿根廷拉斐爾Iri Barren教授等發(fā)表的研究結(jié)果顯示，屈光度0在傳統(tǒng)認(rèn)識(shí)上不能成為直視化的終點(diǎn)。

Ma Y, Lin S, Morgan IG, Rozema JJ, Iribarren R, Zhu J, Zhao R, Zhang B, Yin Y, Shao Y, He X, Xu X, Zou H. Eyes grow towards mild hyperopia rather than emmetropia in Chinese preschool children. Acta Ophthalmol. 2021 May 3. doi: 10.1111. Epub ahead of print. PMID: 33942521.

研究目的

研究正常學(xué)齡前兒童屈光及屈光參數(shù)一年的變化及變化規(guī)律。

研究方法

在上海市城鄉(xiāng)結(jié)合區(qū)，隨機(jī)納入7所幼兒園，納入其中3-5歲，小班及中班兒童，并隨訪一年?；€研究在2014年11月至12月間展開，隨訪在2015年11月至12月間展開。眼軸采用IOL Master 5.02測(cè)量。納入研究的兒童也接受了裂隙燈、眼壓、散瞳、及散瞳后的屈光度數(shù)、角膜曲率檢查及主覺驗(yàn)光。經(jīng)眼科醫(yī)師評(píng)判后，認(rèn)為可以接受散瞳驗(yàn)光的兒童，予以散瞳檢查。眼軸、屈光度數(shù)、角膜曲率均取三次測(cè)量平均值。由于沒有測(cè)量前房深度和晶體厚度，因此，我們采用第二主焦點(diǎn)的方法對(duì)晶體度數(shù)進(jìn)行估算。研究采用右眼數(shù)據(jù)進(jìn)行分析。由于考慮嚴(yán)重屈光不正眼屈光發(fā)育的規(guī)律可能與正常眼不同，因此，本研究將患有嚴(yán)重屈光不正的眼排除，僅納入正常眼進(jìn)入分析，即屈光度數(shù)的SE在-0.5D至+3.0D范圍內(nèi)，散光度數(shù)的絕對(duì)值小于2D的眼。

研究結(jié)果

基線時(shí)，共903名兒童接受了散瞳檢查。其中，857名兒童（94.9%）接受了隨訪，其中613人（67.9%）在隨訪時(shí)散瞳。

就整體而言，一年時(shí)間內(nèi)，僅眼軸和晶體屈光力發(fā)生了顯著變化。眼軸的改變隨著年齡的增長有變慢的趨勢(shì)。晶體屈光力的變化也隨著年齡的增加而減少。球鏡、柱鏡、等效球鏡及角膜曲率在各年齡組間，一年內(nèi)均沒有顯著改變。

基線屈光度數(shù)對(duì)個(gè)體層面屈光力改變的影響：基線屈光力與屈光力的改變具有顯著線性相關(guān)性。當(dāng)基線SE在1.25D左右時(shí)，1年內(nèi)SE的改變約為0D。當(dāng)基線SE＞1.25D時(shí)，SE改變更多發(fā)生近視漂移；而當(dāng)基線SE＜1.25D時(shí)，SE改變更多發(fā)生遠(yuǎn)視漂移。無論在3，4，5歲組，基線SE均與SE改變存在線性相關(guān)。

此外，基線SE與眼軸或者角膜曲率的改變未表現(xiàn)出顯著相關(guān)?；€SE與晶體屈光力的改變，在5歲兒童組，表現(xiàn)出顯著相關(guān)：基線SE越小，晶體屈光力的減少越多。

多元回歸的結(jié)果顯示：采用穩(wěn)健回歸，調(diào)整了性別和年齡后，基線SE與SE改變顯著相關(guān)?；€SE增加1D，SE的改變就減少0.15D。采用bootstrap法得到，當(dāng)基線SE為1.05D時(shí)，SE改變?yōu)?D?；貧w結(jié)果也顯示，基線SE與眼軸的改變沒有相關(guān)性（p=0.957），與角膜曲率變化也沒有相關(guān)（p=0.263）。而基線SE與晶體屈光力變化存在相關(guān)性（p=0.013）。

結(jié)論與啟示

本研究得到，對(duì)于正常兒童，雖然在整體層面3-5歲兒童，一年內(nèi)SE沒有顯著變化，但在個(gè)體層面上，由于眼軸及晶體屈光力的變化，SE仍處于活躍的改變中，而SE的改變與基線SE顯著相關(guān)。當(dāng)基線SE小于1D時(shí)，晶體屈光力的減少會(huì)大于眼軸的增長帶來的屈光力改變，導(dǎo)致SE遠(yuǎn)視漂移；然而當(dāng)基線SE大于1D時(shí)，晶體屈光力的減少會(huì)小于眼軸的增長帶來的屈光力改變，導(dǎo)致SE近視漂移。本研究得到的正常學(xué)齡前兒童屈光變化的模式，結(jié)果佐證了人類正視化的過程，即保持輕度遠(yuǎn)視作為正視化的終點(diǎn)，而非屈光度數(shù)為0作為傳統(tǒng)認(rèn)識(shí)上正視化的終點(diǎn)。本文也細(xì)致地展示了在3-5歲年齡段的兒童正視化的過程，及屈光發(fā)育的過程中是如何將屈光度數(shù)保持在輕度遠(yuǎn)視的機(jī)制。

參考文獻(xiàn)

1.Atchison DA & Smith G (2000): Optics of the human eye. Oxford: Butterworth-Heinemann. 2.Cook RCGR (1951): Refractive and ocular fifindings in the newborn. Am J Ophthalmol 34: 1407–1413.3.Dirani M, Chan YH, Gazzard G et al. (2010): Prevalence of refractive error in Singaporean Chinese children: the strabismus, amblyopia, and refractive error in young Singaporean Children (STARS) study. Invest Ophthalmol Vis Sci 51: 1348–1355. 4.Ehrlich DL, Atkinson J, Braddick O, Bobier W & Durden K (1995): Reduction of infant myopia: a longitudinal cycloplegic study. Vision Res 35: 1313–1324. 5.Ehrlich DL, Braddick OJ, Atkinson J, Anker S, Weeks F, Hartley T, Wade J & Rudenski A (1997): Infant emmetropization: longitudinal changes in refraction components from nine to twenty months of age. Optom Vis Sci 74: 822–843. 6.Giordano L, Friedman DS, Repka MX, Katz J, Ibironke J, Hawes P & Tielsch JM (2009): Prevalence of refractive error among preschool children in an urban population: the Baltimore Pediatric Eye Disease Study. Ophthalmology 116: 739–746,46 e1–4. 7.Grosvenor T & Goss DA (1998): Role of the cornea in emmetropia and myopia. Optom Vis Sci 75: 132–145.8.Guo X, Fu M, Ding X, Morgan IG, Zeng Y & He M (2017): Signifificant axial elongation with minimal change in refraction in 3- to 6- year-old Chinese preschoolers: The Shenzhen Kindergarten Eye Study. Ophthalmology 124: 1826–1838. 9.Iribarren R (2015): Crystalline lens and refractive development. Prog Retin Eye Res 47: 86–106. 10.Iribarren R, Morgan IG, Chan YH, Lin X & Saw SM (2012): Changes in lens power in Singapore Chinese children during refractive development. Invest Ophthalmol Vis Sci 53: 5124–5130. 11.Lan W, Zhao F, Lin L, Li Z, Zeng J, Yang Z & Morgan IG (2013): Refractive errors in 3–6 year-old Chinese children: a very low prevalence of myopia? PLoS One 8: e78003. 12.Ma Y, Qu X, Zhu X et al. (2016): Age-specifific prevalence of visual impairment and refractive error in children aged 3–10 years in Shanghai, China. Invest Ophthalmol Vis Sci 57: 6188–6196. 13.Ma Y, Zou H, Lin S et al. (2018): Cohort study with 4-year follow-up of myopia and refractive parameters in primary schoolchildren in Baoshan District, Shanghai. Clin Exp Ophthalmol 46: 861–872. 14.Mayer DL, Hansen RM, Moore BD, Kim S & Fulton AB (2001): Cycloplegic refractions in healthy children aged 1 through 48 months. Arch Ophthalmol 119: 1625–1628. 15.Morgan IG, Rose KA & Ellwein LB (2010): Is emmetropia the natural endpoint for human refractive development? An analysis of population-based data from the refractive error 6 Acta Ophthalmologica 2021study in children (RESC). Acta Ophthalmol 88: 877–884. 16.Multi-Ethnic Pediatric Eye Disease Study Group (2010): Prevalence of myopia and hyperopia in 6- to 72-month-old African American and Hispanic children: the multiethnic pediatric eye disease study. Ophthalmology 117: 140–147 e3. 17.Mutti DO, Mitchell GL, Jones LA, Friedman NE, Frane SL, Lin WK, Moeschberger ML & Zadnik K (2005): Axial growth and changes in lenticular and corneal power during emmetropization in infants. Invest Ophthalmol Vis Sci 46: 3074–3080. 18.Mutti DO, Sinnott LT, Lynn Mitchell G, Jordan LA, Friedman NE, Frane SL & Lin WK (2018): Ocular component development during infancy and early childhood. Optom Vis Sci 95: 976–985. 19.Pai AS, Wang JJ, Samarawickrama C, Burlutsky G, Rose KA, Varma R, Wong TY & Mitchell P (2011): Prevalence and risk factors for visual impairment in preschool children the sydney paediatric eye disease study. Ophthalmology 118: 1495–1500. 20.Retzlaffff JA, Sanders DR & Kraffff MC (1990): Development of the SRK/T intraocular lens implant power calculation formula. J Cataract Refr Surg 16: 333–340. 21.Rozema JJ, Herscovici Z, Snir M & AxerSiegel R (2018): Analysing the ocular biometry of new-born infants. Ophthalmic Physiol Opt 38: 119–128. 22.Saunders KJ, Woodhouse JM & Westall CA (1995): Emmetropisation in human infancy: rate of change is related to initial refractive error. Vision Res 35: 1325–1328. 23.Thorn F, Gwiazda J & Held R (2005): Myopia progression is specifified by a double exponential growth function. Optom Vis Sci 82: 286–297. 24.Twelker JD, Mitchell GL, Messer DH et al. (2009): Children’s ocular components and age, gender, and ethnicity. Optom Vis Sci 86: 918–935. 25.Wen G, Tarczy-Hornoch K, McKean-Cowdin R et al. (2013): Prevalence of myopia, hyperopia, and astigmatism in non-Hispanic white and Asian children: multi-ethnic pediatric eye disease study. Ophthalmology 120: 2109–2116. 26.Wood IC, Hodi S & Morgan L (1995): Longitudinal change of refractive error in infants during the fifirst year of life. Eye (Lond) 9(Pt 5): 551–557. 27.Xiang F, He M & Morgan IG (2012): Annual changes in refractive errors and ocular components before and after the onset of myopia in Chinese children. Ophthalmology 119: 1478–1484.

關(guān)注眼健康，我們是專業(yè)的

有陽光 有未來 防控近視科普常識(shí)”已經(jīng)以口袋書、宣傳海報(bào)等多種形式開始發(fā)放給廣大兒童青少年、家長及教師，希望廣大家長、教師朋友共同參與，助力科學(xué)防控近視，讓孩子們擁有一個(gè)光明的未來。同時(shí)我們也聯(lián)合“北京眼視光學(xué)會(huì)”共同創(chuàng)立了科普抖音號(hào)，為廣大的家長、教師朋友提供移動(dòng)信息科普，讓大家可以隨時(shí)獲得最新的眼健康常識(shí)，在這里我們也會(huì)不定期的邀請(qǐng)王凱醫(yī)生等知名眼科專家為大家共同科普。

敬請(qǐng)期待下期資訊，關(guān)注今日頭條【北京大學(xué)人民醫(yī)院眼視光中心】，為您解決心里的煩惱，歡迎留言、評(píng)論，謝謝