Congdon Nathan G, Patel Nita, Esteso Paul, Chikwembani Florence, Webber Fiona, Msithini Robert Bongi, Ratcliffe Amy
Chinese University of Hong Kong, Department of Ophthalmology and Visual Sciences, Hong Kong Eye Hospital 3/F, 147K Argyle St., Kowloon, Hong Kong SAR.
Br J Ophthalmol. 2008 Jan;92(1):13-8. doi: 10.1136/bjo.2007.122028. Epub 2007 Jun 25.
To evaluate different refractive cutoffs for spectacle provision with regards to their impact on visual improvement and spectacle compliance.
Prospective study of visual improvement and spectacle compliance.
South African school children aged 6-19 years receiving free spectacles in a programme supported by Helen Keller International.
Refractive error, age, gender, urban versus rural residence, presenting and best-corrected vision were recorded for participants. Spectacle wear was observed directly at an unannounced follow-up examination 4-11 months after initial provision of spectacles. The association between five proposed refractive cutoff protocols and visual improvement and spectacle compliance were examined in separate multivariate models.
Refractive cutoffs for spectacle distribution which would effectively identify children with improved vision, and those more likely to comply with spectacle wear.
Among 8520 children screened, 810 (9.5%) received spectacles, of whom 636 (79%) were aged 10-14 years, 530 (65%) were girls, 324 (40%) had vision improvement > or = 3 lines, and 483 (60%) were examined 6.4+/-1.5 (range 4.6 to 10.9) months after spectacle dispensing. Among examined children, 149 (31%) were wearing or carrying their glasses. Children meeting cutoffs < or = -0.75 D of myopia, > or = +1.00 D of hyperopia and > or = +0.75 D of astigmatism had significantly greater improvement in vision than children failing to meet these criteria, when adjusting for age, gender and urban versus rural residence. None of the proposed refractive protocols discriminated between children wearing and not wearing spectacles. Presenting vision and improvement in vision were unassociated with subsequent spectacle wear, but girls (p < or = 0.0006 for all models) were more likely to be wearing glasses than were boys.
To the best of our knowledge, this is the first suggested refractive cutoff for glasses dispensing validated with respect to key programme outcomes. The lack of association between spectacle retention and either refractive error or vision may have been due to the relatively modest degree of refractive error in this African population.
评估不同的配镜屈光度数临界值对视力改善及配镜依从性的影响。
关于视力改善及配镜依从性的前瞻性研究。
在海伦·凯勒国际组织支持的项目中接受免费眼镜的6至19岁南非学童。
记录参与者的屈光不正、年龄、性别、城乡居住情况、初诊视力及最佳矫正视力。在首次配镜后4至11个月进行的一次未事先通知的随访检查中直接观察眼镜佩戴情况。在单独的多变量模型中检验五种提议的屈光度数临界值方案与视力改善及配镜依从性之间的关联。
确定能有效识别视力得到改善的儿童以及更有可能依从眼镜佩戴的儿童的配镜屈光度数临界值。
在筛查的8520名儿童中，810名（9.5%）获得了眼镜，其中636名（79%）年龄在10至14岁，530名（65%）为女孩，324名（40%）视力改善≥3行，483名（60%）在配镜后6.4±1.5（范围4.6至10.9）个月接受了检查。在接受检查的儿童中，149名（31%）佩戴或携带着眼镜。在调整年龄、性别及城乡居住情况后，近视度数≤ -0.75 D、远视度数≥ +1.00 D以及散光度数≥ +0.75 D的儿童视力改善明显大于未达这些标准的儿童。所提议的屈光方案均无法区分佩戴眼镜和未佩戴眼镜的儿童。初诊视力及视力改善情况与随后的眼镜佩戴无关，但女孩（所有模型中p≤0.0006）比男孩更有可能佩戴眼镜。
据我们所知，这是首个针对配镜关键项目结果进行验证的配镜屈光度数临界值建议。眼镜留存率与屈光不正或视力之间缺乏关联可能是由于该非洲人群屈光不正程度相对较轻。
