State Key Laboratory of Ophthalmology and Division of Preventive Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Invest Ophthalmol Vis Sci. 2014 Jan 7;55(1):154-61. doi: 10.1167/iovs.13-13250.
We assessed the prevalence and predictors of inaccurate refractive error among rural refractionists in western China.
A subset of primary school children with visual acuity (VA) ≤6/12 in ≥1 eye, undergoing subjective refinement by local refractionists after cycloplegic autorefraction in an ongoing population-based study, received repeat refraction by university optometrists for quality control.
Among 502 children (mean age 10.5 years, 53.2% girls), independent predictors of poor (inaccurate by ≥1.0 diopter [D]) refraction by 21 rural practitioners (66.7% with high school or lower education) included hyperopia (odds ratio [OR], 4.2; 95% confidence interval [CI], 2.4-7.3, P < 0.001), astigmatism (OR = 3.8; 95% CI, 2.5-5.6; P < 0.001) and VA uncorrectable to >6/12 by the rural refractionist (OR = 4.7; 95% CI, 3.1-7.3; P = < 0.001). Among 201 children whose vision was uncorrectable in ≥1 eye by the rural refractionists, vision could be improved to >6/12 by the university optometrist in 110 (54.7%). We estimate vision could be so improved in 9.1% of all children refracted by these rural refractionists. A reason for inaccuracy in this setting is the erroneous tendency of rural refractionists to adjust instrument values for accommodation, even under cycloplegia.
Rural refractionists in western China have little formal training and frequently fail to optimize VA among children, even when autorefractors are used. Training is needed emphasizing better use of automated refraction, particularly in children with astigmatism and hyperopia.
我们评估了中国西部农村验光师中不准确的屈光不正的患病率和预测因素。
在一项正在进行的基于人群的研究中，对一只或多只视力（VA）≤6/12 的小学生进行睫状肌麻痹自动验光后，由当地验光师进行主观细化，其中一部分小学生接受了大学视光师的重复验光，以进行质量控制。
在 502 名儿童（平均年龄 10.5 岁，53.2%为女孩）中，21 名农村从业者（66.7%具有高中或以下学历）进行的不准确（相差≥1.0 屈光度[D]）折射的独立预测因素包括远视（优势比[OR]，4.2；95%置信区间[CI]，2.4-7.3，P <0.001）、散光（OR = 3.8；95% CI，2.5-5.6；P <0.001）和农村验光师无法将 VA 矫正至>6/12（OR = 4.7；95% CI，3.1-7.3；P = <0.001）。在 201 名农村验光师认为至少一只眼视力无法矫正的儿童中，大学视光师可将 110 名（54.7%）儿童的视力改善至>6/12。我们估计，在这些农村验光师验光的所有儿童中，有 9.1%的儿童视力可以得到改善。在这种情况下出现不准确的一个原因是农村验光师在睫状肌麻痹下为适应调整仪器值的错误倾向。
中国西部农村的验光师几乎没有接受过正规培训，即使使用自动验光仪，他们也经常无法优化儿童的视力。需要进行培训，强调更好地使用自动验光，特别是在有散光和远视的儿童中。
