Goodman Lucy, Chakraborty Arijit, Paudel Nabin, Yu Tzu-Ying, Jacobs Robert J, Harding Jane E, Thompson Benjamin, Anstice Nicola S
School of Optometry and Vision Science, The University of Auckland, Auckland, New Zealand.
School of Optometry and Vision Science, The University of Waterloo, Waterloo, Ontario, Canada.
Clin Exp Optom. 2018 Jul;101(4):527-534. doi: 10.1111/cxo.12645. Epub 2017 Nov 28.
There is currently insufficient evidence to recommend vision screening for children < 36 months of age. This study assessed the effect of comprehensive vision screening, as well as the sensitivity of age-appropriate vision tests, at two years of age on habitual visual acuity at 4.5 years of age.
Children born at risk of neonatal hypoglycaemia (n = 477) underwent vision assessment at 54 ± 2 months of age including measurement of monocular and binocular habitual visual acuity, assessment of binocularity and stereopsis. Of these children, 355 (74.4 per cent) had also received vision screening at two years of age (mean age = 24± 1 months), while 122 were not screened.
Eighty (16.8 per cent) children were classified as having reduced vision at 4.5 years of age, but the prevalence of reduced vision did not differ between children who had previously been screened at two years of age and those who had not (15.5 per cent versus 20.5 per cent, p = 0.153). However, children with reduced vision at 4.5 years of age were more likely to have had visual abnormalities requiring referral detected at two years of age (p = 0.02). Visual acuity and mean spherical equivalent autorefraction measurements were also worse (higher values) in two-year-old children who were later classified with reduced habitual visual acuity (p = 0.031 and p = 0.001, respectively). Nevertheless, unaided binocular visual acuity, non-cycloplegic refractive error, and stereopsis at two years all showed poor sensitivity and specificity for predicting visual outcomes at 4.5 years of age.
Our findings do not support the adoption of early vision screening in children as current vision tests suitable for use with two-year-old children have poor sensitivity for predicting mild-moderate habitual vision impairment at 4.5 years of age.
目前尚无足够证据推荐对36个月以下儿童进行视力筛查。本研究评估了综合视力筛查以及两岁时适合该年龄段的视力测试对4.5岁时习惯性视力的影响。
有新生儿低血糖风险的477名儿童在54±2个月龄时接受视力评估，包括测量单眼和双眼习惯性视力、双眼视和立体视评估。其中355名（74.4%）儿童在两岁时（平均年龄24±1个月）也接受了视力筛查，122名未接受筛查。
80名（16.8%）儿童在4.5岁时被归类为视力下降，但两岁时接受过筛查的儿童与未接受过筛查的儿童相比，视力下降的患病率无差异（分别为15.5%和20.5%，p = 0.153）。然而，4.5岁时视力下降的儿童在两岁时更有可能被检测出需要转诊的视觉异常（p = 0.02）。后来被归类为习惯性视力下降的两岁儿童的视力和平均球镜等效自动验光测量值也更差（数值更高）（分别为p = 0.031和p = 0.001）。尽管如此，两岁时的裸眼双眼视力、非睫状肌麻痹屈光不正和立体视对预测4.5岁时的视觉结果均显示出较差的敏感性和特异性。
我们的研究结果不支持对儿童进行早期视力筛查，因为目前适用于两岁儿童的视力测试对预测4.5岁时的轻度至中度习惯性视力损害敏感性较差。
