Su Han, Fu Jing, Chen Weiwei, Meng Zhaojun, Li Lei, Dai Wei, Yao Yao
Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology & Visual Sciences Key Laboratory, Beijing, China.
Beijing Institute of Ophthalmology, Beijing, China.
J Ophthalmol. 2020 Dec 24;2020:9570908. doi: 10.1155/2020/9570908. eCollection 2020.
The study aims to explore the prevalence of heterophoria and associate factors in Tibetan grade-one students.
The Lhasa Childhood Eye Study (LCES) is a school-based cohort study. 1942 grade-one students from 7 elementary schools were randomly sampled by stratified cluster sampling. Ocular examinations were performed in participants, including ocular motility, distance and near visual acuity, cycloplegic autorefraction, and stereoacuity. The near (33 cm) and distance (6 m) fixation cover test was used to differentiate orthophoria, heterophoria, and heterotropia, and the magnitude of the phoria was measured by the Maddox rod and prisma.
Of 1856 grade-one students completing all the ocular examinations, 1852 participants finished the ocular alignment test. The mean age was 6.82 ± 0.46 years (range 6∼10 years); 981 (52.97%) were males, and 871 (47.03%) were females. The prevalence of phoria was 22.89% ( = 424). At distance fixation, the prevalence of heterophoria, exophoria, and esophoria was 4.64%, 4.21%, and 0.43% separately, while at near fixation, the prevalence was 22.73%, 22.35%, and 0.38%. No vertical phoria was detected. The mean magnitude of heterophoria at near and distance fixation was -7.63 ± 5.15 PD (exo: -7.83 ± 4.91 PD, eso: +5.67 ± 3.61 PD) and -4.84 ± 5.94 PD (exo: -6.26 ± 4.20 PD, eso: +8.13 ± 3.04 PD). The prevalence of esophoria was associated with hyperopia (OR = 6.38, 95% CI: 1.15-35.28, = 0.03; OR = 5.42, 95% CI: 1.04-28.24, = 0.04) and amblyopia (OR = 16.02, 95% CI: 1.81∼141.96, = 0.01; OR = 11.37, 95% CI: 1.34∼96.52, = 0.03) at near and distance fixation. The prevalence of exophoria was associated with myopia at near fixation (OR = 2.43, 95% CI: 1.47-4.00, <0.01). In the near heterophoria group, the proportion of children with abnormal stereoacuity was 23.26% ( = 97), significantly higher ( = 5.70, = 0.017) than that in orthophoria (17.99%, = 244).
In Lhasa, grade-one pupils have a lower prevalence of heterophoria. Near exophoria was associated with myopia, while esophoria was related to hyperopia and amblyopia both near and distance. Heterophoria may be one of the affected factors for reducing stereoacuity.
本研究旨在探讨藏族一年级学生隐斜视的患病率及其相关因素。
拉萨儿童眼病研究（LCES）是一项基于学校的队列研究。通过分层整群抽样从7所小学随机抽取1942名一年级学生。对参与者进行眼科检查，包括眼动、远视力和近视力、睫状肌麻痹验光以及立体视锐度。采用近（33厘米）和远（6米）注视遮盖试验来区分正位视、隐斜视和显斜视，并使用马多克斯杆和棱镜测量隐斜视的度数。
在完成所有眼科检查的1856名一年级学生中，1852名参与者完成了眼位检查。平均年龄为6.82±0.46岁（范围6至10岁）；男性981名（52.97%），女性871名（47.03%）。隐斜视的患病率为22.89%（n = 424）。在远距离注视时，外隐斜视、外斜视和内隐斜视的患病率分别为4.64%、4.21%和0.43%，而在近距离注视时，患病率分别为22.73%、22.35%和0.38%。未检测到垂直隐斜视。近距离和远距离注视时隐斜视的平均度数分别为-7.63±5.15棱镜度（外隐斜：-7.83±4.91棱镜度，内隐斜：+5.67±3.61棱镜度）和-4.84±5.94棱镜度（外隐斜：-6.26±4.20棱镜度，内隐斜：+8.13±3.04棱镜度）。近距离和远距离注视时，内隐斜视的患病率与远视相关（比值比[OR]=6.38，95%置信区间[CI]：1.15至35.28，P = 0.03；OR = 5.42，95% CI：1.04至28.24，P = 0.04）以及与弱视相关（OR = 16.02，95% CI：1.81至141.96，P = 0.01；OR = 11.37，95% CI：1.34至96.52，P = 0.03）。近距离注视时，外隐斜视的患病率与近视相关（OR = 2.43，95% CI：1.47至4.00，P < 0.01）。在近距离隐斜视组中，立体视锐度异常的儿童比例为23.26%（n = 97），显著高于正位视组（17.99%，n = 244）（P = 5.70，P = 0.017）。
在拉萨，一年级学生隐斜视的患病率较低。近距离外隐斜视与近视相关，而内隐斜视在近距离和远距离均与远视及弱视相关。隐斜视可能是降低立体视锐度的影响因素之一。
