Al-Romhein Philip, Fröhlich Monika, Schmickler Stefanie, Salchow Daniel J
Augen-Zentrum-Nordwest MVZ, Ahaus, Deutschland.
Klinik für Augenheilkunde, Sektion Kinderaugenheilkunde | Strabologie/Orthoptik | Neuroophthalmologie, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
Ophthalmologie. 2022 Oct;119(10):1035-1040. doi: 10.1007/s00347-022-01645-z. Epub 2022 May 4.
Amblyopia is the most frequent cause for decreased vision in childhood. Important risk factors for amblyopia (ARF) are refractive errors. The aim of this study was to examine the reliability of the Plusoptix Autorefractor A09 (POA09) to detect refractive ARF.
This prospective non-blinded, one-armed study was conducted between February 2012 and September 2015. Children aged 6 months to 12 years were screened in kindergarten and schools for refractive errors. Thresholds for screening failure were hyperopia ≥ 3.5 diopters (D), myopia ≥ 3.0 D, anisometropia ≥ 1.5 D and astigmatism ≥ 1.5 D (axis 90° or 180° ± 10°) or ≥ 1.0 D (≥ 10° axis deviation of 90° or 180°). Children who failed screening were advised to see an ophthalmologist for a comprehensive eye examination. After the visit, parents were asked for the results of the examination. A reference group of children who did not fail screening also received a comprehensive eye examination. Based on the number of children who failed screening, we calculated the proportion of correctly detected refractive errors. Based on the children of the reference group we calculated the proportion of correctly excluded refractive errors and the false negative rate.
In this study 3170 children were screened, 715 children (22.3%) failed screening. For 460 of these (64.3%) follow-up was available and for 132 children information on refractive errors in cycloplegia was available. Most frequent refractive errors at screening were astigmatism (90.9%) and anisometropia (11.4%). Most frequent refractive errors in cycloplegia were astigmatism (56.8%) and hyperopia (18.9%). The proportion of correctly detected refractive errors in the screening was highest for astigmatism (60%) and anisometropia (53.3%), followed by hyperopia (33.3%) and myopia (25%).
The reliability of POA09 to detect refractive ARF in children without cycloplegia was limited, highlighting the importance of a systematic amblyopia screening. A screening in cycloplegia can increase the proportion of correctly detected refractive ARF and should be studied.
弱视是儿童视力下降的最常见原因。弱视的重要危险因素（ARF）是屈光不正。本研究的目的是检验Plusoptix自动验光仪A09（POA09）检测屈光性ARF的可靠性。
这项前瞻性非盲单臂研究于2012年2月至2015年9月进行。在幼儿园和学校对6个月至12岁的儿童进行屈光不正筛查。筛查失败的阈值为远视≥3.5屈光度（D）、近视≥3.0 D、屈光参差≥1.5 D以及散光≥1.5 D（轴位90°或180°±10°）或≥1.0 D（90°或180°轴位偏差≥10°）。筛查失败的儿童被建议去看眼科医生进行全面的眼部检查。就诊后，询问家长检查结果。未筛查失败的儿童参考组也接受了全面的眼部检查。根据筛查失败的儿童数量，我们计算出正确检测出的屈光不正比例。根据参考组的儿童，我们计算出正确排除屈光不正的比例和假阴性率。
本研究共筛查了3170名儿童，715名儿童（22.3%）筛查失败。其中460名（64.3%）有随访结果，132名儿童有睫状肌麻痹下屈光不正的信息。筛查时最常见的屈光不正为散光（90.9%）和屈光参差（11.4%）。睫状肌麻痹下最常见的屈光不正为散光（56.8%）和远视（18.9%）。筛查中正确检测出的屈光不正比例以散光（60%）和屈光参差（53.3%）最高，其次是远视（33.3%）和近视（25%）。
POA09在未使用睫状肌麻痹剂的情况下检测儿童屈光性ARF的可靠性有限，突出了系统性弱视筛查的重要性。使用睫状肌麻痹剂进行筛查可提高正确检测出的屈光性ARF的比例，值得进一步研究。
