Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Ophthalmology & Visual Sciences, Beijing, China.
Industrial Engineering and Operations Research, University of California, Berkeley, California, United States.
Invest Ophthalmol Vis Sci. 2023 Aug 1;64(11):4. doi: 10.1167/iovs.64.11.4.
The purpose of this study was to describe the baseline refractive error, habitual accommodative tone (HAT) in Tibetan children and its longitudinal association with incident myopia and myopia progression.
This was a prospective cohort study. From 7 elementary schools, 1440 children with mean age of 6.83 ± 0.46 years were included with full noncycloplegic and cycloplegic refraction data at baseline, 1-year and 2-year follow-up in the Lhasa Childhood Eye Study. Noncycloplegic and cycloplegic automated refraction were performed at baseline and annually over the next 2 years. HAT was measured as the difference in spherical equivalent (DSE) between noncycloplegic and cycloplegic refraction.
The mean HAT decreased from a baseline value of 0.92 ± 0.82 diopters (D) to 0.55 ± 0.65 D, P < 0.0001 at 2 years. In multivariable logistic regression models, only baseline spherical equivalent (SE; P < 0.0001) was significantly (negatively) associated with 1- and 2-year incident myopia. Among 1386 children without myopia at baseline, 271 developed myopia over 2 years. For hyperopic children, baseline HAT was significantly associated with the incidence of myopia over 2 years (odds ratio [OR] = 0.43, P < 0.001), and the incidence of myopia was significantly lower with baseline HAT ≥0.5 D, compared to children <0.5 D. For 54 (3.75%) children who were myopic at baseline, SE was significant positively associated with myopic progression in univariable (P = 0.03) and multivariable general mixed linear regression analysis (P = 0.03).
Baseline SE was an independent influencing factor for the incidence of myopia and its progression. The incidence of myopia was significantly higher with lower baseline HAT among hyperopic children, indicating that lower HAT was potentially associated with myopic development.
本研究旨在描述藏族儿童的基础屈光度、习惯性调节幅度（HAT），以及其与近视发生和近视进展的纵向关联。
这是一项前瞻性队列研究。在拉萨儿童眼研究中，从 7 所小学招募了 1440 名平均年龄为 6.83 ± 0.46 岁的儿童，在基线、1 年和 2 年随访时进行了全面的非睫状肌麻痹和睫状肌麻痹屈光检查。在基线时和随后的 2 年内每年进行非睫状肌麻痹和睫状肌麻痹自动验光。HAT 测量为非睫状肌麻痹和睫状肌麻痹屈光度之间的球镜等效差（DSE）。
HAT 平均值从基线时的 0.92 ± 0.82 屈光度（D）下降到 2 年时的 0.55 ± 0.65 D，P < 0.0001。在多变量逻辑回归模型中，只有基线时的球镜等效值（SE；P < 0.0001）与 1 年和 2 年的近视发生率显著（负）相关。在 1386 名基线时无近视的儿童中，271 名在 2 年内发展为近视。对于远视儿童，基线 HAT 与 2 年内近视的发生率显著相关（优势比[OR] = 0.43，P < 0.001），与基线 HAT < 0.5 D 的儿童相比，基线 HAT ≥0.5 D 的儿童近视发生率显著降低。对于 54 名（3.75%）基线时近视的儿童，在单变量（P = 0.03）和多变量一般混合线性回归分析（P = 0.03）中，SE 与近视进展显著正相关。
基线 SE 是近视发生和进展的独立影响因素。在远视儿童中，基线 HAT 越低，近视发生率越高，表明较低的 HAT 可能与近视发展有关。
