儿童近视发生前后的屈光度和眼生物参数变化:安阳儿童眼病研究
Changes in refractive power and ocular biometrics before and after the onset of myopia in children:the Anyang Childhood Eye Study
石梦海 1黄瑛 2李翯 3屠永芳 3李蕾 2康梦田 2魏士飞 2孙芸芸 2尹磊 4王宁利 2李仕明2
作者信息
- 1. 郑州大学人民医院眼科 河南省人民医院眼科 河南省立眼科医院,郑州 450003
- 2. 首都医科大学附属北京同仁医院 北京同仁眼科中心 北京市眼科研究所 北京市眼科学与视觉科学重点实验室,北京 100730
- 3. 安阳市眼科医院,安阳 455000
- 4. 郑州市第一人民医院,郑州 450003
- 折叠
摘要
目的 分析小学生5年间的屈光度和眼生物参数变化趋势,探讨其在近视发生前后的变化规律.方法 采用队列研究方法,以"安阳儿童眼病研究"中的1年级小学生为研究对象,共纳入1 986人,其中男生1 126人,女生860人,均取右眼数据进行分析.每年采用1％环戊通滴眼液进行睫状肌麻痹后电脑验光获得等效球镜度(SE),采用眼生物测量仪测量眼轴长度(AL)、前房深度、晶状体厚度、平均角膜曲率(Km)等,采用Bennett公式计算晶状体屈光力(LP).根据随访时近视发生情况将受检者分为持续近视组、非近视组和新发近视组,又根据发病年龄将新发近视组细分为8岁近视组、9岁近视组、10岁近视组、11岁近视组和12岁近视组,比较各组屈光度和眼生物参数在不同随访时间点的差异.结果 随着年龄增加,所有儿童的屈光度均逐渐向近视漂移、眼轴逐渐增长,各组内相邻随访年龄间SE和AL比较,差异均有统计学意义(均P＜0.05).在相同随访年龄下,近视发生越早,其近视屈光度数越高,AL越长;各相邻组间SE比较差异均有统计学意义(均P＜0.05);8～12岁随访年龄下各相邻组间AL比较,差异均有统计学意义(均P＜0.05).在非近视组,屈光度以缓慢均匀的速度向正视漂移,5年平均SE变化速度为(-0.23±0.27)D/年,AL亦缓慢均匀增长,5年平均增长速度为(0.18±0.13)mm/年;在新发近视组中,近视发生前第3年、第2年和第1年的SE年变化量分别为(-0.32±0.25)、(-0.45±0.33)和(-0.98±0.44)D,AL年增长量分别为(0.25±0.12)、(0.32± 0.15)和(0.48±0.19)mm,SE和AL变化速度均在近视发生前开始加快,并于近视发生后变缓,各近视前后不同时间段SE和AL变化速度总体比较差异均有统计学意义(均P＜0.001).新发近视组中发生近视时男生的AL 为(24.11±0.70)mm,明显长于女生的(23.60±0.66)mm,差异有统计学意义(t=159.71,P＜0.001).LP 随年龄增加而下降,9岁前下降速度较快,9岁后下降速度变缓.持续近视组和8～11岁近视组的LP平均下降速度分别为(-0.48±0.19)、(-0.44±0.20)、(-0.49±0.16)、(-0.51±0.18)、(-0.48±0.19)D/年,明显快于12岁近视组的(-0.42±0.17)D/年和非近视组的(-0.37±0.15)D/年,差异均有统计学意义(均P＜0.05).各组不同随访年龄Km比较差异均无统计学意义(均P＞0.05).结论 AL在儿童近视发生的前3年内开始加速增长,在近视发生后增长速度逐渐变缓,但仍明显快于非近视儿童;在此过程中,LP下降起到一定的代偿作用,Km无显著变化.相同年龄下男生发生近视时的AL比女生长.AL是近视防控的重要指标,评估时要考虑性别差异,更要关注AL的增长速度.
Abstract
Objective To analyze the trends in refractive error and ocular biological parameters in elementary school students over 5 years,and to investigate the patterns of change before and after myopia onset.Methods A cohort study was adopted.A total of 1 986 first-grade students from the Anyang Childhood Eye Study were enrolled in this cohort study and their right eye data were taken for analysis,including 1 126 boys and 860 girls.Every year,cycloplegic autorefraction was performed with 1％cyclopentolate eyedrops to obtain the spherical equivalent(SE).The axial length(AL),anterior chamber depth,lens thickness,mean corneal curvature(Km)and other parameters were obtained by ocular biometry.The lens refractive power(LP)was calculated using the Bennett formula.The subjects were assigned to persistent myopia group,non-myopia group and new onset myopia group.According to the age of myopia onset,the new onset myopia group was subdivided into the 8-,9-,10-,11-and 12-year-old myopia groups to compare the differences in refractive error and ocular bioparameters among groups at different time points of follow-up.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Beijing Tongren Hospital,Capital Medical University(No.TRECKY2018-030).Written informed consent form was obtained from the guardians of each subject.Results All children had a gradual SE drift toward myopia and a gradual increase in the AL with age,and there were significant differences in SE and AL between adjacent follow-up ages within the three groups(all at P＜0.05).The earlier the onset of myopia,the higher the myopia SE and the longer the AL of the eye at the same follow-up age,the differences in SE between adjacent groups were statistically significant(all at P＜0.05),and the differences in AL between adjacent groups at the follow-up age of 8 to 12 years were statistically significant(all at P＜0.05).In the nonmyopia group,SE drifted toward emmetropia at a slow and steady rate of(-0.23±0.27)D/year,and AL also increased slowly and steadily at(0.18±0.13)mm/year.In the new onset myopia group,the changes in SE in the third,second,and first years before myopia onset were(-0.32±0.25),(-0.45±0.33),and(-0.98±0.44)D,and the increases in AL were(0.25±0.12),(0.32± 0.15),and(0.48±0.19)mm,respectively.Both SE and AL change rates began to accelerate before myopia onset and slowed down after myopia onset,with statistically significant differences in the overall comparison of SE and AL change rates at different time intervals before and after myopia onset(all at P＜0.001).The AL at myopia onset in boys was(24.11±0.70)mm,which was longer than(23.60±0.66)mm in girls(t=159.71,P＜0.01).LP decreased with age in all groups,with a faster rate before the age of 9 years and a slower rate after the age of 9 years.The mean decrease rate in LP was(-0.48±0.19),(-0.44±0.20),(-0.49±0.16),(-0.51±0.18),and(-0.48±0.19)D/year in the persistent myopia group and 8～11-year-old myopia group,respectively,which were significantly faster than-0.42±0.17 D/year in 12-year-old myopia group and(0.37±0.15)D/year in nonmyopia group(all at P＜0.05).There was no statistically significant difference in Km among groups at different follow-up ages(all at P＞0.05).Conclusions The AL begins to grow at an accelerated rate 3 years before myopia onset,and the increase rate of the AL slows down after the onset of myopia,but it is still significantly faster than that of non-myopic children.In this process,the decrease in LP plays a compensatory role;there is no significant change in corneal curvature.The AL of males at the onset of myopia is longer than that of females at the same age.AL is an important indicator for the prevention and control of myopia.It is important to consider gender differences and to pay more attention to the growth rate when assessing AL.
关键词
近视/屈光度/眼生物参数/眼轴长度/晶状体屈光力/眼/儿童/纵向研究Key words
Myopia/Refractive power/Biological parameters,ocular/Axial length/Lens power/Eye/Child/Longitudinal studies引用本文复制引用
基金项目
国家重点研发计划(2022YFC3502502)
国家自然科学基金(82071000)
北京市自然科学基金杰出青年科学基金(JQ20029)
河南省医学科技攻关计划联合共建项目(LHGJ20210073)
郑州市科技惠民项目(2021KJHM0009)
出版年
2024
NETL
NSTL
万方数据