6～11岁儿童眼球生物学参数的分布及对屈光状态的影响
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摘要
目的了解学龄儿童眼轴长度(axial length,AL)、角膜曲率半径(corneal radius of curvature,CR)等眼球参数分布情况,探讨屈光状态的影响因素,并评估眼球生物学参数对屈光发育的监测作用。方法纳入重庆市永川区6～11岁学龄儿童共1 768例,采用AL-Scan测量AL、角膜曲率(corneal curvature,K),角膜白到白(white-to-white,WTW),中央角膜厚度(central corneal thickness,CCT),使用1%环喷托酯散瞳验光后,所有右眼根据等效球镜度数(spherical equivalent,SE)分为远视、正视、近视3组,分析不同年龄、不同屈光组之间各参数的关系以及眼部参数对屈光状态的影响。结果1 768名学生的AL、K、AL/CR、WTW、CCT、SE分别为(23. 17±0. 86) mm、(43. 22±1. 41) D、2. 97±0. 10、(11. 92±0. 42) mm、(558. 27±31. 86)μm、(0. 26±1. 26) D。与女生比较,男生的AL增长(0. 49 mm),AL/CR比值增大(0. 1),WTW增长(0. 18 mm),CCT增厚(6. 31μm),K值降低(0. 71D),差异均有统计学意义(P <0. 001)。AL、CR、AL/CR在不同屈光状态组间差异均有统计学意义(P <0. 01),近视组AL、AL/CR最大,且AL/CR均值大于3;近视组CR最小。AL与CR呈正相关(r=0. 571,P <0. 001),SE与AL/CR、AL、CR的相关系数分别为-0. 802、-0. 609和0. 106 (P <0. 001)。在不同年龄组中,SE与AL、AL/CR的相关性随年龄增加呈增强趋势。在不同屈光状态组中,SE与AL、AL/CR的相关性在近视组最强。多元线性回归显示:AL/CR、AL以及性别均对SE有影响(P <0. 05)。结论重庆市永川区6～11岁学龄儿童眼球生长发育过程中AL变化较明显,不同性别儿童眼球发育存在差异; SE与AL、AL/CR、性别均存在相关性,其中AL/CR对屈光改变影响最大,对近视发生、发展的监测具有一定的临床意义。
Objective To investigate the distribution of axial length( AL),corneal radius of curvature( CR) and other ocular biological parameters in 6 ～ 11-year-old school-age children,and to explore the influencing factors for refractive status and evaluate the monitoring effect of above parameters on refractive development. Methods A total of 1 768 children aged 6 to 11 years,resident in Yongchuan District,Chongqing were enrolled in this study. Their AL,corneal curvature( K),white to white( WTW),and central corneal thickness( CCT) were measured by AL-Scan. After pupillary dilatation with 1%cyclopentanlol,cycloplegic retinoscopy was performed for refractive status. According to the spherical equivalent( SE), all right eyes were divided into myopia, hyperopia and emmetropia groups. The relationships of above parameters among different age groups and among different refractive groups and their effect on refractive status were analyzed. Results The mean AL,K,AL/CR,WTW,CCT and SE were23. 17 ± 0. 86 mm,43. 22 ± 1. 41 D,2. 97 ± 0. 10,11. 92 ± 0. 42 mm,558. 27 ± 31. 86 μm,and 0. 26 ±1. 26 D,respectively in the 1 768 students. Compared with the girls,the boys had significantly longer AL( 0. 49 mm),greater AL/CR( 0. 1),larger WTW( 0. 18 mm),thicker CCT( 6. 31 μm),and smaller K( 0. 71 D)( P < 0. 001). There were statistically differences in AL,CR,AL/CR among different refractive status groups( P < 0. 01). The myopia group had the largest AL and AL/CR,and mean AL/CR greater than3; but smallest CR. AL was positively correlated with CR( r = 0. 571,P < 0. 001),and the correlation coefficients of SE with AL/CR ratio,AL and CR were-0. 802,-0. 609 and 0. 106( P < 0. 001),respectively. In different age groups,the correlation coefficients of SE with AL and AL/CR ratio were increased with age. In the different refractive statuses,the correlation of SE with AL and AL/CR was the strongest in the myopia group. Multiple linear regression analysis showed that AL/CR,AL,and gender all had effect on SE( P < 0. 05). Conclusion Significant alteration in AL is seen during the growth and development of eyeballs in 6 ～ 11-year-old school-age children among school-age children in the Yongchuan District of Chongqing City. There are significant differences in eyeball development between boys and girls; SE is associated with AL,AL/CR and gender. AL/CR ratio can explain most of the total variance in SE and have clinical significance for the monitoring of the development of myopia.
Objective To investigate the distribution of axial length( AL),corneal radius of curvature( CR) and other ocular biological parameters in 6 ～ 11-year-old school-age children,and to explore the influencing factors for refractive status and evaluate the monitoring effect of above parameters on refractive development. Methods A total of 1 768 children aged 6 to 11 years,resident in Yongchuan District,Chongqing were enrolled in this study. Their AL,corneal curvature( K),white to white( WTW),and central corneal thickness( CCT) were measured by AL-Scan. After pupillary dilatation with 1%cyclopentanlol,cycloplegic retinoscopy was performed for refractive status. According to the spherical equivalent( SE), all right eyes were divided into myopia, hyperopia and emmetropia groups. The relationships of above parameters among different age groups and among different refractive groups and their effect on refractive status were analyzed. Results The mean AL,K,AL/CR,WTW,CCT and SE were23. 17 ± 0. 86 mm,43. 22 ± 1. 41 D,2. 97 ± 0. 10,11. 92 ± 0. 42 mm,558. 27 ± 31. 86 μm,and 0. 26 ±1. 26 D,respectively in the 1 768 students. Compared with the girls,the boys had significantly longer AL( 0. 49 mm),greater AL/CR( 0. 1),larger WTW( 0. 18 mm),thicker CCT( 6. 31 μm),and smaller K( 0. 71 D)( P < 0. 001). There were statistically differences in AL,CR,AL/CR among different refractive status groups( P < 0. 01). The myopia group had the largest AL and AL/CR,and mean AL/CR greater than3; but smallest CR. AL was positively correlated with CR( r = 0. 571,P < 0. 001),and the correlation coefficients of SE with AL/CR ratio,AL and CR were-0. 802,-0. 609 and 0. 106( P < 0. 001),respectively. In different age groups,the correlation coefficients of SE with AL and AL/CR ratio were increased with age. In the different refractive statuses,the correlation of SE with AL and AL/CR was the strongest in the myopia group. Multiple linear regression analysis showed that AL/CR,AL,and gender all had effect on SE( P < 0. 05). Conclusion Significant alteration in AL is seen during the growth and development of eyeballs in 6 ～ 11-year-old school-age children among school-age children in the Yongchuan District of Chongqing City. There are significant differences in eyeball development between boys and girls; SE is associated with AL,AL/CR and gender. AL/CR ratio can explain most of the total variance in SE and have clinical significance for the monitoring of the development of myopia.
引文
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[15] TEASDALE T W,GOLDSCHMIDT E. Myopia and its relationship to education,intelligence and height:Preliminary results from an on-going study of Danish draftees[J]. Acta Ophthalmol Suppl,1988,185:41-43. DOI:10. 1111/j.1755-3768. 1988. tb02660. x.
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[18] GARNER L F,YAP M K,KINNEAR R F,et al. Ocular dimensions and refraction in Tibetan children[J]. Optom Vis Sci,1995,72(4):266-271. DOI:10. 1097/00006324-199504000-00007.
[19]卓德义,肖林.基于人群的角膜在正视与近视中变化的流行病学研究[J].国际眼科杂志,2017,17(3):454-457. DOI:10. 3980/j. issn. 1672-5123. 2017. 3. 16.ZHUO D Y,XIAO L. Change of the cornea in emmetropia and myopia in population-based epidemiological studies[J].Int Eye Sci,2017,17(3):454-457. DOI:10. 3980/j.issn. 1672-5123. 2017. 3. 16.
[20]陈镇国,陈茂冲,张加裕,等.学龄期儿童屈光状态影响因素的调查与分析[J].中华眼科杂志,2016,52(11):831-835. DOI:10. 3760/cma. j. issn. 0412-4081. 2016. 11. 006.CHEN Z G,CHEN M C,ZHANG J Y,et al. Analysis of the influence factors of school-age children’s refractive status[J]. Chin J Ophthalmol,2016,52(11):831-835.DOI:10. 3760/cma. j. issn. 0412-4081. 2016. 11. 006.
[21] HE X,ZOU H,LU L,et al. Axial length/corneal radius ratio:association with refractive state and role on myopia detection combined with visual acuity in Chinese school children[J]. PLo S ONE,2015,10(2):e0111766. DOI:10.1371/journal. pone. 0111766.
[22]王弘,赵珂珂,渠继芳,等.眼轴与角膜曲率半径比值定性评估青少年儿童近视的准确性[J].中华眼视光学与视觉科学杂志,2016,18(2):108-110. DOI:10. 3760/cma. j.issn. 1674-845X. 2016. 02. 010.WANG H,ZHAO K K,QU J F,et al. The accuracy of the axial length/corneal radius ratio in the diagnosis of myopia in adolescents and children[J]. Chin J Optom Ophthalmol Vis Sci,2016,18(2):108-110. DOI:10. 3760/cma. j. issn.1674-845X. 2016. 02. 010.
[2] MORGAN I G,OHNO-MATSUI K,SAW S M. Myopia[J].Lancet,2012,379(9827):1739-1748. DOI:10. 1016/S0140-6736(12)60272-4.
[3] FOSTER P J,JIANG Y. Epidemiology of myopia[J]. Eye(Lond),2014,28(2):202-208. DOI:10. 1038/eye. 2013.280.
[4] PAN C W,RAMAMURTHY D,SAW S M. Worldwide prevalence and risk factors for myopia[J]. Ophthalmic Physiol Opt,2012,32(1):3-16. DOI:10. 1111/j. 1475-1313.2011. 00884. x.
[5] SAW S M,KATZ J,SCHEIN O D,et al. Epidemiology of myopia[J]. Epidemiol Rev,1996,18(2):175-187.
[6] XU X Q,LI S P,XU Y J,et al. Prevalence of myopia among primary school students in mainland China; a Meta-analysis[J]. Int J Ophthalmol,2016,16(7):1221-1227. DOI:10.3980/j. issn. 1672-5123. 2016. 7. 05.
[7] HE M,ZENG J,LIU Y,et al. Refractive error and visual impairment in urban children in Southern China[J]. Invest Opthalmol Vis Sci,2004,45(3):793-799. DOI:10. 1167/iovs. 03-1051.
[8] XIANG F,HE M,MORGAN I G. Annual changes in refractive errors and ocular components before and after the onset of myopia in Chinese children[J]. Ophthalmology,2012,119(7):1478-1484. DOI:10. 1016/j. ophtha. 2012. 01. 017.
[9] ZHOU W J,ZHANG Y Y,LI H,et al. Five-year progression of refractive errors and incidence of myopia in school-aged children in Western China[J]. J Epidemiol,2016,26(7):386-395. DOI:10. 2188/jea. JE20140258.
[10] GWIAZDA J,NORTON T T,HOU W,et al. Longitudinal changes in lens thickness in myopic children enrolled in the correction of myopia evaluation trial(COMET)[J]. Curr Eye Res, 2016, 41(4):492-500. DOI:10. 3109/02713683. 2015. 1034372.
[11] GUO X,FU M,DING X,et al. Significant axial elongation with minimal change in refraction in 3-to 6-year-old Chinese preschoolers:the Shenzhen kindergarten eye study[J].Ophthalmology,2017,124(12):1826-1838. DOI:10.1016/j. ophtha. 2017. 05. 030.
[12] TWELKER J D,MITCHELL G L,MESSER D H,et al.Children’s ocular components and age,gender,and ethnicity[J]. Optom Vis Sci,2009,86(8):918-935. DOI:10.1097/opx. 0b013e3181b2f903.
[13] WANG D,DING X,LIU B,et al. Longitudinal changes of axial length and height are associated and concomitant in children[J]. Invest Ophthalmol Vis Sci,2011,52(11):7949-7953. DOI:10. 1167/iovs. 11-7684.
[14] ZHANG J,HUR Y M,HUANG W,et al. Shared genetic determinants of axial length and height in children:the Guangzhou twin eye study[J]. Arch Ophthalmol,2011,129(1):63-68. DOI:10. 1001/archophthalmol. 2010. 323.
[15] TEASDALE T W,GOLDSCHMIDT E. Myopia and its relationship to education,intelligence and height:Preliminary results from an on-going study of Danish draftees[J]. Acta Ophthalmol Suppl,1988,185:41-43. DOI:10. 1111/j.1755-3768. 1988. tb02660. x.
[16] SAW S M,CARKEET A,CHIA K S,et al. Component dependent risk factors for ocular parameters in Singapore Chinese children[J]. Ophthalmol,2002,109(11):2065-2071. DOI:10. 1016/S0161-6420(02)01220-4.
[17] ZADNIK K,MANNY R E,YU J A,et al. Ocular component data in schoolchildren as a function of age and gender[J]. Optom Vis Sci,2003,80(3):226-236. DOI:10.1097/00006324-200303000-00012.
[18] GARNER L F,YAP M K,KINNEAR R F,et al. Ocular dimensions and refraction in Tibetan children[J]. Optom Vis Sci,1995,72(4):266-271. DOI:10. 1097/00006324-199504000-00007.
[19]卓德义,肖林.基于人群的角膜在正视与近视中变化的流行病学研究[J].国际眼科杂志,2017,17(3):454-457. DOI:10. 3980/j. issn. 1672-5123. 2017. 3. 16.ZHUO D Y,XIAO L. Change of the cornea in emmetropia and myopia in population-based epidemiological studies[J].Int Eye Sci,2017,17(3):454-457. DOI:10. 3980/j.issn. 1672-5123. 2017. 3. 16.
[20]陈镇国,陈茂冲,张加裕,等.学龄期儿童屈光状态影响因素的调查与分析[J].中华眼科杂志,2016,52(11):831-835. DOI:10. 3760/cma. j. issn. 0412-4081. 2016. 11. 006.CHEN Z G,CHEN M C,ZHANG J Y,et al. Analysis of the influence factors of school-age children’s refractive status[J]. Chin J Ophthalmol,2016,52(11):831-835.DOI:10. 3760/cma. j. issn. 0412-4081. 2016. 11. 006.
[21] HE X,ZOU H,LU L,et al. Axial length/corneal radius ratio:association with refractive state and role on myopia detection combined with visual acuity in Chinese school children[J]. PLo S ONE,2015,10(2):e0111766. DOI:10.1371/journal. pone. 0111766.
[22]王弘,赵珂珂,渠继芳,等.眼轴与角膜曲率半径比值定性评估青少年儿童近视的准确性[J].中华眼视光学与视觉科学杂志,2016,18(2):108-110. DOI:10. 3760/cma. j.issn. 1674-845X. 2016. 02. 010.WANG H,ZHAO K K,QU J F,et al. The accuracy of the axial length/corneal radius ratio in the diagnosis of myopia in adolescents and children[J]. Chin J Optom Ophthalmol Vis Sci,2016,18(2):108-110. DOI:10. 3760/cma. j. issn.1674-845X. 2016. 02. 010.