Two infant vision screening programmes: Prediction and prevention of strabismus and amblyopia from photo- and video refractive screening
Two infant vision screening programmes: Prediction and prevention of strabismus and amblyopia from photo- and video refractive screening
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作者：
Atkinson, J;Braddick, O;Moore, A
在剑桥卫生区的总人口中设计了两个婴儿视力筛查项目，以在7-9个月大时识别、显示斜视以及斜视性和弱视性屈光不正。第一，完成，程序使用各向同性photorefractor与睫状肌麻痹症一起标准的正视检查。第二个，目前，程序使用VRP-1各向同性视频屈光检查仪，以确定婴儿屈光迟滞，随后屈光下睫状肌麻痹。这两个程序显示良好的协议之间的婴儿识别在筛选和视网膜屈光度在后续行动中，表明照片和视频屈光度（有或没有睫状肌麻痹）可以有效的方法来筛选屈光不正的婴儿和幼儿。在每个程序中，5-6%的婴儿表现出异常水平的远视（在任何子午线上大于或等于3.5 D），小于1%的婴儿表现出大于或等于1.5 D的屈光参差;极少数婴儿（0.25%）表现出-3 D或更大的近视。不到1%的人表现出明显的斜视。远视和屈光参差儿童进入一项随机对照试验的部分屈光矫正。筛选时确定的所有儿童以及适当的对照组都将接受广泛随访，直至4岁。第一个项目发现，与对照组相比，婴儿期患有远视的儿童患斜视的可能性高13倍，4岁时表现出可测量的视力缺陷的可能性高6倍。佩戴部分眼镜矫正将这些风险比分别降低至4：1和2.5：1。视力受损可部分归因于持续散光导致的视神经性弱视。在9个月到4岁之间，远视和近视婴儿都表现出正视方向的屈光变化。佩戴部分眼镜矫正并不影响正视化的过程，但确实提供了减少常见学龄前视力问题发生率的可能性。
Two infant vision screening programmes on total populations in the Cambridge Health District have been designed to identify,manifest strabismus and strabismogenic and amblyogenic refractive errors at 7-9 months of age. The first, completed, programme used the isotropic photorefractor with cycloplegia together with a standard orthoptic examination. The second, current, programme uses the VRP-1 isotropic videorefractor to identify infants with accommodative lags which are followed up by refraction under cycloplegia. Both programmes show good agreement between infants identified at screening and retinoscopic refractions at follow-up, showing that photo- and videorefraction (with or without cycloplegia) can be effective methods for screening for ametropia in infants and young children. In each programme 5-6% of infants showed abnormal levels of hyperopia (greater than or equal to 3.5 D in any meridian), less than 1% showed anisometropia greater than or equal to 1.5 D; very few infants (0.25%) showed -3 D myopia or greater. Less than 1% showed manifest strabismus. Hyperopic and anisometropic children entered a randomised controlled trial of partial refractive correction. All children identified at screening, alongside appropriate control groups, are extensively followed up to age 4 years. The first programme has found that children who were hyperopic in infancy were 13 times more likely to become strabismic, and 6 times more likely to show measurable acuity deficits by 4 years, compared with controls. Wearing a partial spectacle correction reduced these risk ratios to 4:1 and 2.5:1 respectively. The impaired acuity can be attributed, in part, to meridional amblyopia resulting from persisting astigmatism. Both hyperopic and myopic infants showed refractive changes in the direction of emmetropia between 9 months and 4 years. Wearing a partial spectacle correction did not affect this process of emmetropisation, but does provide the possibility of reducing the incidence of common pre-school vision problems.