18~72月龄正常儿童视动性眼球震颤反应视力分布及发育特征

Age-related distribution and developmental characteristics of optokinetic nystagmus-based visual acuity in normal children aged 18-72 months

摘要

目的 基于多中心数据,探索18~72月龄正常儿童视动性眼球震颤反应(OKN)视力的年龄相关分布与发育轨迹特征。方法 本研究为横断面研究。于2024—2025年在8个参与中心招募18~72月龄受试儿童3 118例(其中男童占50.8%,女童49.2%),仅纳入无弱视风险因素的正常儿童,进行包括自动化OKN视力检测在内的综合性眼科检查。年龄按照每6个月的间隔分为10个组进行分析,双眼OKN视力比较采用配对Wilcoxon符号秩检验,Spearman秩相关用于非参数单调趋势检验。结果 OKN视力随年龄呈显著上升趋势(Spearman ρ=0.888,P<0.001)。18月龄时测OKN视力P₅与P₅₀分别为4.3与4.4,至72月龄上升至4.6与4.9。分段线性回归显示OKN视力发育轨迹存在明确的年龄“拐点”:最优断点为36月龄;36月龄前斜率为0.110/每6个月,36月龄后斜率约为0.015/每6个月。分段模型较单线模型拟合显著更优(ΔAIC=514.0,LRT F=560.6,P<2.2×10^-16)。结论 正常儿童OKN视力呈两阶段发育模式:18~36月龄为快速增长期,年龄每增长6个月视力提升约1行,此后进入缓慢提升/平台期。该结果为建立18~72月龄OKN视力参照范围与临床解释提供了依据。

Abstract

Objective To characterize the age-specific distribution and developmental pattern of optokinetic nystagmus (OKN)-based visual acuity in children aged 18-72 months using multicenter data. Methods This multicenter cross-sectional study recruited 3 118 children aged 18-72 months from eight participating centers between 2024 and 2025, including 50.8% boys and 49.2% girls. Only children without identified amblyopia risk factors were included. All participants underwent comprehensive ophthalmic examinations, including automated OKN-based visual-acuity testing. Children were stratified into 10 age groups at 6-month intervals. Interocular differences in OKN-based visual acuity were assessed using the paired Wilcoxon signed-rank test, and monotonic age trends were evaluated using Spearman rank correlation. Results OKN-based visual acuity increased significantly with age (Spearman's ρ=0.888, P<0.001). The 5th and 50th percentile values at 18 months were 4.3 and 4.4, respectively, and increased to 4.6 and 4.9 at 72 months. Piecewise linear regression identified an age-related change point at 36 months. The slope was 0.110 per 6 months before the change point and approximately 0.015 per 6 months thereafter. The piecewise model provided a significantly better fit than the single linear model (ΔAIC=514.0, F=560.6, P<2.2×10^-16). Conclusions OKN-based visual acuity exhibited a two-phase age-related pattern. Values increase rapidly between 18 and 36 months—by approximately one visual-acuity line per 6-month increase in age—and then showed a slower increase or approaches a plateau. These findings provide an empirical basis for establishing age-specific reference values and interpreting OKN-based visual acuity in children aged 18-72 months.

关键词

视力 / 视动性眼球震颤 / 发育 / 百分位数 / 儿童

Key words

visual acuity / optokinetic nystagmus / development / percentile / children

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基金资助

中华预防医学会儿童保健研究项目(39);国家自然科学基金青年科学项目(82003475);江苏省妇幼保健协会科研项目(FYX202340);江苏省人民医院妇幼高质量发展项目(GZL2533)