2019-2024 年以行政辖区小学生人群为基础的近视情况调查

A population-based survey of myopia on primary school students in an administrative district， 2019 to 2024

摘要

目的：描述2019年小学生近视患病率和等效球镜度数情况，并对比分析其在2020年及2024年的变化情况，以获得相关基础数据并探究视屏时间变化对视力的潜在影响，为相关部门制定有针对性的近视防控措施提供参考数据。方法：本研究为横断面研究，对象为 2019 年（基线时期）、2020年（视屏时间增加期）、2024年（视屏时间恢复期）视力筛查的全部小学生，年级、性别、视力与屈光检查数据均来自筛查数据库。应用 FKR-710 电脑验光仪在未散瞳状态下进行屈光检查，获得球镜度数和柱镜度数；应用 K238-AZ 液晶视力表检测裸眼远视力。等效球镜度数=球镜度数＋ 1/2× 柱镜度数；近视定义为任意一眼裸眼远视力<5.0且该眼等效球镜度数 ⩽-0.50 D。采用百分比、均数及 95% 置信区间（confidence interval，CI）描述近视患病率和等效球镜度数，采用卡方检验和单因素方差分析比较不同年份近视患病率和等效球镜度数差异，再按年级分层分析。结果：共筛查小学生183204名，2019年45294名、2020年52922名和2024年84988名。2019年近视患病率为 $30.8\mathrm{\%}\text{ }(95\mathrm{\%}\mathit{C}\mathit{I}:30.4\mathrm{\%},31.2\mathrm{\%})$ ，男生 28.4% (27.8%,29.0%) 、女生 $33.7\mathrm{\%}\text{ }(33.1\mathrm{\%},34.3\mathrm{\%})\text{ }(\mathit{P}<0.001)$ ；一年级 11.0% (10.4%,11.6%) ，二至六年级 35.7% (35.2%,36.2%) ，呈随年级而升高的趋势（P<0.001）。2020年近视患病率为 35.1% ，较2019年上升 4.3 (3.7,4.9)  个百分点 (P<0.001); 2024 年为 41.8% ，较2020年继续惯性上升6.7（6.2，7.2）个百分点（P<0.001）。分年级看，与2019年相比，2020年一年级升幅最大；与2020年相比，2024年一年级惯性升幅最小。此外，对等效球镜度数的定量分析显示，2020年等效球镜度数（-0.72 D）较2019年下降 0.21D(0.19D ， $0.23\mathrm{D}\left)\text{ }\right(\mathit{P}<0.001)\text{ }$ ，2024年等效球镜度数 (-0.68D) 较2020年回升 $0.04\mathrm{D}(0.02\mathrm{D},0.06\mathrm{D})(\mathit{P}<0.001)$ ；按年级分层显示一年级学生2024年（0.08 D）已接近2019年水平（0.09 D）。结论：研究地区小学生2019年近视患病率为 30.8% ，高于全球水平，接近美国的两倍、德国的四倍，提示小学生近视防控工作依旧面临挑战。2020年和2024年近视患病率高于2019年；低年龄组2020年升幅最大，2024年惯性升幅最小且定量的等效球镜度数已恢复至2019年水平，但高年龄组则不然，提示视屏时间增加等生活习惯变化影响小学生近期视力，低龄学生眼球结构具有可塑性，对负性暴露较敏感并且脱离暴露后又易于恢复，具体机制有待进一步研究。此外，小学生近视患病率女生高于男生且随年级而上升的特点与既往研究结果一致。 [关键词]视力筛查；近视；等效球镜度数；学校；学生

Abstract

Objective：To describe the myopia prevalence and spherical equivalent among primary school students in a district of Anhui Province in 2019，to analyze their changes in 2020 and 2024，to ob-tain baseline data，and to explore the potential impact of changes in screen time on vision，providing scientific evidence for myopia prevention and control strategies. Methods：This cross-sectional study included all the primary school students who underwent vision screening in 2019 （baseline period）， 2020 （period of increased screen time），and 2024 （period of slightly resumed screen time）.Data on grade， gender，uncorrected distance visual acuity，and refraction were extracted from the screening database. Noncycloplegic refraction was assessed using an FKR-710 autorefractor to measure sphere and cylinder， and uncorrected distance visual acuity was assessed using an K238-AZ LCD visual acuity chart.The spherical equivalent was calculated as sphere +0.5× cylinder.Myopia was defined as uncorrected dis- tance visual acuity<5.0 in either eye with a corresponding spherical equivalent ⩽-0.50D.Myopia prevalence and spherical equivalent were described using percentage and mean with 95％confidence inter- val (CI).The Chi-square test and One-way analysis of variance were used to compare myopia prevalence and spherical equivalent across different years，followed by stratified analysis by grade. Results：A total of 183204 students were screened： 45294 in 2019， 52922 in 2020，and 84988 in 2024.In 2019，the myopia prevalence was 30.8%(95%CI:30.4%,31.2%），higher in girls (33.7%) than in boys （28.4%）and increased with grade（P<0.001），rising from 11.0% in Grade 1 to 35.7% in Grades 2-6.Compared with 2019，the myopia prevalence in 2020 increased by 4.3（3.7，4.9）percentage points to 35.1%(P<0.001).By 2024，it further increased by 6.7(6.2,7.2) percentage points from the 2020 level to 41.8%(P<0.001).In grade-stratified analyses，compared with 2019，Grade 1 students showed the largest increase in 2020 ；compared with 2020，Grade 1 students showed the smallest subsequent increase in 2024.Quantitative analysis of spherical equivalent showed that the mean spherical equivalent in 2020 was-0.72 D，representing a myopia shift of-0.21 D（-0.23 D，-0.19 D） compared with the 2019 level (P<0.001) ；by 2024，the mean spherical equivalent was -0.68 D ，in- dicating a hyperopic shift of 0.04D(0.02D,0.06D) compared with the 2020 level (P<0.001). Further grade-stratified analyses indicated that the mean spherical equivalent for Grade 1 students in 2024 （0.08 D）had nearly returned to the 2019 level（0.09 D）. Conclusion：The myopia prevalence among primary school students in the study area was 30.8% in 2019，higher than the global level and approxi- mately twice that of the United States and four times that of Germany，indicating that myopia prevention and control among primary school students remains challenging.The myopia prevalence in 2020 and 2024 was higher than in 2019，suggesting that lifestyle changes，such as increased screen time，affect the short-term visual status.Younger students experienced the greatest increase in myopia prevalence in 2020 and the mildest subsequent increased in 2024，and their spherical equivalent in 2024 had almost recovered to the 2019 level，but not for older students.These findings indicate greater ocular plasticity in younger students，i.e.more sensitive to negative exposures and easier to recover after removing such ex- posures，warranting further investigation on the underlying mechanisms.Additionally，patterns of higher myopia prevalence in girls than in boys and a gradual increase with grade support previous studies，also enhancing the reliability of the relevant results in our study.

Key words

Vision screening / Myopia / Spherical equivalent / School / Students

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基金资助

北大医学-阜阳妇儿临床转化研究联合实验室项目