3~14岁儿童屈光性散光和角膜散光患病率分析^*

Prevalence of Refractive and Corneal Astigmatism in Children Aged 3-14 Years

摘要

目的 调查四川省成都市3~14岁儿童屈光性散光（refractive astigmatism, RA）和角膜散光（corneal astigmatism, CA）患病率。方法 采用随机抽样方法，纳入2024年成都市3个行政区内共500所学校（幼儿园、小学、中学）的学龄儿童散光筛查结果，收集患者基本信息以及非睫状肌麻痹下自动验光仪和眼光学生物测量仪测量的眼部参数信息。仅纳入患者右眼数据进行分析，比较不同年龄段儿童散光均值和散光发生率差异。结果 研究共纳入255 959名成都市3~14岁学龄儿童散光筛查结果，其中RA平均为（-0.56±0.59） D，CA平均为（-1.23±0.62） D，散光类型以顺规散光为主。RA（≤-1.00 D）和CA（≤-1.00 D）患病率分别为18.16%和62.29%。随年龄增长，散光屈光度和患病率呈现不同变化趋势（P<0.001），在3~8岁表现为RA和CA屈光度和患病率随年龄增加逐渐下降或保持稳定，在9~14岁表现为随年龄增加而不断增加。结论 成都市3~14岁学龄儿童RA和CA屈光度以及患病率随年龄变化呈先下降或保持稳定后上升的趋势，中小学阶段散光患病率更高。

Abstract

Objective To investigate the prevalence of refractive astigmatism (RA) and corneal astigmatism (CA) among children aged 3 to 14 years in Chengdu, Sichuan Province, China. Methods Using a random sampling method, astigmatism screening data were collected from school-aged children attending 500 schools, including kindergartens, primary schools, and junior middle schools, located in three administrative districts of Chengdu in 2024. Basic demographic information and ocular biometric parameters measured by noncycloplegic autorefractometry and optical biometry were collected. Only data from the right eye were included in the analysis. The mean astigmatism values and the prevalence of astigmatism were compared across age groups to examine the differences. Results A total of 255 959 school-aged children and adolescents aged 3 to 14 years in Chengdu were included in the analyses. The mean RA was (-0.56 ± 0.59) diopters (D), and the mean CA was (-1.23 ± 0.62) D, with with-the-rule (WTR) astigmatism being the predominant subtype. The prevalence rates of RA (≤ −1.00 D) and CA (≤-1.00 D) were 18.16% and 62.29%, respectively. The magnitude and prevalence of astigmatism exhibited age-dependent trends (P < 0.001). In the group of children aged 3-8 years, both the magnitude and prevalence of RA and CA gradually decreased or remained stable with increasing age, whereas in the 9-to-14-year age group, both the magnitude and prevalence increased progressively with increasing age. Conclusion Among school-aged children and adolescents aged 3 to 14 years in Chengdu, the magnitude and prevalence of RA and CA exhibited an age-dependent pattern characterized by an initial decrease or stabilization followed by a subsequent increase. The prevalence of astigmatism was found to be higher in primary and junior middle school students.

关键词

散光 / 角膜散光 / 患病率

Key words

Astigmatism / Corneal astigmatism / Prevalence

参考文献

[1] Kam K W, Shing E, Zhang Y, et al. Prevalence and severity of astigmatism in children after COVID-19[J]. JAMA Ophthalmol, 2025, 143(5): 393. DOI: 10.1001/jamaophthalmol.2025.0205.

[2] Kee C S. Astigmatism and its role in emmetropization[J]. Exp Eye Res, 2013, 114: 89. DOI: 10.1016/j.exer.2013.04.020.

[3] Harvey E M, Miller J M, Twelker J D, et al. Longitudinal change and stability of refractive, keratometric, and internal astigmatism in childhood[J]. Inves Ophthalmol Vis Sci, 2015, 56(1): 190. DOI: 10.1167/iovs.14-13898.

[4] Namba H, Sugano A, Murakami T, et al. Age-related changes in astigmatism and potential causes[J]. Cornea, 2020, 39(1): S34. DOI: 10.1097/ICO.0000000000002507.

[5] Sun Y, Fu J, Li L, et al. Stereoacuity and its determinants in 7-year-old children: the Lhasa Childhood Eye Study[J]. Graefes Arch Clin Exp Ophthalmol, 2022, 260(2): 599. DOI: 10.1007/s00417-021-05390-y.

[6] Wu S S A, Leung T W. Meridional anisotropy in contrast sensitivity and visual evoked potential in adults with high myopic astigmatism[J/OL]. Front Neurosci, 2024, 18: 1457297. https://doi.org/10.3389/fnins.2024.1457297.

[7] Hsu C C, Lee L C, Chang H C, et al. Comparative outcomes of amblyopia treatment in high astigmatism: stability and sustained improvements[J/OL]. J Clin Med, 2025, 14(10): 3577. https://doi.org/10.3390/jcm14103577.

[8] Zhang Y, He X, Dong W, et al. Prevalence of astigmatism among 99, 515 children in different areas of Xi’an city, China[J/OL]. J Optom, 2025, 18(1): 100538. https://doi.org/10.1016/j.optom.2025.100538.

[9] Zhang L, Zeng L, Ye Y, et al. Refractive and corneal astigmatism in Chinese 4-15 years old children: prevalence and risk factors[J/OL]. BMC Ophthalmol, 2023, 23(1): 449. https://doi.org/10.1186/s12886-023-03201-y.

[10] Pan C W, Ke C, Hu D N, et al. Iris colour and astigmatism among Chinese teenagers[J]. Br J Ophthalmol, 2019, 103(12): 1810. DOI: 10.1136/bjophthalmol-2018-313357.

[11] Yang Z, Lu Z, Shen Y, et al. Prevalence of and factors associated with astigmatism in preschool children in Wuxi city, China[J/OL]. BMC Ophthalmol, 2022, 22(1): 146. https://doi.org/10.1186/s12886-022-02358-2.

[12] Liang D, Du B, Leung T W, et al. Impact of astigmatism on axial elongation in school-age children: a five-year population-based study in Tianjin, China[J/OL]. Invest Ophthalmol Vis Sci, 2024, 65(13): 45. https://doi.org/10.1167/iovs.65.13.45.

[13] Li H, Li S M, Liu L R, et al. Astigmatism and its components in 12-year-old Chinese children: the Anyang Childhood Eye Study[J]. Br J Ophthalmol, 2019, 103(6): 768. DOI: 10.1136/bjophthalmol-2018-312114.

[14] Wang J, Cheng Q E, Fu X, et al. Astigmatism in school students of eastern China: prevalence, type, severity and associated risk factors[J/OL]. BMC Ophthalmol, 2020, 20(1): 155. https://doi.org/10.1186/s12886-020-01425-w.

[15] Huynh S C, Kifley A, Rose K A, et al. Astigmatism in 12-year-old Australian children: comparisons with a 6-year-old population[J]. Invest Ophthalmol Vis Sci, 2007, 48(1): 73. DOI: 10.1167/iovs.06-0263.

[16] Fotouhi A, Hashemi H, Yekta A A, et al. Characteristics of astigmatism in a population of schoolchildren, Dezful, Iran[J]. Optom Vis Sci, 2011, 88(9): 1054. DOI: 10.1097/OPX.0b013e318221727d.

[17] Read S A, Collins M J, Carney L G. A review of astigmatism and its possible genesis[J]. Clin Exp Optom, 2007, 90(1): 5. DOI: 10.1111/j.1444-0938.2007.00112.x.

[18] Wang Z, Huang D, Chen X, et al. Preschool children exhibit evident compensatory role of internal astigmatism in distribution of astigmatism: The Nanjing Eye Study[J/OL]. Invest Opthalmol Vis Sci, 2019, 60(1): 73. https://doi.org/10.1167/iovs.18-24799.

[19] Chu C H G, Kee C S. Effects of optically imposed astigmatism on early eye growth in chicks[J/OL]. PLoS One, 2015, 10(2): e0117729. https://doi.org/10.1371/journal.pone.0117729.

[20] Fan D S P, Rao S K, Cheung E Y Y, et al. Astigmatism in Chinese preschool children: prevalence, change, and effect on refractive development[J]. Br J Ophthalmol, 2004, 88(7): 938. DOI: 10.1136/bjo.2003.030338.

[21] Semeraro F, Forbice E, Nascimbeni G, et al. Ocular refraction at birth and its development during the first year of life in a large cohort of babies in a single center in Northern Italy[J/OL]. Front Pediat, 2020, 7: 539. https://doi.org/10.3389/fped.2019.00539.

[22] Leung T W, Lam A K C, Deng L, et al. Characteristics of astigmatism as a function of age in a Hong Kong clinical population[J]. Optom Vis Sci, 2012, 89(7): 984. DOI: 10.1097/OPX.0b013e31825da156.

[23] Sinjab M M. Introduction to astigmatism and corneal irregularities[M/OL]//SINJAB M M, CUMMINGS A B. Customized Laser Vision Correction. Cham: Springer International Publishing, 2018: 1-64. DOI: 10.1007/978-3-319-72263-4_1.

[24] Shah M, Natarajan S B, Ahmad N. Association of excessive screen time exposure with ocular changes leading to astigmatism in children[J/OL]. PLoS One, 2025, 20(4): e0317961. https://doi.org/10.1371/journal.pone.0317961.

[25] Gong W, Wang J, Zhang B, et al. Cylinder power progression associated with axial length in young children: a two-year follow-up study[J]. Graefes Arch Clin Exp Ophthalmol, 2024, 262(1): 295. DOI: 10.1007/s00417-023-06149-3.

[26] Preechawai P, Amrith S, Wong I, et al. Refractive changes in epiblepharon[J]. Am J Ophthalmol, 2007, 143(5): 835. DOI: 10.1016/j.ajo.2007.01.043.

[27] Wang Y, Mu J, Yang Y, et al. Prevalence and risk factors for astigmatism in 7 to 19-year-old students in Xinjiang, China: a cross-sectional study[J/OL]. BMC Ophthalmol, 2024, 24(1): 116. https://doi.org/10.1186/s12886-024-03382-0.

[28] Lei Y, Chen X, Cheng M, et al. Comparisons of objective and subjective refraction with and without cycloplegia using binocular wavefront optometer with autorefraction and retinoscopy in school-age children[J]. Graefes Arch Clin Exp Ophthalmol, 2023, 261(5): 1465. DOI: 10.1007/s00417-022-05936-8.

基金资助

*四川省科技计划项目(2022YFS0368)

四川大学华西医院学科卓越发展1·3·5工程临床研究基金(2024HXFH043)