基于列线图建立儿童双眼屈光不均衡的风险因素模型及应用价值探讨*邱明忠，邹美波，赵晨皓，钱汉良（江苏大学附属医院 眼科， 江苏 镇江 212001）

摘要:

目的 探讨儿童双眼屈光不均衡的风险因素。方法 回顾性分析2020年1月—2022年12月在江苏大学附属医院眼科接受视力检查的156例儿童的临床资料，根据检查结果分为屈光正常组82例和屈光不均衡组74例。收集两组儿童的性别、年龄、体质量指数、睡眠时间、用眼时间、阅读距离、眼部家族病史等资料；采用眼科光学生物测量仪和角膜地形图仪等仪器检测两组儿童的视力测试指标，包括眼压、角膜前表面平均屈光力、等效球镜度、眼轴长度、瞳孔直径、功能性光学区、球差和彗差；采用多因素Logistic回归模型分析筛选儿童双眼屈光不均衡的风险因素，构建列线图预测模型，并评价模型的拟合效果。结果 屈光不均衡组儿童的用眼时间更长（P <0.05），眼部疾病家族史比例、双眼眼压、屈光力、等效球镜度、眼轴长度和瞳孔直径的差值及高阶像差均高于屈光正常组（P <0.05），而每日睡眠时间、阅读距离和功能性光学区均低于屈光正常组（P <0.05）。多因素Logistic回归分析结果显示，眼部家族病史［O^R =13.523（95% CI：3.358，54.461）］、睡眠时间［O^R =0.064（95% CI：0.023，0.179］、用眼时间［O^R =21.424（95% CI：6.121，74.983）］、阅读距离［O^R =0.087（95% CI：0.036，0.211）］、眼压差值［O^R =86.960（95% CI：14.687，514.897）］、角膜屈光力差值［O^R =1.736（95% CI：1.043，2.890）］、等效球镜度差值［O^R =12.937（95% CI：4.300，38.925）］、眼轴长度差值［O^R =29.077（95% CI：10.166，83.170）］、瞳孔直径差值［O^R =14.179（95% CI：4.880，41.198）］、功能性光学区差值［O^R =0.495（95% CI：0.291，0.844）］、球差［O^R =68.843（95% CI：16.304，290.687）］、彗差［O^R =2.085（95% CI：1.007，4.318）］均是儿童双眼不均衡的风险因素（P <0.05）。结论 儿童的用眼习惯和眼部检测指标均是影响其双眼屈光不均衡的重要因素，针对这些因素可以及时采取干预措施，防止儿童屈光异常的发生。

Abstract:

Objective To explore the risk factors for bilateral refractive asymmetry in children.Methods A retrospective analysis was conducted on the clinical data of 156 children who underwent visual acuity examination in the Department of Ophthalmology of the Affiliated Hospital of Jiangsu University from January 2020 to December 2022. The children were divided into a normal refraction group (82 cases) and a refractive asymmetry group (74 cases) according to the examination results. Data on gender, age, body mass index, sleep time, eye use time, reading distance, and family history of eye diseases were collected for both groups of children. Optical biometers and corneal topographers were used to measure visual test indexes, including intraocular pressure, corneal average refractive power, equivalent spherical diopter, axial length, pupil diameter, functional optical zone, spherical aberration, and comet aberration. The risk factors for bilateral refractive asymmetry in children were screened using a multivariate logistic regression model, and a column line chart prediction model was constructed to evaluate the fitting effect of the model.Results The children in the refractive asymmetry group had longer eye use time (P < 0.05) and a higher proportion of family history of eye diseases, as well as higher differences in intraocular pressure, refractive power, equivalent spherical diopter, axial length, and pupil diameter between both eyes, and higher-order aberrations than those in the normal refraction group (P < 0.05). However, the daily sleep time, reading distance, and functional optical zone were lower in the refractive asymmetry group than in the normal refraction group (P < 0.05). The multivariate logistic regression model showed that a family history of eye diseases [O^R = 13.523 (95% CI: 3.358, 54.461)], sleep time [O^R = 0.064 (95% CI: 0.023, 0.179)], eye use time [O^R = 21.424 (95% CI: 6.121, 74.983)], reading distance [O^R = 0.087 (95% CI: 0.036, 0.211)], intraocular pressure difference [O^R = 86.960 (95% CI: 14.687, 514.897)], corneal refractive power difference [O^R = 1.736 (95% CI: 1.043, 2.890)], equivalent spherical diopter difference [O^R = 12.937 (95% CI: 4.300, 38.925)], axial length difference [O^R = 29.077 (95% CI: 10.166, 83.170)], pupil diameter difference [O^R = 14.179 (95% CI: 4.880, 41.198)], functional optical zone difference [O^R = 0.495 (95% CI: 0.291, 0.844)], spherical aberration [O^R = 68.843 (95% CI: 16.304, 290.687)], and comet aberration [O^R = 2.085 (95% CI: 1.007, 4.318)] were all risk factors for bilateral refractive asymmetry in children (P < 0.05).Conclusion Children's eye habits and eye examination indicators are important factors affecting bilateral refractive asymmetry. Intervention measures can be taken in a timely manner to prevent children from developing refractive abnormalities.