青少年屈光不正患者扩瞳后验光结果与配镜处方的比较分析

Comparison and analysis of mydriasis optometry and prescription for refractive error in juveniles

摘要:

目的：比较青少年屈光不正患者扩瞳后电脑验光、扩瞳后试镜与配镜处方的差异，探讨青少年屈光不正验光配镜的重点和注意事项。

方法：选取334例青少年屈光不正患者(包括212例近视和122例远视)，进行扩瞳后电脑验光并试镜，恢复自然瞳孔后再试镜确定配镜处方。回顾性分析扩瞳后电脑验光、扩瞳后试镜和配镜处方之间的差异。

结果：扩瞳后电脑验光和扩瞳后试镜之间，总体数据中球镜和轴向的差异具有统计学意义(P<0.05)，近视组中球镜、柱镜和轴向的差异均具有统计学意义(P<0.05)，远视组中轴向的差异具有统计学意义(P<0.05)。总体数据和远视组中，扩瞳后电脑验光、扩瞳后试镜与配镜处方的球镜和轴向的差异有统计学意义(P<0.05)。远视组中扩瞳后电脑验光和扩瞳后试镜的球镜均大于配镜处方，且扩瞳后试镜与配镜处方柱镜的差异也有统计学意义(P<0.05)。近视组中扩瞳后电脑验光与配镜处方的球镜、柱镜和轴向的差异均有统计学意义(P<0.05)，扩瞳后试镜与配镜处方的柱镜和轴向的差异均有统计学意义(P<0.05)。Bland-Altman分析提示，无论屈光性质，扩瞳后电脑验光和扩瞳后试镜的球镜、柱镜存在较好一致性，二者之间的差异在临床上可以接受，而轴向的一致性则较差。Bland-Altman分析提示，总体数据和远视组中，扩瞳后电脑验光、扩瞳后试镜分别与配镜处方的球镜和轴向的一致性较差，柱镜则存在较好一致性。近视组中扩瞳后电脑验光、扩瞳后试镜分别与配镜处方的球镜、柱镜具有较好的一致性，轴向的一致性则较差。

结论：扩瞳后电脑验光、扩瞳后试镜结果均不能作为配镜处方。扩瞳后电脑验光与扩瞳后试镜之间的差异有统计学意义，二者的球镜、柱镜存在较好的临床一致性。扩瞳后电脑验光和扩瞳后试镜的轴向不具有一致性，二者与配镜处方的一致性也较差。所以复光试镜时要加强对轴向的反复验证。

Abstract:

AIM:To compare the results of computer optometry and manifest refraction after mydriasis and prescription for refractive error in juveniles and explore the emphasis and notes of juvenile optometry.

METHODS: Totally 334 ametropic eyes of juveniles(including 212 myopic eyes and 122 hypermetropic eyes)were examined with computer optometry and manifest refraction after mydriasis. The manifest refraction was done again after the pupil recovered to obtain the prescription for refractive error. The results of computer optometry and manifest refraction after mydriasis and prescriptions for refractive error were compared and analyzed retrospectively.

RESULTS: When comparing computer optometry and manifest refraction after mydriasis, the differences of spherical power and cylindrical axis in general group, the differences of spherical power, cylindrical power and axis in myopia group and cylindrical axis in hyperopia group were all statistically significant(P<0.05). The differences of spherical power and cylindrical axis between computer optometry and manifest refraction after mydriasis and prescriptions in general and hyperopia group were statistically significant(P<0.05). The spherical power of computer optometry and manifest refraction after mydriasis in hyperopia group was greater than that of prescription and there was statistically significant difference in cylindrical power between manifest refraction after mydriasis and prescription(P<0.05). In myopia group the differences in spherical power, cylindrical power and axis between computer optometry after mydriasis and prescription were statistically significant(P<0.05)and the differences in cylindrical power and axis between manifest refraction after mydriasis and prescription were statistically significant(P<0.05). The Bland-Altman analysis in three groups showed the good consistency of spherical and cylindrical power between computer optometry and manifest refraction after mydriasis and that the differences between them were acceptable clinically. It also showed the poor consistency of cylindrical axis between them. The Bland-Altman analysis in general and hyperopia groups showed the poor consistency of spherical power and cylindrical axis and the good consistency of cylindrical power between computer optometry and manifest refraction after mydriasis and prescription. In myopia group the spherical and cylindrical power between computer optometry and manifest refraction after mydriasis and prescription revealed good consistency and the cylindrical axis presented poor consistency.

CONCLUSION: The results of computer optometry and manifest refraction after mydriasis cannot be used as prescription. There was statistically significant difference between computer optometry and manifest refraction after mydriasis, but the spherical and cylindrical power between them revealed good consistency clinically. The cylindrical axis between computer optometry and manifest refraction after mydriasis presented poor consistency and so did the cylindrical axis between them and prescription. In conclusion, the cylindrical axis should be paid much attention to in optometry and glasses taking.