目的：基于2021版美国斜视与小儿眼科协会(AAPOS)《儿童视力筛查指南》，修订SPOT屈光筛查仪在6岁以下儿童的转诊标准，并评估其准确性。

方法：纳入2022-01/2023-04在南京市雨花台区妇幼保健所就诊的儿童，进行SPOT屈光筛查仪、睫状肌麻痹检影验光等检查，并根据AAPOS指南定义具有弱视危险因素(ARFs)及有临床意义屈光不正(VSRE)的目标人群。使用受试者工作曲线计算最佳转诊标准，并与厂商标准、吴标准、Peterseim标准进行对比。

结果：共有959名儿童接受检查，其中<4岁组342人，≥4岁组617人。<4岁组的最佳转诊标准为：近视≤-2.75D、远视≥+2.25D、散光≤-2.75D、屈光参差≥1.00D； ≥4岁组为近视≤-1.75D、远视≥+2.00D、散光≤-2.25D、屈光参差≥1.00D； 其约登指数分别为0.38与0.52，均高于其他标准。

结论：采用新的6岁以下儿童屈光筛查转诊标准，其准确性较高，优于既往其他标准，能为儿童眼保健工作提供有益参考。

METHODS: Children who visited the Maternal and Child Health Center of Yuhuatai District in Nanjing city from January 2022 to April 2023 were included in the study and underwent SPOT refractive screening, cycloplegic retinoscopy, and other examinations. Abnormal children were defined according to AAPOS guidelines with amblyopia risk factors(ARFs)and visually significant refractive error(VSRE). Receiver operating characteristic(ROC)curve was used to calculate the optimal referral criteria and compared with manufacturer criteria, Wu's criteria, and Peterseim's criteria.

RESULTS: A total of 959 children were examined, with 342 in the <4-year-old group and 617 in the ≥4-year-old group. The optimal referral criteria for the <4-year-old group were myopia ≤-2.75 D, hyperopia ≥+2.25 D, astigmatism ≤-2.75 D, and anisometropia ≥1.00 D. For the ≥4-year-old group, the criteria were myopia ≤-1.75 D, hyperopia ≥+2.00 D, astigmatism ≤-2.25 D, and anisometropia ≥1.00 D. The Youden index was 0.38 and 0.52, respectively, which were higher than other criteria.

CONCLUSION: The use of new referral criteria for refractive screening in children under 6 years old demonstrates higher accuracy compared to previous criteria. It provides valuable guidance for pediatric eye care and vision health in children.