Page 109 - 中国全科医学2022-30

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method to reverse myopia in children. Therefore，it is important to standardize the screening for ametropia to realize early detection
and intervention of myopia. As a primary care institution，a community health center may accurately understand the prevalence of
myopia in teenagers in its service coverage area. So giving full play to the role of community health center has important practical
significance for the containment of myopia in children and adolescents. Objective To explore the feasibility of community-based
prevention and control of myopia in school-age children. Methods A cohort study was conducted. The information about visual
acuity and refractive status of students in a primary school in Beijing's Chaoyang District from September 2019 to September 2021
were collected for statistical analysis，among which four groups of data in September 2019，September 2020，March 2021 and
September 2021 were finally included according to the inclusion and exclusion criteria，with a total of 5 558 records. Then，based
on the data，an electronic students' refractive database was established，with uncorrected visual acuity，corrected visual acuity，
refractive status（power of a spherical lens，power of a cylindrical lens，axis），prevalence of wearing glasses or orthokeratology
incorporated. The warning levels of vision screening were set to be 0，1，2 and 3 from low to high. The visual change，visual
warning level，spherical equivalent（SE）of students were compared by grade. The visual changes and warning level evolution at
different times were compared at the individual level. Corresponding interventions were implemented for different warning levels，
and the intervention results were analyzed and discussed. Results There were statistically significant differences in uncorrected
distance visual acuity（UDVA）among students by grade（F=100.413，P<0.05）. The UDVA differed significantly in male
or female students（F=47.168，53.042，P<0.05）. Compared with the lower grade students（grades 1 and 2），middle and
higher grade students（grades 3，4，5 and 6）had lower UDVA（P<0.003）. The UDVA decreased with the increase in grade
in male and female students，and the decline in female students was faster. The composition of the warning levels of myopia risk
assessed based on the UDVA in male and female students in all grades was similar，mainly composed of 0，1，and 3 levels.
With the increase in grade，the number of low warning level（level 0） gradually decreased，while that of high warning level
（level 3）gradually increased. The SE in students differed obviously by grade（F=474.728，P<0.05）. The SE also differed
much in male or female students（F=121.704，123.807，P<0.05）. With the increase of grade，SE tended to be negative，
and the difference in SE between left and right eyes was statistically significant（t=-4.67，P<0.05）. The negative trend of SE
for the right eye was more remarkable，suggesting that the warning level of the right eye was higher，and the right eye was more
prone to myopia. The follow-up of three consecutive years for assessing individual visual changes revealed that the results of four
UDVA screening differed significantly in all students and female students（F=8.727，10.221，P<0.05）. The UDVA result
screened in March 2021 for all students decreased significantly compared with that screened in September 2019 or September 2020
（P<0.008），so did the UDVA result screened in September 2021（P<0.008）. During the evolution of warning level，higher
warning level was associated with lower possibility of returning to the low warning level，and the possibility of progressing to a
higher warning level increased with the growth of warning level. Conclusion The visual acuity and refractive status of students in
this primary school in Beijing's Chaoyang District were not optimistic. With the increase in grade，the UDVA decreased and the
number of high warning level gradually increased. To actively contain myopia in school-age children，it is suggested to establish a
community-based vision screening and warning mechanism，and to promote the containing of myopia by home-school-community
collaboration efforts.
【Key words】 Community health services；Myopia；Refractive errors；Tertiary prevention；Vision screening；
Cohort studies；School-age children

近视是导致视觉损害的主要眼病，已经成为世界范 力筛查，将眼部健康数据及时更新到视力健康电子档案
围内的公共卫生问题 ［1-2］ 。据估计，到 2050 年全球近 中 ［6］ 。目前临床上尚无儿童近视的逆转方法，因此规
视患者将有 47.58 亿人，占全球总人口的 49.8% ［3］ 。我 范化开展屈光不正的筛查工作，实现近视的早发现、早
国是近视大国，2020 年 6 月教育部调查结果显示，与 干预极其重要。社区卫生服务中心作为基层卫生健康专
2019 年年底相比，半年期间中小学生近视患病率增加 业机构，能够准确掌握本地儿童青少年近视的分布情
了 11.7%，其中小学生的近视患病率增加了 15.2% ［4］ 。 况。有效发挥社区卫生服务中心的作用，对于儿童青少
我国学生近视呈现高发、低龄化趋势，严重影响了学生 年近视防控有着重要的实践意义。本研究采用队列研究
们的身心健康，这是一个关系国家和民族未来的大问 对 1~6 年级学生进行视力及非睫状肌麻痹状态下屈光状
题 ［5］ 。2018 年，教育部、国家卫生健康委员会等八部 态筛查，设立视力筛查警戒级别，以期通过观察学生视
委联合印发《综合防控儿童青少年近视实施方案》明确 力及屈光状态的动态变化及相关性分析，探索社区卫生
要求医疗卫生机构应在学校配合下认真开展中小学生视 服务机构在学龄儿童近视防控中的作用。