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眼轴长度在近视防控管理中的应用专家共识(2023)
《眼轴长度在近视防控管理中的应用专家共识(2023)》专家组
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DOI: 10.3760/cma.j.cn115989-20231010-00121
Expert consensus on the application of axial length in myopia prevention and control management (2023)
Expert Workgroup of Expert consensus on the application of axial length in myopia prevention and control management (2023)
He Xiangui
Xu Xun
Authors Info & Affiliations
Expert Workgroup of Expert consensus on the application of axial length in myopia prevention and control management (2023)
He Xiangui
Shanghai Eye Disease Prevention and Treatment Center, Shanghai 201103, China
Xu Xun
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China
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DOI: 10.3760/cma.j.cn115989-20231010-00121
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摘要

当前眼轴长度(AL)的测量方法无创、便捷,结果客观、稳定。与眼屈光度数的测量结果不同,AL测量不受眼调节能力的影响,近年来在近视防控中逐渐受到关注和应用,已成为青少年近视防控管理的重要评价指标。然而,目前尚缺乏全面反映我国3~18岁儿童青少年屈光状态或屈光进展的AL参考值及针对AL测量方法、测量设备评价方法的操作规范,给儿童青少年近视筛查结果的判定、屈光档案的准确建立、屈光状态的纵向趋势观察以及测量数据的可比性等带来了很大挑战。为了促进和规范我国已有的儿童青少年眼轴数据的合理应用以及规范眼轴数据的测量和记录,《眼轴长度在近视防控管理中的应用专家共识(2023)》专家组在全国范围内广泛征求和收集目前我国在儿童青少年近视筛查和临床实践中关于AL评价的主要问题并进行分析和归纳,就我国儿童青少年AL及相关参数的定义与测量要求、人群生长发育特征、在人群横断面筛查中的应用、在屈光动态管理中的应用、AL变化与屈光度数变化的换算关系、AL联合其他参数对近视的预测效果、眼轴测量仪器的准确性评估等7个科学内容进行研究和讨论,根据对国内外重要文献进行归纳分析,结合我国的具体实践,制定《眼轴长度在近视防控管理中的应用专家共识(2023)》,为公共卫生、临床医师和相关从业人员的具体工作实践和操作过程提供相对标准化的专家建议,同时为相关政策管理者制定我国近视防控技术方案、实施近视公共卫生预防、早期近视预警和风险判断以及近视的临床控制提供指导意见,促进近视分级分类管理迈向精准化,提升防控近视发生发展的效果。

近视;眼轴长度;人群筛查;动态管理;安全增长值;共识
ABSTRACT

The current measurement method of axial length (AL) is non-invasive and convenient, with objective and stable results.Unlike refractive diopter, which is influenced by the eye accommodation, the measurement of AL is not affected.Therefore, AL has gradually received attention and application in myopia prevention and control in recent years, and has become an important evaluation index for myopia management in children and adolescents.However, there is currently a lack of AL reference values that comprehensively reflect the refractive status or progression of children and adolescents aged 3-18 years in China, as well as operational standards for AL measurement and measurement equipment evaluation, posing great challenges to the determination of myopia screening results, the accurate establishment of refractive profiles, the observation of longitudinal trend of refractive status, and the comparability of measurement data of children and adolescents.In order to promote and standardize the rational application of existing AL data of children and adolescents in China, as well as the measurement and recording of AL data, the Expert consensus on the application of axial length in myopia prevention and control management (2023) expert workgroup extensively solicited and collected the main issues related to AL evaluation in myopia screening and clinical practice in children and adolescents in China, and conducted analysis and summary.The expert workgroup conducted research and discussion on seven scientific contents, including the definition and measurement requirements of AL and related parameters in children and adolescents in China, the growth and development characteristics of the population, the application in cross-sectional screening of populations, the application in dynamic management of refraction, the conversion relationship between AL changes and refractive diopter changes, the predictive effect of AL combined with other parameters on myopia, and the accuracy evaluation of AL measurement instruments.Based on the summary and analysis of important literature at home and abroad and combined with the specific practices in China, the Expert consensus on the application of axial length in myopia prevention and control management (2023) was formulated to provide relatively standardized expert recommendations for public health, clinical physicians, and related practitioners in the specific working practices and operational processes.Meanwhile, the consensus aims to provide guidance for relevant policy managers to formulate programs about myopia prevention and control in China and implement public health prevention, early myopia warning and risk assessment, as well as clinical control of myopia, to promote the precision of stratified and classified management of myopia and improve the effectiveness of prevention and control of myopia onset and progression.

Myopia;Axial length;Screening of population;Dynamic management;Safety growth value;Consensus
He Xiangui, Shanghai Eye Disease Prevention and Treatment Center, Shanghai 201103, China, Email: mocdef.3ab61izehnaix;
Xu Xun, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China, Email: nc.defudabe.utjsnuxuxrd
引用本文

《眼轴长度在近视防控管理中的应用专家共识(2023)》专家组. 眼轴长度在近视防控管理中的应用专家共识(2023)[J]. 中华实验眼科杂志,2024,42(01):1-11.

DOI:10.3760/cma.j.cn115989-20231010-00121

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儿童青少年近视已成为我国重要的公共卫生问题。全国调查数据显示,2020年中国6~18岁儿童青少年总体近视率为52.7%,近视人数约达1亿,若无有效的近视干预措施,据估计2030年我国儿童青少年近视率将达到61.8% [ 1 , 2 , 3 ],其防控刻不容缓。从儿童生长发育早期即开始建立屈光发育档案有助于我们深入探讨近视发生的病因、机制、发展规律,抓住个体适当干预时点和采取有效防控措施,是防控儿童青少年近视发生及发展的重要基础 [ 4 ]。针对近视筛查建档工作,目前我国已发布了多个专业性指导文件,如全国近视调查方案(国卫办疾控函〔2018〕932号) [ 5 ]、国家卫健委《儿童青少年近视防控适宜技术指南》(国卫办疾控函〔2019〕780号) [ 6 ]、国家卫生行业标准《中小学生屈光不正筛查规范》(WS/T 663-2020) [ 7 ]等,在近视筛查过程中主要推行裸眼远视力检测联合非睫状肌麻痹验光方法 [ 8 , 9 ]。鉴于目前全国已逐步推进近视筛查建档全覆盖、每年定期开展,档案资料的有效整合应用与动态管理成为新需求 [ 10 , 11 ]。然而,相关研究数据表明,目前视力联合非睫状肌麻痹验光方法尚无法获得与睫状肌麻痹状态下屈光度一致的结果 [ 12 ],不能准确量化屈光度数及其变化量,给近视防控工作精准化的实施和效果评价带来困难,检测方法和评价方法亟待进一步完善。
眼轴长度(axial length,AL)是衡量儿童青少年眼球发育情况的主要参数之一,与屈光度测量受眼调节能力的影响不同,AL测量不受调节能力的影响,且AL的变化范围随年龄增长呈现较为稳定的规律性,是客观、便捷地评估儿童青少年眼球发育规律和预测近视发生和进展的重要指标。与儿童各器官和身高随年龄的生理发育过程相对应的生理现象相似,AL在眼球发育过程中相应增长 [ 13 ],并与屈光度数变化密切相关 [ 14 , 15 ];持续监测AL有助于更为准确地评估儿童青少年的屈光状态或屈光进展情况,比如通过AL所处相应年龄人群中百分位可预测未来近视的发生风险、通过一次测量数据和计算轴率比(axial length/curvature radius,AL/CR)可判断是否已发生了或将发生近视、通过对照AL安全性增长参考值可判断2次测量周期内AL增长量即屈光发育是否正常或远视储备量是否过快消耗或近视控制措施是否有效等,以帮助我们识别近视高危人群或具有近视进展过快风险的对象,并及时采取个性化精准近视防控措施。国家卫健委《儿童青少年近视防控适宜技术指南》提出 [ 6 ],鼓励有条件地区增加AL、角膜曲率等指标的检测。此外,目前也出现了多种类型的生物测量设备,为推广AL指标在近视防控管理中的应用提供了可能。
眼轴评估作为儿童青少年近视筛查和临床管理的稳定指标已成为趋势,然而,迄今我国仍缺乏全面反映3~18岁不同年龄儿童青少年屈光状态或屈光进展的AL参考值,以及针对AL测量、测量设备准确性和可靠性评价的标准化操作方法。《眼轴长度在近视防控管理中的应用专家共识(2023)》(简称《共识》)专家组基于当前AL在我国儿童青少年近视筛查和临床应用中存在的操作方法、已收集的相关调查数据、分析方法及结果评价中存在的问题,依据国内外发表的文献证据,结合我国的公共卫生与临床实践,对儿童青少年AL测量、在近视筛查建档及近视随访管理中的价值及应用方法和参考值进行讨论并达成共识性意见,为我国眼科临床、眼公共卫生工作者及近视防控相关从业人员的工作实践提供规范化指导意见,为制定近视防控技术方案、实施公共卫生人群防控、研制相关应用工具和设备以及开展近视防控相关研究提供参考依据,促进近视分级分类精准管理工作的开展,进一步提升近视防控的有效性。
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备注信息
A
何鲜桂,上海市眼病防治中心,上海 201103,Email: mocdef.3ab61izehnaix
B
许迅,上海交通大学医学院附属第一人民医院,上海 200080,Email: nc.defudabe.utjsnuxuxrd
C
http://www.guidelines-registry.cn,PREPARE-2023CN574
D
http://www.guidelines-registry.cn,PREPARE-2023CN574
E
本文主要为专家意见和建议,为临床研究和医疗服务提供指导,并非是在各种情况下都必须遵循的标准。本文内容与相关设备的生产和销售企业无经济利益关系
F
衷心感谢复旦大学附属眼耳鼻喉科医院褚仁远教授、香港理工大学何明光教授、澳大利亚新南威尔士大学Padmaja Sankaridurg教授、美国加州大学伯克利视光学院刘悦教授对本共识制定给予的指导
G
国家重点研发计划项目 (2021YFC2702100)
上海申康医院发展中心,三年行动计划研究型医师项目 (SHDC2022CRD015)
上海市科委生物医药领域项目 (21S31900800)
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