Refractive Profiles in Children Receiving School-Based Eye Exams Following Vision Screening from a Large School-Based Vision Program in 2016 to 2022

To describe refractive error findings and associated factors in students who received school-based eye exams following vision screenings. Cross-sectional study of pre-kindergarten through 12th grade students who failed vision screening and underwent a school-based eye exam in the Northeast region of the United States during 2016–2022. Non-cycloplegic autorefraction and visual acuity measurements were used to categorize refractive error by type and severity. Main outcomes included any refractive error (at least −0.50D myopia, +0.50 hyperopia, 1.00D astigmatism, or 1.00D anisometropia), clinically significant refractive error (CSRE; more severe refractive error with decreased vision), and refractive amblyopia risk (RAR). Multivariable mixed-effects logistic regression was used to determine student- and school-level characteristics associated with refractive error outcomes. Of 103,159 included students who failed screening, 95,875 (92.9%) were analyzed. Overall prevalence of any refractive error was 94.2%, with 81.7% having CSRE. Pre-kindergarten & kindergarten students had the highest prevalence of CSRE (85.7%), which dropped to 77.0% by 3rd and 4th grade before rising with each higher grade level thereafter. Prevalence of RAR was 60.9% overall and highest in pre-kindergarten and kindergarten students (73.8%). Myopia was the most prevalent refractive error, followed by astigmatism, anisometropia, then hyperopia. The odds of hyperopia, astigmatism, and anisometropia decreased with higher grade level. Over 80% of students who failed vision screening at a large school-based vision program had CSRE, and over 60% had RAR. Pre-kindergarten and kindergarten students had an especially high prevalence of RAR. Refractive error remained common in every grade level.

本数据集旨在描述经视力筛查后接受校园眼部检查的学生的屈光不正检出结果及相关影响因素。本研究为横断面研究，纳入2016-2022年美国东北部地区学前至12年级、初筛视力不合格并接受校园眼部检查的学生。研究采用非睫状肌麻痹下自动验光与视力检测结果，按类型与严重程度对屈光不正进行分类。主要结局指标包括：任意屈光不正（至少-0.50D近视、+0.50D远视、1.00D散光或1.00D屈光参差）、临床意义重大屈光不正（CSRE）——即程度更严重且伴视力下降的屈光不正，以及屈光不正性弱视风险（RAR）。本研究采用多变量混合效应logistic回归分析，探究与屈光不正结局相关的学生个体及学校层面特征。纳入本研究的103159名初筛不合格学生中，最终有95875名（92.9%）纳入分析。任意屈光不正的总体患病率为94.2%，其中81.7%为CSRE。学前及幼儿园学生的CSRE患病率最高（85.7%），该比例在3、4年级降至77.0%，之后随年级升高逐步回升。屈光不正性弱视风险（RAR）的总体患病率为60.9%，同样在学前及幼儿园学生中最高（73.8%）。近视为最常见的屈光不正类型，依次为散光、屈光参差及远视。远视、散光及屈光参差的发生风险随年级升高而降低。在大型校园视力筛查项目中初筛不合格的学生中，超80%存在CSRE，超60%存在RAR。学前及幼儿园学生的RAR患病率尤其高。各年级学生中均普遍存在屈光不正。