Dynamic Observation Of Vision In Preschool Children Aged 4-6 Years In Some Kindergartens In Jinan

ObjectiveThe purpose of this study is to understand the law of visual acuity development,to explore the influencing factors of abnormal vision and to provide data for protecting children's visual acuity and preventing refractive errors by exploring the abnormal visual acuity of preschoolers aged 4-6 years old in several kindergartens in Jinan.The visual acuity of preschoolers aged 4-6 years was studied by dynamic observation and cross-sectional study.That will provide reference for the healthcare department and formulate the appropriate intervention measures,and carry out the eye care work for preschool children.It will help to promote vision health for preschoolers.MethodsFive kindergartens that meet the requirements in TianQiao and ChangQing districts of JiNan city were selected according to the investigation of the physical examination of each kindergarten.Three consecutive physical examination follow-up studies were carried out by sampling kindergarten students of five grades in 2010-2014 years,and 782 people were actually included in the sample.The physical examination files of the above subjects were collected,and the date of birth,gender,weight,height,eyesight and other information of the research objects were sorted into files.The standard of poor vision in preschool children is defined as follows:4 years old single eye naked eye vision less or equal to 4.8,5 years old and above single eye naked eye vision less or equal to 4.9 as abnormal vision.First of all,the general description of visual acuity and abnormal rate of visual acuity in different age groups was made.For longitudinal data,using statistical analysis methods including chi-square test,Repeated Measure ANOVA and Generalized Estimating Equations,the study analyzed the effects of baseline age,gender,grade on visual acuity;analyzed the effects of different areas,different kindergartens,different years of admission,height,weight and measuring time on the incidence of visual abnormalities;analyzed the change process of abnormal to normal vision and normal to abnormal vision in different physical examinations.Results1.Average visual acuity of naked eye for three tested times:4.93,4.97 and 4.98 for the left eye;4.94,4.98 and 4.98 for the right eye.There was statistical significance between the left and right eyes(p=0.00).There were statistical significances in average visual acuity with different measurement time(left eye:p=0.00;right eye:p=0.00).2.Baseline age groups:there were statistically significant differences in visual acuity between the ages of 4 and 5(p=0.00);there was no statistical significance in the interaction between baseline age and time(left eye:p=0.63;right eye:p=0.09),indicating that the effect of time did not vary with baseline age.Gender groups:there was no significant difference in visual acuity between boys and girls(left eye:p=0.65;right eye:p=0.41),there was no significant interaction between time and gender(left eye:p=0.64;right eye:p=0.34).Kindergarten groups:there were significant differences in visual acuity of the left eye and the right eye between the kindergarten groups(p=0.00).The comparison between kindergartens showed that there was no significant difference in visual acuity between Ji*kindergarten and Xiao*kindergarten(left eye:p=0.39;right eye:p=0.16),while there were statistically significant differences in visual acuity between other kindergartens(p<0.05).There was a significant interaction in visual acuity between time and kindergarten(p=0.00).Grade groups:there were significant differences visual acuity among different grades(p=0.00).The comparison between different grades showed that the visual acuity of all grades was statistically significant(p<0.05)except for grades 10 and 11,12 and 14;the mean visual acuity of grade 13 was significantly higher than that of other grades.There was a significant interaction in visual acuity of left and right eye between time and grade(p=0.00).3.There were significant differences in abnormal visual acuity of left eye and right eye among different districts(p=0.00),kindergartens(p=0.00).The abnormal vision risk of TianQiao area is higher than that of ChangQing area(Left eye:OR=6.26.Right eye:OR=6.52),The difference between Ji*kindergarten and Chang*kindergarten and the difference between Xiao*kindergarten and Chang*kindergarten were statistically significant.The abnormal vision risk in Ji*kindergarten and Xiao*kindergarten were higher than that in Chang*kindergarten(Left eye:Ji*kindergarten's OR=15.01,Xiao*kindergarten's OR=7.76.Right eye:Ji*kindergarten's OR=15.00,Xiao*kindergarten's OR=5.82).There were significant differences in abnormal visual acuity of left eye and right eye among different grades(p=0.00),including the difference between the abnormal visual acuity of the 11 and the 14 grad and the difference between the abnormal visual acuity of the 13 grades(left eye:11 grade's OR=3.26,13 grade's OR=0.17;Right eye:11 grade's OR=3.27,13 grade's OR=0.17).The abnormal visual acuity of the two eyes enrolled in 2013 was significantly lower than that in other years,which was 0.17 times of the incidence of low visual acuity in 2014.The risk of abnormal vision in the left eye and right eye decreased with age(left eye's OR=0.48,right eye's OR=0.96).With the increase of body height,the risk of abnormal vision in left eye and right eye decreased(left eye's OR=0.96,right eye's OR=0.96).There was no statistically significant relationship between gender and abnormal visual acuity,There was no statistically significant relationship between weight and abnormal visual acuity.There were significant differences in the abnormal visual acuity of the left eye and the right eye measured at different times(p=0.00),and the risk of abnormal visual acuity of both eyes measured at the first time was significantly higher than that measured at the last time.4.Compared with the first measurement,the number of eyes with normal vision changed from abnormal vision(left eye 136,right eye 134)at the last measurement was much higher than that of eyes with abnormal vision changed from normal vision(left eye 32,right eye 40)at the last measurement.There were more eyes with normal vision changed from abnormal vision in the previous period(from the first measurement to the second measurement)than in the later period(from the second measurement to the last measurement).Conclusion1.The mean visual acuity of the data is basically consistent with many reports,but the abnormal rate of visual acuity is higher than that of other reports.2.The change of vision in preschool children aged 4-6 is not uniform,but faster in the early stage and slower in the late stage.At the same time,visual acuity development was not related to baseline age and gender,but was related to different kindergartens and different years of enrollment.3.The occurrence of abnormal vision was time-dependent,with a higher risk of abnormal vision in the early stage from 4 to 6 years old.4.The risk of abnormal vision may be affected by different regional kindergartens and school years.Gender and weight may not be associated with the occurrence of abnormal vision,but with the increase in height and age will reduce the risk of abnormal vision.4.The changes of vision not only include the "emmetropization process" from abnormal vision to normal vision but the process from normal vision to abnormal vision.In addition,the changes of vision from 4 to 6 years old are not consistent,and the "emmetropization process" of vision mainly occurs in the front stage.Many factors such as age,height and location can affect vision development and interfere with the "emmetropization process".