Abstract：
OBJECTIVE: This study aims to investigate the relationship between the type and severity of refractive error and anisometropia development in preschool children.
METHODS: Retrospective cohort study.
METHODS: Data from Maccabi Healthcare Services, Israel\'s second-largest Health Maintenance Organization (HMO), were analyzed. The study included all isometropic children aged 1 to 6 years, re-examined for refraction at least 2 years following their initial examination between 2012 and 2022. Anisometropia was defined as a ≥1 diopter interocular difference in spherical equivalent. Relationships were assessed using logistic regression models adjusted for key sociodemographic factors.
RESULTS: Among 33,496 isometropic children (51.2% male, mean age 3.2 ± 1.5 years), the prevalences of emmetropia, myopia, and hyperopia were 26.7% (n = 8944), 4.2% (n = 1397), and 69.1% (n = 23,155), respectively. Over a mean follow-up period of 5.1 ± 2.4 years, 2593 children (7.7%) were diagnosed with anisometropia. Adjusted odds ratios (ORs) for anisometropia gradually increased with baseline refractive error severity, reaching 13.90 (5.32-36.34) in severe myopia and 4.19 (3.42-5.15) in severe hyperopia. This pattern was also evident in cylindrical anisometropia, where ORs increased with greater baseline astigmatism, peaking at 12.10 (9.19-15.92) in children with high astigmatism (≥3 D). Associations remained consistent in sensitivity and subgroup analyses including across both sexes and when using a stricter anisometropia criterion.
CONCLUSIONS: Children aged 1 to 6 years, initially without anisometropia but showing increasing severity of myopia, hyperopia, or astigmatism, are more likely to develop anisometropia. This underscores the importance of follow-up refractive measurements within this population to promptly diagnose and treat anisometropia and prevent potential visual complications.
METHODS: Retrospective cohort study.
METHODS: Data from Maccabi Healthcare Services, Israel\'s second-largest Health Maintenance Organization (HMO), were analyzed. The study included all isometropic children aged 1 to 6 years, re-examined for refraction at least 2 years following their initial examination between 2012 and 2022. Anisometropia was defined as a ≥1 diopter interocular difference in spherical equivalent. Relationships were assessed using logistic regression models adjusted for key sociodemographic factors.
RESULTS: Among 33,496 isometropic children (51.2% male, mean age 3.2 ± 1.5 years), the prevalences of emmetropia, myopia, and hyperopia were 26.7% (n = 8944), 4.2% (n = 1397), and 69.1% (n = 23,155), respectively. Over a mean follow-up period of 5.1 ± 2.4 years, 2593 children (7.7%) were diagnosed with anisometropia. Adjusted odds ratios (ORs) for anisometropia gradually increased with baseline refractive error severity, reaching 13.90 (5.32-36.34) in severe myopia and 4.19 (3.42-5.15) in severe hyperopia. This pattern was also evident in cylindrical anisometropia, where ORs increased with greater baseline astigmatism, peaking at 12.10 (9.19-15.92) in children with high astigmatism (≥3 D). Associations remained consistent in sensitivity and subgroup analyses including across both sexes and when using a stricter anisometropia criterion.
CONCLUSIONS: Children aged 1 to 6 years, initially without anisometropia but showing increasing severity of myopia, hyperopia, or astigmatism, are more likely to develop anisometropia. This underscores the importance of follow-up refractive measurements within this population to promptly diagnose and treat anisometropia and prevent potential visual complications.
摘要：
目的：本研究旨在调查学龄前儿童屈光不正的类型和严重程度与屈光参差发展之间的关系。
方法：回顾性队列研究。
方法：来自马卡比医疗保健服务的数据，以色列第二大健康维护组织(HMO)进行了分析。该研究包括所有1-6岁的等屈光参比儿童，在2012年至2022年的初次检查后至少两年重新检查屈光。屈光参差定义为等效球眼间屈光度≥1。使用针对关键社会人口统计学因素调整的逻辑回归模型评估关系。
结果：在33,496名同角儿童中（男性占51.2％，平均年龄3.2±1.5岁)，近视的盛行，近视,远视率为26.7%(n=8,944)，4.2%(n=1,397)，和69.1%(n=23,155)，分别。在5.1±2.4年的平均随访期内，2,593名儿童（7.7％）被诊断为屈光参差。屈光参差的校正比值比(ORs)随着基线屈光不正的严重程度逐渐增加,在重度近视中达到13.90（5.32-36.34），在重度远视中达到4.19（3.42-5.15）。这种模式在圆柱形屈光参差中也很明显，其中ORs随着基线散光的增加而增加，高散光（≥3D）儿童的峰值为12.10（9.19-15.92）。在敏感性和亚组分析中，包括跨性别以及使用更严格的屈光参差标准时，关联保持一致。
结论：1-6岁儿童，最初没有屈光参差，但表现出近视的严重程度增加，远视,或散光，更容易出现屈光参差.这强调了在该人群中进行随访屈光参差测量以及时诊断和治疗屈光参差并防止潜在的视觉并发症的重要性。
方法：回顾性队列研究。
方法：来自马卡比医疗保健服务的数据，以色列第二大健康维护组织(HMO)进行了分析。该研究包括所有1-6岁的等屈光参比儿童，在2012年至2022年的初次检查后至少两年重新检查屈光。屈光参差定义为等效球眼间屈光度≥1。使用针对关键社会人口统计学因素调整的逻辑回归模型评估关系。
结果：在33,496名同角儿童中（男性占51.2％，平均年龄3.2±1.5岁)，近视的盛行，近视,远视率为26.7%(n=8,944)，4.2%(n=1,397)，和69.1%(n=23,155)，分别。在5.1±2.4年的平均随访期内，2,593名儿童（7.7％）被诊断为屈光参差。屈光参差的校正比值比(ORs)随着基线屈光不正的严重程度逐渐增加,在重度近视中达到13.90（5.32-36.34），在重度远视中达到4.19（3.42-5.15）。这种模式在圆柱形屈光参差中也很明显，其中ORs随着基线散光的增加而增加，高散光（≥3D）儿童的峰值为12.10（9.19-15.92）。在敏感性和亚组分析中，包括跨性别以及使用更严格的屈光参差标准时，关联保持一致。
结论：1-6岁儿童，最初没有屈光参差，但表现出近视的严重程度增加，远视,或散光，更容易出现屈光参差.这强调了在该人群中进行随访屈光参差测量以及时诊断和治疗屈光参差并防止潜在的视觉并发症的重要性。
