目的:患有自闭症谱系障碍(ASD)和智力障碍(ID)的儿童通常不能忍受戴眼镜或隐形眼镜,这是治疗屈光不正的护理标准1,2.我们旨在评估屈光手术对该人群的社会功能和特定视力生活质量的影响。
方法:前瞻性,前后案例系列。
方法:设置:单身,学术三级护理中心。
方法:18名患有ASD和/或ID的儿童,屈光不正,和眼镜不依从性被纳入分析。
方法:受试者接受人工晶状体植入术或角膜切削术的屈光手术。父母在基线和手术后1、6和12个月完成了社交反应量表(SRS-2)和儿科眼科问卷(PedEyeQ)。3,4主要结果指标:手术后12个月SRS-2T评分和PedEyeQ评分的中位数变化,与基线相比。最小临床重要差异(MCID)对于SRS-2设定为5点,对于PedEyeQ设定为10点。
结果:手术后12个月,在社会意识的SRS-2领域观察到统计学上显著的改善(8分,95%CI2至13,p=0.03)和社会动机(7分,95%CI2至15,p=0.03)。56%(10/18)的患者的总SRS-2T评分以临床重要的方式改善,但中位数变化无统计学意义(5分,95%CI-1至9,p=.10)。特定于视觉的生活质量在功能视觉领域显示出统计学上的显着改善(40分,95%CI7至73,p=0.02),并受到眼睛/视觉的困扰(23分,95%CI3至45,p=0.02)。
结论:屈光手术在术后12个月时在社会功能和特定于视觉的生活质量方面有临床和统计学上的显著改善。一小部分患者在整体社会功能方面表现出临床上重要的改善,但这些变化没有统计学意义.结果表明,屈光手术在患有神经发育障碍的儿童中,屈光不正,和眼镜不依从可能提供发展和生活质量的好处。较大,需要对照研究来验证这些发现。
OBJECTIVE: Children with autism spectrum disorder (ASD) and intellectual disability (ID) often cannot tolerate wearing spectacles or contact lenses, which are the standard of care for treating ametropia.1,2. We aimed to assess the impact of refractive surgery on social functioning and vision-specific quality of life in this population.
METHODS: Prospective, before-and-after case series.
METHODS: SETTING: Single, academic tertiary care center.
METHODS: 18 children with ASD and/or ID, ametropia, and spectacle non-adherence were included in the analysis.
METHODS: Participants underwent refractive surgery with either intraocular lens implantation or keratectomy. Parents completed the Social Responsiveness Scale (SRS-2) and Pediatric Eye Questionnaire (PedEyeQ) at baseline and 1, 6, and 12 months post-surgery.3,4 MAIN OUTCOME MEASURES: Median change in SRS-2 T-scores and PedEyeQ scores 12 months after surgery, compared to baseline. The minimum clinically important difference (MCID) was set at 5 points for the SRS-2 and 10 points for the PedEyeQ.
RESULTS: At 12 months after surgery, statistically significant improvements were observed in the SRS-2 domains of Social Awareness (8 points, 95% CI 2 to 13, p = .03) and Social Motivation (7 points, 95% CI 2 to 15, p = .03). Total SRS-2 T-score improved in a clinically important manner for 56% (10/18) of patients, but the median change was not statistically significant (5 points, 95% CI -1 to 9, p = .10). Vision-specific quality of life showed statistically significant improvements in the domains of Functional Vision (40 points, 95% CI 7 to 73, p = .02) and Bothered by Eyes/Vision (23 points, 95% CI 3 to 45, p = .02).
CONCLUSIONS: Refractive surgery led to clinically and statistically significant improvements in domains of social functioning and vision-specific quality of life at 12 months after surgery. A narrow majority of patients demonstrated a clinically important improvement in overall social functioning, but these changes were not statistically significant. The results suggest that refractive surgery in children with neurodevelopmental disorders, ametropia, and spectacle non-adherence may provide developmental and quality of life benefits. Larger, controlled studies are required to validate these findings.