群馬県3歳児眼科健診における手引きに準じた屈折検査導入の成果

Results of the introduction of refractometry in ophthalmic checkup for 3-year-olds in accordance with the Gunma Prefecture manual

要約　目的：群馬県では2017年に「3歳児健康診査の眼科検査に関する検討会議」を設置し，手引きを作成して屈折検査導入など，全県下統一で取り組んできた。その結果，要治療児の検出率が改善したので報告する。

対象と方法：対象は2018年度の3歳児健診でフォトスクリーナー装置による屈折検査を施行した26市町村の受診者10,798名。屈折検査の判定基準は検討会議で設定した。屈折検査は手引きに準じて視能訓練士5市町村，眼科研修を受けた保健師20市町村，眼科医1町が実施し，結果を屈折検査導入前の2016年度と比較した。

結果：10,798名のうち，視力検査で異常あり273名（2.5％），検査不可2,688名（24.9％），屈折検査で異常あり1,039名（9.9％），検査不可45名（0.4％）であった。二次検査での要精検は1,398名（12.9％）であった。精検結果は，要治療193名（13.8％），要観察643名（46.0％），異常なし213名（15.2％），精検未受診349名（25.0％）であった。全受診者のうち，要治療は248名（2.3％）となり，屈折検査導入前の2016年度の要治療検出率0.1％と比べて有意に改善した。

結論：屈折検査は視力検査に比べて検査可能率，異常検出率が高かった。手引きに準じた屈折検査導入により，全県下で弱視など要治療児発見の精度が向上し，早期治療につながった。

Abstract　Purpose：In 2017, Gunma Prefecture established the “Investigative Meeting on Ophthalmic Examination for 3-Year-Olds,” created a manual, and introduced the photoscreening refraction test. The accuracy of detection of children requiring treatment was significantly improved.

Subjects and methods：The subjects were 10,798 3-year-old children from 26 municipalities in Gunma Prefecture who underwent refractometry during the 2018 3-year-old health checkup. The ophthalmic examination was performed according to the manual, and the prefectural committee set the criteria. Refractometry was conducted by orthoptists（5 municipalities）, public health nurses who received eye training（20 municipalities）, and ophthalmologists（1 municipality）and compared the results to those obtain in 2016 before the introduction of the refractive examination.

Results：Of the 10,798 children, 273（2.5％）had poor visual acuity and 2,688（24.9％）could not be tested. On refractometry, 1,039（9.9％）subjects had abnormalities and 45（0.4％）could not be performed. At the second screening, 1,398（12.9％）subjects required a detailed examination. On the detailed examination, 193（13.8％）required treatment, 643（46.0％）required observation, 213（15.2％）had no abnormality, and 349（25.0％）could not be tested. Of all patients, treatment required was 248 patients：2.3％, a treatment detection rate that was significantly improved compared with the required treatment detection rate of 0.1％ in 2016 before the introduction of the refractive examination.

Conclusion：The refraction test had higher testability and abnormality detection rates than visual acuity tests. The introduction of refractometry has improved the detection rate of children in need of treatment, leading to the early detection of amblyopia.