富山市における3歳児健診後の眼科追跡調査により判明した弱視有病率と課題

Prevalence of amblyopia and issues identified by ophthalmological follow-up survey after 3-year-old health checkup in Toyama City

要約　目的：富山市での屈折検査機器を併用した3歳児健診で眼科精密検査の対象となり受診した児を対象に，受診6か月後に追跡調査を実施し，弱視有病率と課題を検討したので報告する。

方法：2023年度の富山市3歳児健診受診者2,796人を対象とした。眼科精密検査の対象者は，①家庭での視力検査が不能または視力0.5未満，②アンケートなどで異常が疑われるまたは自覚的症状がある，③受診会場で全員に屈折検査機器にて屈折検査を施行し異常判定となった，のいずれかに該当するものとした。対象者に精密健康診査受診票が交付され，精密検査にて「経過観察」「要治療」の場合，受診から6か月後に富山市が医療機関へ追跡調査として精密検査報告書を送付し，回答を回収した。これをもとに富山市が公表した統計から弱視有病率，弱視分類の内訳，今後の課題を検討した。

結果：3歳児健診受診者2,796人のうち，精密検査対象者は641人（23％）で，6か月後の追跡調査により弱視有病率は2.5％（71人）であった。精密検査対象者のうち受診しなかった児の家庭に富山市から電話にて受診勧奨を行ったが，111名（17％）が受診しなかった。医療機関からの追跡調査の回答率は96％であった。

結論：弱視有病率は1〜2％と報告されているが，富山市での屈折検査機器を使用した3歳児健診で，精密検査を受診した6か月後に追跡調査を行った結果，弱視は2.5％と高い率であった。精密検査の対象となりながら受診しなかった児が17％に認められ，精密検査の受診を徹底することが課題である。

Abstract　Purpose：To examine prevalence of amblyopia and related issues during the 3-year-old health check in Toyama City. A follow-up survey was conducted 6 months after children who underwent detailed ophthalmologic examinations following the 3-year-old health check.

Method：Participants were children who underwent the Toyama City 3-year-old health check in fiscal year 2023. Children were eligible for detailed ophthalmologic examination if they met at least one of the following criteria：（1） inability to complete the home vision test conducted during the primary checkup or visual acuity below 0.5；（2） subjective symptoms suggesting a potential abnormality based on a questionnaire or other information；or （3） an abnormal finding on a refraction test using the Spot Vision Screener^® during the secondary checkup. Toyama City issued detailed admission tickets for health checkups to the children classified as “observation” or “requiring treatment” during the detailed ophthalmologic examination. Six months after the examination, Toyama City sent detailed examination reports—including visual acuity, diagnosis, and overall assessment—to the medical institutions as a follow-up survey, which were then collected for analysis Using the published data from Toyama City, we examined prevalence of amblyopia, details of amblyopia classifications, and future challenges.

Results：Among 2,796 children who underwent the 3-year-old health checkups, 641 children（23％） were eligible for further examinations, of whom 111 children（17％） did not undergo further examinations. A follow-up survey 6 months after detailed ophthalmic examinations showed that amblyopia was detected in 2.5％（71 children） of all children who underwent the 3-year-old health checkup. Toyama City called the families of children who were eligible for detailed testing but did not undergo the test, urging them to undergo the test. However, 111 children（17％） did not undergo the test. The follow-up survey achieved a response rate of 96％.

Conclusion：In the 3-year-old health check using refractive examination equipment in Toyama City, a follow-up survey conducted six months after recommending a detailed examination found the prevalence of amblyopia to be 2.5％. Although recommendations for further consultation were made, 17％ of children who were eligible for detailed examination did not attend, highlighting the need to ensure thorough participation in such examinations.