Standard for Eye Care and Vision Examination Services for Children Aged 0-6 (Trial Implementation)
In order to implement the Implementation Plan for the Comprehensive Prevention and Control of Myopia in Children and Adolescents by the Ministry of Education, the National Health Commission and other 8 departments, further standardize and strengthen the eye care and vision examination services for children aged 0 to 6 years old, and promote children's eye health, combined with the National Basic Public Health Service Specification (Third Edition) (Guowei Grassroots Development [2017] No. 13), further refine the content of children's eye health care and vision examination services, and formulate this specification.
1. Service Targets
Children aged 0 to 6 years old who live in the jurisdiction.
2. Service time and frequency
According to the characteristics of normal eye and visual development of children of different ages, combined with the time and frequency of health management services for children aged 0 to 6 years, 13 eye care and vision examination services are provided for children aged 0 to 6 years. Among them, there were 2 neonatal visits and full moon health management, 4 times in infancy, at 3, 6, 8 and 12 months of age, 4 times in early childhood from 1 to 3 years old, at the age of 18, 24, 30 and 36 months, and 3 times in the early school years, at the age of 4, 5 and 6 years.
3. Service content
The main purpose of children's eye care and vision examination is to detect common eye diseases, poor vision and insufficient reserves of farsightedness in children early, timely referral intervention, control and reduce the development of controllable eye diseases and poor vision in children, and prevent the occurrence of myopia.
Eye care and vision examination services for children aged 0 to 6 are mainly provided by primary medical and health institutions such as township health centers and community health service centers with corresponding service capabilities, or county-level maternal and child health care institutions and other qualified county-level medical institutions, including health education, eye disease screening and vision assessment, health guidance, referral services, and registration of children's eye health file information.
County-level maternal and child health care establishments or other qualified county-level medical institutions accept referred children, carry out special examinations, vision re-screening and re-examination, eye disease diagnosis and treatment, referral services, and register children's eye health file information.
The contents of eye care and vision examination services for children aged 0 to 6 years are shown in Annexes 1 and 2.
(1) Health education.
Popularize the scientific knowledge of children's eye care for the public and parents of children, improve the awareness of the prevention and control of poor vision, improve the awareness rate of scientific knowledge, and guide families to actively accept children's eye care and vision examination services.
(2) Eye disease screening and vision assessment.
1. Neonatal period (neonatal home visits and full moon health management)
Routine eye care services for newborns and screening services for retinopathy in preterm infants are the responsibility of midwifery facilities. On this basis, primary medical and health institutions carry out the following services.
(1) Check the appearance of the eye. Observe whether there are defects and ptosis of the eyelids, whether there is purulent discharge and continuous lacrimation in the eyes, whether the size of the bulbs of both eyes is symmetrical, whether the cornea is transparent and bilaterally symmetrical, whether the pupil is centered, rounded, and bilaterally symmetrical, whether the pupil area is whitish, and whether the sclera is yellow-stained.
(2) Screening for high-risk factors for eye diseases. Focus on asking and observing newborns for the presence of the following major risk factors for eye disease:
Low birth weight < 2000 g of low birth weight or birth week
Have been in the NEO intensive care unit for more than 7 days and have a history of continuous high concentration oxygen;
Have a family history of inherited eye diseases, or have family eye disease-related syndromes, including a family history of myopia, congenital cataracts, congenital glaucoma, congenital microglobulus, nystagmus, retinoblastoma, etc.;
Intrauterine infections caused by cmOMA, rubella, herpes, syphilis, or toxoplasmosis during pregnancy;
Craniofacial deformities, large facial hemangiomas, or bulging of the eyeball when crying;
The eye area is constantly lacrimated and has a large amount of secretions.
(3) Light response examination (when health management of the full moon). Evaluates newborns for a sense of light. The examiner quickly moves the flashlight to the baby's eyes to illuminate the pupil area, repeating several times, with both eyes separate. It is normal for infants to have reflex closed eye movements, indicating that the baby's eyes have a sense of light.
(4) Referral indications. Eyelid defects, ptosis, purulent discharge in the eyes, persistent lacrimation, inconsistent bulb size in both eyes, corneal opacity, bilateral unequal size, pupil inconcentration, not round, bilateral unequal size, whitish pupil area, yellowing of the sclera, etc.; birth weight < 2000 g of low birth weight or gestational age
2. Infancy (3, 6, 8, 12 months of age)
(1) Check the appearance of the eye. Observe whether the size of the bulbs in both eyes is symmetrical, whether the conjunctiva is congested, whether there is secretion or continuous tearing in the eyes, whether the cornea is transparent and bilaterally symmetrical, whether the pupil is centered, rounded, bilaterally symmetrical, whether the pupil area is whitish, and whether there is nystagmus at 6 months of age and later.
(2) Transient reflex (at 3 months of age). Assess the baby's ability to see in close proximity. The subject takes the direction of the light, and the examiner moves quickly in front of the subject's eyes with his hand or large object, without touching the subject. Babies immediately present with reflex defensive blinking as normal.
(3) Red ball test (at 3 months of age). Assess the infant's eye following and gaze ability. At 20 to 33 cm in front of the baby's eyes, use a red ball about 5 cm in diameter to slowly move and repeat 2 to 3 times. Infants show a brief search or follow-up gaze to the red ball as normal.
(4) Observation of visual behavior. Through observation and questioning of parents, find out whether there are abnormal behaviors in children's daily vision, such as not looking at their families at 3 months of age, poor response to the outside world, obvious tilting of the head or close distance of vision at 6 months of age, photophobia, squinting or frequent rubbing of eyes.
(5) Red light reflex examination, eye position examination, monocular masking aversion test (at 6 months of age).
At the age of 6 months, the primary medical and health institutions inform parents to take the baby to the county-level maternal and child health care institution or other qualified county-level medical institutions for special examinations such as red light reflex examination, eye position examination, and one-eye masking aversion test, and give referral.
At the age of 8 months, primary medical and health institutions ask parents whether the baby has undergone special examinations such as red light reflex examination, eye position examination, and one-eye mask aversion test at the age of 6 months. For those who have not yet been examined, parents are again advised to take the baby to the county maternal and child health institution or other qualified county-level medical institution as soon as possible to accept the examination.
Encourage qualified township health centers and community health service centers to provide red light reflex examination, eye position examination, and one-eye masking aversion test for infants at the age of 6 months.
Red light reflex examination: to assess the presence of opacity or mass lesions on the optic axis of the pupillary region. In a semi-dark room, the inspection distance is about 50 cm, the diopter of the glasses is adjusted to 0, and the irradiation spot is adjusted to a large spot. In the infant's awake state, the spot is simultaneously illuminated in both eyes, and the red reflection in the pupil area of both eyes is observed. Normal should be a bright red reflection of the symmetry of both eyes. Abnormal if the reflection brightness of the eyes is inconsistent, the red light reflection is absent, dim, or the appearance of dark spots is abnormal.
Eye position examination: screens infants for strabismus. Place the flashlight 33 cm in front of the child's eyes to attract the child's attention to the light source and check whether the refractive point of the cornea of the two eyes is in the center of the pupil. Cover the child's left and right eyes with an eye covering plate to observe horizontal or upward and downward movements of the eyeballs. When normal children gaze at the light source, there is a reflective point in the center of the pupil, and there is no obvious eyeball movement when covering the left and right eyes, respectively.
Monocular masking aversion test: to assess whether there is a large gap in binocular vision in children. Cover the children's eyes separately with an eye covering plate to see if the children's behavioral responses are consistent. Children with symmetrical binocular vision have the same response when they occlude their eyes separately; if one eye is obviously resistant to occlusion and the other is not, it indicates a large difference in binocular vision.
(6) Referral indications. Eye appearance abnormalities, including infants with inconsistent bulb size, conjunctival congestion, secretions from the eye, persistent tearing, corneal opacity or bilateral asymmetry, pupil misalignment or irregularity, whitish pupil area, nystagmus, abnormal transient reflex test results, abnormal red ball test results, abnormal visual behavior, abnormal red light reflex test results, oblique eye position examination, abnormal monocular masking aversion test.
3. Early childhood (18, 24, 30, 36 months of age)
(1) Check the appearance of the eye. The method is the same as infancy. Increase the presence or absence of redness or swelling of the eyelids, the presence or absence of inward and valgus of the eyelids, and whether the eyelashes are inverted.
(2) Observation of visual behavior. The method is the same as infancy. When asking parents, add the following to understand whether children are slow to avoid obstacles when they see things in their daily lives, whether it is difficult to walk in the dark, whether there is obvious tilting of the head or too close to the object, and there are behaviors such as fearless light, squinting or frequent rubbing of the eyes.
(3) Eye position examination, monocular masking aversion test, refractive screening (at 24 and 36 months of age).
At the age of 24 and 36 months, primary medical and health institutions separately inform parents that they should take young children to county-level maternal and child health care institutions or other qualified county-level medical institutions for special examinations such as eye position examination, one-eye masking aversion test, and refractive screening, and give referrals.
In follow-up services, primary medical and health institutions ask parents whether the children have undergone eye position examinations, one-eye mask aversion tests, refractive screening and other special examinations at the age of 24 or 36 months. For those who have not yet been examined, parents are again advised to take their young children to the county-level maternal and child health institutions or other qualified county-level medical institutions as soon as possible to accept the examination.
Encourage qualified township health centers and community health service centers to provide eye position examinations, one-eye mask aversion tests, and refractive screening for young children at the age of 24 and 36 months.
Eye position examination: the method is the same as in infancy.
Monocular coverage disgust test: methods are the same as infancy.
Refractive screening: Use a refractive screener to carry out eye refractive index screening, understand the refractive status of young children's eyeballs, monitor the reserve of hyperopia, and early detection of risk factors such as hyperopia, myopia, astigmatism, refractive error, insufficient hyperopia reserve and amblyopia. If refractive errors are abnormal but below the high refractive error and indications for referral of refractive errors, they should be re-examined six months later.
(4) Referral indications. Abnormal eye appearance examination, redness or swelling of the eyelids, varus or valgus of the eyelids, inverted eyelashes, etc., other symptoms are the same as infancy; abnormal visual behavior; skewed eye position examination; abnormal one-eye covering disgust test;
Refractive screening results are abnormal.
1) The following refractive errors and refractive errors may lead to amblyopia, see the following criteria:
24 months old. Refractive error: Astigmatism > 2.00D, hyperopia > +4.50D, myopia 1.50D or binocular column degree (astigmatism) difference > 1.00D.
36 months old. Refractive error: Astigmatism > 2.00D, farsightedness > +4.00D, myopia 1.50D or binocular column degree (astigmatism) difference > 1.00D.
2) The refractive screening results at the age of 24 or 36 months exceed the normal value range of the instrument examination, but are lower than the above standards, and the re-examination results are still abnormal after half a year.
3) Insufficient reserve of suspicious farsightedness: equivalent spherical degree
4) If the child cooperates well, repeated refractive examination three times on the same day cannot detect the value and exclude equipment problems, indicating a suspected refractive error or organic eye disease.
4. Preschoolers (4, 5, 6 years old)
(1) Check the appearance of the eye. The method is the same as in infancy.
(2) Observation of visual behavior. The method is the same as in infancy.
(3) Vision examination. Children's vision is checked using an international standard or standard logarithmic eye chart. During the examination, the detection distance is 5 meters, the illuminance of the eye chart is 500 Lux, and the height of the eye chart 1.0 row is the height of the subject's eye. Cover a glance, do not press the eyeball, and check one eye in the order of first right and then left. Visual markers are identified from top to bottom until a line that is illegible is recorded as a child's vision. The visual acuity value of the naked eye in one eye of the child is used as the criterion for judging whether the vision is abnormal. Naked-eye vision is generally 4.8 (0.6) or more in children aged 4 years, and naked-eye vision in children aged 5 years and above is generally 4.9 (0.8) or more.
(4) Eye position examination, refractive screening.
At the age of 4, 5 or 6, the primary medical and health institutions inform parents that they should take their children to the county-level maternal and child health care institutions or other qualified county-level medical institutions every year to receive special examinations such as eye position examination and refractive screening, and to be referred.
Primary medical and health institutions ask parents during follow-up services whether the child has undergone eye position examination, refractive screening and other special examinations at the age of 4, 5 or 6. For those who have not yet been examined, parents are again advised to take the child to the county maternal and child health institution or other qualified county-level medical institution as soon as possible to accept the examination.
Encourage qualified township health centers and community health service centers to provide eye position examinations and refractive screening for children at the age of 4, 5 and 6.
Eye position examination, refractive screening, the same method as in early childhood.
(5) Referral indications: abnormal eye appearance examination; abnormal visual behavior; naked eye vision ≤ 4.8 (0.6), naked eye vision ≤ 4.9 (0.8) in children aged 5 years and older, or two lines or more of bibular visual acuity difference (standard logarithmic visual chart), or binocular visual acuity difference of 0.2 and above (international standard visual chart). Skewed eye position; refractive screening results are abnormal.
4 years old. Refractive error: Astigmatism > 2.00D, farsightedness > +4.00D, myopia 1.50D or binocular column degree (astigmatism) difference > 1.00D.
5 years old, 6 years old. Refractive error: Astigmatism > 1.50D, hyperopia > +3.50D, myopia 1.50D or binocular columnar degree (astigmatism) difference > 1.00D.
2) The refractive screening results of 4, 5 and 6 years old exceed the normal value range of the instrument examination, but are lower than the above standards, and the re-examination results are still abnormal after half a year.
5. Check the results of the abnormal prompt
Abnormal results from eye disease screening and vision assessment suggest that the child may be at risk of eye disease or severe eye disease, and may have insufficient reserves of hyperopia.
(1) Abnormal eye appearance examination. If there is a defect in the eyelid, it is indicated as a suspicious eyelid deformity; the upper eyelid is droopy, indicating a suspicious oculomotor nerve or the congenital dysplasia of the upper eyelid muscle or caused by trauma; there is a purulent discharge in the eye, continuous lacrimation, indicating suspected conjunctivitis and lacrimal cystitis; corneal opacification, suggesting suspected congenital glaucoma, corneal edema, corneal disease, etc., which can cause vision decline or even blindness; the double size of the binocular balls is inconsistent, the cornea is asymmetrical, the pupil is not centered, not round, and the bilateral is not large, suggesting suspected congenital eye structure malformation; the pupil area is white, Suggests suspected congenital cataracts, retinoblastoma, etc.; sclera yellowing suggests suspected jaundice; nystagmus suggests suspected visual abnormalities; eyelid redness or swelling suggests possible eyelid inflammation, chalasma, or stye; and inverted eyelashes suggest the presence of eyelid varus.
(2) There are high-risk factors for eye disease. Suggests a risk of developing severe eye disease.
(3) Abnormal light response. Unresponsive to light, suggesting suspected visual abnormalities or blindness.
(4) Instantaneous reflection inspection abnormality. Infants do not have reflexive defensive blinking movements that suggest suspicious close-range vision abnormalities.
(5) The red ball test is abnormal. Infants cannot follow and gaze at red balls, suggesting suspicious visual abnormalities.
(6) Abnormal visual behavior. Suggests possible vision or eye position abnormalities.
(7) Abnormal red light reflection inspection. If the brightness of the reflection of the eyes is inconsistent, the red light reflection is absent, dim or dark spots appear, it indicates that congenital cataracts and leukoplakia are suspected.
(8) Abnormal eye position examination. This suggests that strabismus may be present, which may result in amblyopia.
(9) Abnormal one-eye masking disgust test. Suggests that refractive errors, amblyopia, etc. may be present.
(10) Refractive screening abnormalities. Suspicious hyperopia, myopia, astigmatism, and refractive errors can lead to amblyopia, which requires further examination to determine whether to wear glasses for correction. If equivalent to the number of spherical goggles
(11) Abnormal vision examination. Children aged 4 years with naked eye vision ≤ 4.8 (0.6), 5 years of age and older with naked eye vision ≤ 4.9 (0.8), or binocular vision difference of two lines or more (standard logarithmic visual chart), or binocular vision difference of 0.2 and more (international standard vision chart) is low vision. Suggests refractive errors, strabismus, amblyopia, cataracts, glaucoma, and other eye diseases.
According to the examination results, fill in the "Eye Care and Vision Examination Record Form for Children aged 0 to 6 years old" (Annex 3 Table 1 to Table 5) to gradually form a children's eye health file. If there is no abnormality in the comprehensive analysis, parents are informed to take the child to receive eye care and vision examination regularly in the follow-up; if abnormalities are found, parents are instructed to take the child to the referral in a timely manner.
(3) Health guidance.
After completing eye disease screening and vision assessment every time, parents should be popularized with children's eye care knowledge and health guidance in a timely manner based on the examination results. The key points of health guidance for children of different ages are detailed in Annex 4.
(4) Referral services.
1. Township health centers and community health service centers will refer children who have not yet received red light reflex, eye position examination, one-eye masking aversion test and refractive screening, as well as children with abnormal examination results, to county-level maternal and child health care institutions or other qualified county-level medical institutions, fill in referral recommendations (Annex 3 Table 2 to Table 5) and referral forms (see Annex 5), and guide parents to make timely referrals. Referrals are made in a single form, one is retained by the township health center (community health service center), and the other is handed over by the parents of the child to the county-level maternal and child health care institution or other qualified county-level medical institutions.
2. County-level maternal and child health care establishments or other qualified county-level medical institutions carry out the following reception services.
(1) For children who have not yet received special examinations such as red light reflection, eye position examination, one-eye masking aversion test and refractive screening in township health centers (community health service centers), corresponding examination services are provided according to the requirements of different age groups such as infancy, early childhood, and preschool age.
At the age of 6 months, special examinations such as red light reflex, eye position examination, and one-eye masking aversion test are provided, and the results of the examination are recorded, and the "Eye Care and Vision Examination Record Form for Children Aged 0 to 6 Years Old" (Annex 3) is completed.
At the age of 24 and 36 months, provide eye position examination, monocular masking aversion test and refractive screening, etc., according to the special examination, record the examination results, and fill in the "Eye Care and Vision Examination Record Form for Children aged 0 to 6 years old" (Annex 3) Table 4.
At the age of 4, 5 and 6, provide special examinations such as eye position examination and refractive screening, record the examination results, and fill in table 5 of the "Eye Care and Vision Examination Record Form for Children aged 0 to 6 years old" (Annex 3).
(2) Review children with abnormal examination results referred to township health centers (community health service centers). For children with abnormal re-examination results, as well as children who have received abnormal results in special examinations such as red light reflection, eye position examination, one-eye masking aversion test and refractive screening in this institution, at least the following common eye disease diagnosis, treatment and intervention services for children will be carried out in combination with the actual situation. When necessary, according to the condition, it should be promptly referred to a higher-level qualified medical institution for comprehensive assessment and diagnosis and treatment.
Children with abnormal eye appearance examination require further re-examination.
Children diagnosed with conjunctivitis, lacrimal cystitis, eyelid inflammation, chalacystoma and stye should be controlled in time to prevent the spread of inflammation and promote the regression of inflammation.
In the case of a large amount of purulent discharge in the eye, it is considered that it may be purulent conjunctivitis, and it is necessary to confirm the diagnosis as soon as possible and treat it in a timely and effective manner.
Other abnormalities in the appearance of the eye, such as suspected congenital glaucoma, corneal edema, corneal diseases, ocular structural deformities, jaundice and severe trichiasis, should be referred to a higher-level medical institution for diagnosis and treatment in a timely manner.
For newborns with high risk factors for eye disease, the risk of possible serious eye disease should be checked again, and institutions with the capacity should be further examined. For low-birth weight infants with a birth weight of < 2000 grams or preterm infants < 32 weeks at the age of birth, parents should be informed to promptly refer to a qualified medical institution for fundus lesion screening at 4-6 weeks after birth or 32 weeks of corrected gestational age to exclude retinopathy of prematurity. Qualified county-level maternal and child health care institutions may carry out fundus screening services, and for children who have been diagnosed with retinopathy of preterm infants, parents should be informed to refer them to a medical institution with corresponding treatment capabilities for timely intervention and treatment, and regular follow-up and review to observe the development of the retina until the retina matures.
In children with whitishing of the pupillary region, light response, transient reflexes and abnormal red bulb tests, and abnormal visual behavior, a red light reflex examination is performed to check for opacity and fundus lesions on the optic axis of the pupillary area. If the brightness of the reflection of the eyes is inconsistent, the red light reflection is lost, dim or dark spots appear, indicating that it is suspected to be congenital cataracts, white pupils, etc., it should be referred to a higher-level medical institution for diagnosis and treatment in time. Qualified county-level maternal and child health care institutions may carry out slit lamps and fundus examinations to further confirm the diagnosis.
For children with abnormal eye examination, if strabismus is suspected, professional refraction, fundus examination and other clear strabismus types should be performed, and the treatment plan should be determined in combination with the type of strabismus. The type of strabismus that requires surgical treatment should promptly refer the child to a higher-level medical institution for professional ophthalmology. Early treatment of strabismus can promote vision development and the establishment of binocular visual function on the basis of correcting the eye position and restoring the appearance.
Children with abnormal monocular masking aversion test may be caused by different binocular vision, suggesting suspected refractive error, amblyopia, or other eye diseases that require further diagnosis or prompt referral.
For children with abnormal vision tests and refractive screening, the following tests are performed.
1) Vision examination: For children aged 4 to 6 years old, the international standard eye chart or standard logarithmic eye chart is used for visual examination again, and professional eye examination is carried out in combination with the actual situation.
2) Refractive screening: Carry out refractive screening again for all children, monitor the reserve of farsightedness, and check for farsightedness, myopia, astigmatism and refractive errors.
3) Mydriatic refraction: For children who are still suspected of refractive error or low vision after re-examination, ciliary muscle paralysis refraction is performed according to the actual situation to obtain accurate refractive index. Determine whether the reserve of hyperopia is insufficient, and whether there is hyperopia, myopia, astigmatism and refractive error. Then according to the factors such as vision, eye position and age, it is comprehensively judged whether glasses need to be corrected.
For children with insufficient reserves of farsightedness, parents should be informed that there is a possibility of myopia and should be regularly checked to change bad eye habits and behaviors.
For children diagnosed with amblyopia by mydriatic refraction and combined with ophthalmic examination, risk factors such as refractive error, refractive error, strabismus, congenital cataracts, and severe ptosis are eliminated, and according to the age, vision, compliance, etc. of children, the visual acuity of the amblyopia eye is improved by covering and suppressing the dominant eye and visual training. During the treatment of amblyopia, the treatment plan should be followed up regularly, and the treatment plan should be adjusted in time according to the examination results and compliance assessment.
(3) County-level maternal and child health care institutions or county-level medical institutions with corresponding conditions fill in the receipt form (see Annex 6), record the results of special examinations such as red light reflex, eye position examination, monocular masking aversion test, refractive screening and other special examination results carried out by the institution, as well as review, diagnosis results or further referral information, and feedback them to the township health center (community health service center). The township health center (community health service center) is included in the children's eye health file.
3. Other qualified medical institutions at or above the county level accept referral children to further carry out diagnosis, treatment and intervention services for eye diseases and visual abnormalities. Timely feedback the diagnosis and treatment results to the county-level maternal and child health care institutions, and the county-level maternal and child health care institutions will feedback the results to the township health center (community health service center), and finally the township health center (community health service center) will be included in the children's eye health file.
(5) Establish children's eye health files.
Township health centers (community health service centers), county-level maternal and child health care institutions or county-level medical institutions with corresponding conditions, as well as medical institutions at or above the county level, when carrying out eye disease screening and vision assessment, health guidance, referral and reception services, shall record the corresponding content, establish a two-way exchange mechanism for information such as inter-agency screening, review, and diagnosis, and promptly improve children's eye health files, so that one person and one file are achieved. All localities should vigorously promote the construction of informatization, gradually establish electronic files of children's eye health, connect grass-roots medical and health institutions, county-level maternal and child health care institutions and diagnosis and treatment institutions, so that information is updated in a timely manner, interconnected and shared, and transferred in real time with children and adolescents.
Fourth, the technical requirements of service institutions and personnel
(1) All localities should increase efforts to promote the capacity building of children's eye care and vision examination in grass-roots medical and health institutions, and equip township health centers (community health service centers) with the basic equipment needed to carry out children's eye health care and vision examination services (see Annex 7). Enrich the personnel of children's eye care and vision examination. Eye care and vision examinations should be conducted by qualified medical personnel with professional and technical training.
(2) County-level maternal and child health care institutions or county-level medical institutions with corresponding conditions shall be equipped with the basic equipment needed to carry out children's eye health care and vision examination, review, and corresponding diagnosis and treatment services (see Annex 7), and have at least 1 child eye health consultation room and 1 examination room. At least one qualified practitioner or eye health professional trained in paediatric eye care and vision examination techniques.
Primary level medical and health institutions, county-level maternal and child health care institutions, or county-level medical institutions with corresponding conditions shall actively create conditions based on the total number of children living in the jurisdiction from 0 to 6 years old, and allocate a sufficient number of personnel engaged in child eye care services that meet the requirements.
Encourage qualified township health centers (community health service centers) and maternal and child health care institutions to expand relevant service projects in light of actual conditions, and increase necessary equipment and professionals.
5. Service functions
(1) Township health centers and community health service centers.
1. Carry out health education, popularize children's eye health care and knowledge of the prevention and control of poor vision, enhance the awareness of myopia prevention and control, and publicize that children's eye diseases should be screened, diagnosed early, and treated early. Publicize and mobilize parents to regularly take their children to receive eye care and vision screening services.
2. Combined with children's health management services, simultaneously carry out eye care and vision examination services for children aged 0 to 6 years old, and register and improve children's eye health file information.
3. Carry out targeted health guidance, timely referral, and follow-up of children with abnormal examination results and insufficient hyperopia reserves.
4. Grasp the basic situation of the eye health of children aged 0 to 6 years old in the jurisdiction, and promptly report the number of eye care and vision examinations for children aged 0 to 6 years old, the number of vision examinations for children aged 6 years, the number of children with poor vision at the age of 6, and the number of children under 7 years old (0 to 6 years old) to the county-level maternal and child health care institutions. Registration of children with abnormal eye care and vision examination results (see annex 8).
(2) County-level maternal and child health care establishments.
1. Carry out health education, popularize children's eye health care and knowledge of the prevention and control of poor vision, enhance the awareness of myopia prevention and control, and publicize that children's eye diseases should be screened, diagnosed early, and treated early.
2. Provide special examinations and re-examinations for children referred by township health centers and community health service centers. Qualified county-level maternal and child health care institutions undertake corresponding diagnostic and therapeutic service responsibilities. Encourage and support qualified county-level maternal and child health care institutions to carry out strabismus (non-surgical) and amblyopia correction services. Improve children's eye health records.
3. Assist the health administrative departments to establish regional children's eye health service networks and referral mechanisms, promote the informatization of children's eye health files, and improve the capacity and management level of children's eye health services.
4. Provide professional manpower support for township health centers and community health service centers, and carry out personnel training, technical guidance and quality assessment.
5. Undertake the data management of eye care and vision examination services for children aged 0 to 6 in the jurisdiction, and report them step by step in accordance with the requirements of the maternal and child health statistical survey system to ensure that the data is true and accurate, and strengthen the use of data analysis.
(3) Maternal and child health care institutions at the provincial and prefectural and municipal levels.
Combined with the functional positioning of maternal and child health care institutions, strengthen the capacity building of their own eye care departments, and assist the health administrative departments to focus on the construction of service networks and information systems, personnel training, business guidance, technology promotion, quality control, health education and data management.
(4) Other qualified medical establishments at the county level or above.
2. Provide services such as diagnosis, treatment and intervention of children's eye diseases.
3. Feedback the results of diagnosis and treatment of sick children to county-level maternal and child health care institutions, and the county-level maternal and child health care institutions will feedback the results to township health centers and community health service centers.
4. Carry out personnel training and technical guidance for grass-roots level in conjunction with maternal and child health care institutions in the jurisdiction.
Sixth, work requirements
Health administrative departments at all levels should attach great importance to children's eye care and vision examination services, strengthen organizational leadership, strengthen arrangements and work guidance, and continuously improve service accessibility and coverage. It is necessary to improve the working mechanism, regularly carry out quality inspections, and ensure the quality of service. Strengthen the training of children's eye care and vision examiners to ensure that qualified medical personnel who have received technical training in eye care and vision examinations are engaged in relevant work. Health administrative departments at all levels should strengthen the construction of regional information platforms and information interconnection and sharing, and realize the electronic and informatization of eye health records for children aged 0 to 6 years as soon as possible.
7. Work indicators
(1) Coverage rate of eye care and vision examination for children aged 0 to 6 years: the number of eye care and vision examinations for children aged 0 to 6 years in the jurisdiction during the statistical period / the number of children aged 0 to 6 years in the jurisdiction during the statistical period × 100%.
Among them, "the number of children aged 0 to 6 years old who have eye care and vision examinations" refers to the number of children aged 0 to 6 years who have received eye care and vision examinations once or more in the same year.
(2) Abnormal rate of eye care and vision examination for children aged 0 to 6 years: the number of abnormal eye disease screening and vision assessment of children aged 0 to 6 years old in the jurisdiction during the statistical period / the number of children aged 0 to 6 years in the jurisdiction during the statistical period × 100%.
(3) Abnormal referral rate of eye care and vision examination for children aged 0 to 6 years: the number of referrals for abnormal eye disease screening and vision assessment in children aged 0 to 6 years in the jurisdiction during the statistical period / the number of abnormal eye disease screening and vision assessment in children aged 0 to 6 years in the jurisdiction during the statistical period × 100%.
(4) Detection rate of 6-year-old children with poor vision: the number of people detected with poor vision in 6-year-old children in the jurisdiction during the statistical period / the number of vision examinations of 6-year-old children in the jurisdiction during the statistical period × 100%.
Criteria for judging poor vision in 6-year-old children: Naked eye vision in 6-year-old children ≤ 4.9 (0.8), or two lines or more of binocular vision difference (standard logarithmic visual chart), or binocular visual acuity difference of 0.2 and above (international standard visual chart).
(5) The filing rate of children's eye health files = the number of children aged 0 to 6 in the jurisdiction during the statistical period to establish eye health files / the number of children aged 0 to 6 in the jurisdiction during the statistical period× 100%.
8. Explanation of terms
(1) Vision: that is, visual resolution, is the ability of the eye to distinguish the minimum distance between two external objects. Vision is with the refractive system and retina development gradually mature, 0 to 6 years old is the key period of children's vision development, newborns are born with only light sense, 1 year old vision is generally up to 0.2, 2 years old vision is generally up to 0.4 or more, 3 years old vision is generally up to 0.5 or more, 4 years old vision is generally up to 0.6 or more, 5 years old and above vision is generally up to 0.8 or more.
(2) Naked eye vision: also known as uncorrected vision, refers to the vision measured without any optical lens correction, including naked eye far vision and naked eye near vision.
(3) Orthopedic process: children's eyeballs and vision are gradually mature, when the newborn is born, the eyes are immature, in a state of hyperopia, with the growth and development, the eyeball gradually grows, the diopter of the eyes gradually tends to face up, called "orthopedic process". Physiological diopter is +3.00D before age 3, physiological diopter is +1.50D to +2.00D at age 4-5, and physiological diopter is +1.00D to +1.50D at age 6-7.
(4) Hyperopia reserve: The newborn's eyeball is small, the eye axis is shorter, and the eyes are in a state of farsightedness at this time, which is physiological farsightedness, which is called "farsighted reserve". As children grow and develop, the eyeball gradually grows, the eye axis gradually becomes longer, and the degree of farsightedness gradually decreases and tends to face it. Insufficient hyperopia reserve means that the naked eye has normal visual acuity, and although the refractive state after mydriasis refraction does not meet the myopia standard, the degree of hyperopia is lower than the physiological value range of the corresponding age group. If the physiological refractive index of children aged 4 to 5 years is 150 to 200 degrees of hyperopia, there is a reserve of 150 to 200 degrees of farsightedness, if the physiological refractive index of children of this age is only 50 degrees of farsightedness, it means that their hyperopia reserve is consumed too much, and it is possible to appear myopia earlier.
(5) Diopter: The tortuous ability of the human eye to light is the diopter of the eye, which is generally expressed by "D".
(6) Refractive error: When the eye is in a non-regulated state (resting state), the parallel light from the outside world cannot be focused on the center of the retina macula after passing through the refractive system of the eye, so it is impossible to produce clear imaging, which is called refractive error, including myopia, farsightedness, astigmatism and refractive error.
(7) Strabismus: refers to the abnormal eye position of the other eye when one eye is looking at it, and the axis of sight of the other eye is deviated. Strabismus is a group of disorders that are closely related to visual development, anatomical development, binocular visual function, and eye motor function. The prevalence of strabismus is about 3%, of which the prevalence of congenital esotropia is about 1% to 2% in the first 6 months of life, and the prevalence of congenital strabismus in the population is 0.1%. In addition to affecting the appearance, strabismus can also lead to amblyopia and loss of binocular monosopic function to varying degrees. Early treatment of strabismus can promote vision development and the establishment of binocular visual function on the basis of correcting the eye position and restoring the appearance.
(8) Amblyopia: during visual development, the optimal corrected vision of one eye or both eyes due to abnormal visual experiences such as one-eye strabismus, refractive error, high refractive error, and shape deprivation is lower than that of normal children of the corresponding age, and there are no organic lesions in the eye examination, which is called amblyopia. It is divided into refractive error amblyopia, refractive jestria amblyopia, strabismus amblyopia, shape deprivation amblyopia and so on. According to the results of the census, the lower limit of normal visual acuity in children aged 3 to 5 years was 0.5, and the lower limit of normal visual acuity in children aged 6 years and above was 0.7. The prevalence of amblyopia is high, 1% to 5%, the success rate of amblyopia treatment decreases with the age of the child, and it is difficult to correct after the age of 6 years, and it should be diagnosed early and treated early.
Appendix 1-0 to 6 years old children's eye care and vision examination services
Appendix 2-0 to 6 years old children eye care and vision examination services
Annex 3 - Children's Eye Health Files
Appendix 4-0 to 6 years old children eye care and vision examination health guidance points
Appendix Eye care and vision examination referral form for children aged 5-0 to 6 years
Appendix Receipt for Eye Care and Vision Examination for Children Aged 6-0-6 Years
Annex 7-0 to 6 years old children's eye care and vision examination basic equipment
Appendix Registration Form for Abnormal Eye Care and Vision Examination Results for Children Aged 8-0-6 Years