目的：比较两种电脑验光仪在近视筛查中对中国学龄期儿童屈光度测量的一致性。

方法：应用拓普康RM-8900和天乐RM-9000电脑验光仪对从天津东丽区四所中小学分层抽样得到的6～16岁学生测定非睫状肌麻痹下的屈光度。运用Sperman相关分析和Bland-Altman法评价两种方法测量球镜度、柱镜度和等效球镜度的一致性，同时分析两种方法测量的散光轴向差异分布情况。

结果：研究最终纳入1 138例患者2 276眼，平均年龄10.49±2.66岁。Spearman相关分析显示，天乐RM-9000测量的球镜度(r=0.958， P<0.0001)、柱镜度(r=0.769， P<0.0001)和等效球镜度(r=0.962， P<0.0001)均与拓普康RM-8900测量结果高度相关。Bland-Altman分析表明，天乐RM-9000测定的球镜度比拓普康RM-8900显著偏向远视(P<0.0001)，平均差异为0.44 D(标准差：0.37； 95%置信区间：-0.27，1.16)，其中95%置信区间内最大球镜度差值的绝对值(1.13 D)超出临床误差可接受范围(-0.50～+0.75D)； 然而，两种方法测定的柱镜度差异无统计学意义(P=0.83)，平均差异为-0.01 D(标准差：0.31； 95%置信区间：-0.62，0.61)，其中95%置信区间内最大柱镜度差值的绝对值(0.62 D)在临床误差可接受范围(-0.50～+0.75D)内。两种仪器测定的柱镜轴向差异在20°以内的比例在柱镜度 ≤-0.25 D的散光眼中达到84.6%(1 503/1 777)，而这一比例在柱镜度≤-0.75 D的散光眼(n=885)中升高至96.4%(853/885)。

结论：天乐RM-9000电脑验光仪测量的球镜度相比于Topcon RM-8900结果显著偏向远视，两种仪器对于柱镜度及柱镜轴向的测量一致性在临床可接受范围内。

METHODS: Topcon RM-8900 and Tianle RM-9000 autorefractors were utilized to measure refractive errors under noncycloplegic condition in students aged 6 to 16 years old who were cluster sampled from four primary and secondary schools in Dongli district, Tianjin. Sperman correlation analysis and Bland-Altman method were used to evaluate the consistency of spherical diopters, cylindrical diopters and spherical equivalents measured by the two methods, and the axial difference distribution of astigmatism measured by the two methods was analyzed.

RESULTS:A total of 2 276 eyes of 1 138 subjects with a mean age of 10.49±2.66 a were finally enrolled. Spearman correlation analysis showed that sphere(r=0.958, P<0.0001), cylinder(r=0.769, P<0.0001), and spherical equivalent(r=0.962, P<0.0001)measured by Tianle RM-9000 were highly correlated with those measured by Topcon RM-8900, respectively. Bland-Altman analysis showed spherical diopters measured by Tianle RM-9000 were significantly more hyperopic(P<0.0001)with a mean difference of 0.44 D(SD: 0.37; 95% CI: -0.27, 1.16)while the maximum absolute value(1.13 D)of the difference within the 95% CI was above the clinically acceptable range; however, no significant difference(P=0.83)was found between cylindrical diopters measured by the two methods with a mean difference of -0.01 D(SD: 0.31; 95% CI=-0.62, 0.61)while the maximum absolute value(0.62 D)of the difference within the 95% CI was clinically acceptable. The proportion of the axial deviation within ±20° was 84.6%(1 503/1 777)in eyes with cylinder ≤-0.25D while that rose to 96.4%(853/885)in eyes with cylinder ≤-0.75D.

CONCLUSION: Spherical diopters measured by Tianle RM-9000 have a significant hyperopia bias than those measured by Topcon RM-8900 while the consistency of cylindrical diopters and cylindrical axes is clinically acceptable.