Vision Screening in Young Children: Evidence Review
Untreated amblyopia, strabismus, and nonamblyopic refractive error can lead to bullying, poor academic performance, and reduced quality of life. In 2011, the U.S. Preventive Services Task Force recommended screening for these conditions and their risk factors in 3- to 5-year-olds. In an effort to provide updated information to the task force,
Jonas et al. reviewed recent evidence on the effectiveness and safety of such screening in children aged 6 months to 5 years. They found that, although direct data are limited and inconclusive, indirect evidence supports testing of preschoolers at risk for vision problems.
The authors searched primary databases for English-language articles published from January 2009 through June 2016 and reviewed clinical trial registries. Among the 40 studies analyzed (34,709 children), 34 involved assessment of test accuracy. Positive likelihood ratios for amblyopia risk factors or refractive error were moderate (5-10) in most studies but higher (> 10) in studies involving multiple clinical tests. Test accuracy did not differ by age group. The most common difficulty related to screening was false-positive findings, with higher rates (usually > 75%) in studies with a low prevalence (< 10%) of vision abnormalities.
After 5-12 weeks of treatment, patching improved visual acuity by a mean of < 1 line on a standard chart in children with amblyopic risk factors who were pretreated with eyeglasses. Children who were patched were more likely to improve ≥ 2 lines than those who weren’t (45% vs. 21%, respectively). By 1 year, compared with no treatment, patching plus eyeglasses improved visual acuity by approximately 1 line in children not pretreated with eyeglasses, whereas eyeglasses alone improved it < 1 line. None of the reviewed studies addressed the effects of treatment on school performance, functioning, long-term amblyopia, or quality of life, and none established whether vision screening in preschoolers is beneficial.
The authors acknowledged that inability to cooperate may limit the use of some tests in children who are younger than 3 years of age.
The original article can be found here.