• Vision Screening in Young Children: Evidence Review

    Written By: Lynda Seminara
    Selected By: Deepak P. Edward, MD

    Journal Highlights

    JAMA
    2017;318(9):845-858

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    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.