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Amblyopia treatment outcomes after preschool screening v school entry screening: observational data from a
C Williams1, K Northstone, R A Harrad
1Division of Child Health, University of Bristol, Bristol, UK. Cathy.Williams@bristol.ac.uk
Insights
Preschool vision screening for amblyopia (lazy eye) in children showed a lower prevalence and better treatment outcomes. However, the benefits were small and disappeared when considering all children offered screening.
Area of Science:
- Pediatric Ophthalmology
- Public Health Interventions
- Vision Screening
Background:
- Preschool amblyopia screening is controversial due to debated benefits.
- This study examines visual outcomes in relation to preschool vision screening within a UK birth cohort.
Purpose of the Study:
- To evaluate the impact of preschool vision screening on visual outcomes at 7.5 years of age.
- To assess the effectiveness of early detection and treatment of amblyopia.
Main Methods:
- Monocular logMAR visual acuity measured with and without pinhole by orthoptists.
- Identification of children offered or receiving preschool screening using contemporary records.
Main Results:
- Amblyopia prevalence was 45% lower in screened children (1.1%) vs. unscreened (2.0%).
- Screened amblyopic children had better post-treatment acuity (0.14 logMAR) than unscreened (0.20 logMAR).
- Benefits diminished in intention-to-screen analysis.
Conclusions:
- Preschool screening at 37 months improved amblyopia treatment outcomes, though the clinical significance was small.
- Effectiveness is questionable when considering all children offered screening.
- Further research is needed; current data do not contradict school-entry screening recommendations.
Background/Aims:
Preschool screening for amblyopia has controversially been abandoned in some localities within the United Kingdom, on the basis that there is no clear evidence of benefit to support its continuation. Data collected within a birth cohort study were used to examine visual outcomes at 7(1/2) years in children who did or did not receive preschool vision screening.
Methods:
Monocular logMAR visual acuity with and without a pinhole was assessed by orthoptists. Contemporary records were used to identify children who had been offered and/or received preschool screening.
Results:
Of 6081 children, 24.9% had been offered preschool screening and 16.7% had attended. The prevalence of amblyopia was approximately 45% lower in the children who received preschool screening than in those who did not (1.1% v 2.0%, p = 0.05). The mean acuity in the worse seeing eyes after patching treatment was better for amblyopic children who received preschool screening than for those who did not; 0.14 v 0.20 logMAR (p <0.001). These effects did not persist in an intention to screen analysis.
Conclusions:
Preschool screening at 37 months was associated with an improved treatment outcome for individuals with amblyopia. However, the improvement was clinically small and disappeared when considering all children offered screening rather than only those who received it. Further research is needed into improving the effectiveness of vision screening for preschool children, while in the interim these data do not conflict with current recommendations for school entry screening by orthoptists.