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Diagnostic accuracy of vision screening tests for the detection of amblyopia and its risk factors: a systematic
Christine Schmucker1, Robert Grosselfinger, Rob Riemsma
1German Cochrane Centre, Institute of Medical Biometry and Medical Informatics, Department of Medical Biometry and Statistics, University Medical Centre Freiburg, Freiburg, Germany. schmucker@cochrane.de
Aim:
This systematic review evaluates the diagnostic accuracy of preschool vision screening tests for the detection of amblyopia and its risk factors.
Methods:
The literature searches were conducted in nine bibliographic databases. No limitation to a specific study design, year of publication or language was applied. Studies were included if they compared a vision screening test with a reference test (gold standard) in children from the general population. In addition, the studies had to provide sufficient data to calculate diagnostic accuracy (sensitivity and specificity). Full-text articles were assessed for studies that satisfied the inclusion criteria using the "Quality of Diagnostic Accuracy Studies (QUADAS)" checklist.
Results:
Two studies with a longitudinal design and 25 cross-sectional studies met the inclusion criteria. One of the longitudinal studies compared a screening programme in children between 1 and 2 years of age with a re-examination at the age of 8. The sensitivity for the screening programme was 86% (range: 64-97%) and the specificity 99% (range: 98-99%). The second longitudinal study compared screening examinations at 8, 12, 18, 25 and 31 months, with a re-examination at the age of 37 months. In this study, the sensitivity of the screening examination increased with age, while the specificity remained unchanged. The cross-sectional studies evaluated different screening settings, visual acuity tests, auto- or photorefractors and stereo tests. A large variety of reference tests, differing criteria for defining amblyopia and its risk factors and methodological limitations of the studies prevented a valid data interpretation.
Conclusion:
Diagnostic test accuracy of preschool vision screening tests can only be sufficiently investigated after establishing age-related values defining amblyopia, refractive errors and binocular disorders. To address these questions, we recommend a controlled longitudinal study design.
