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A review of the evidence on the effectiveness of children's vision screening
1Centre for Community Health, Royal Children's Hospital Murdoch Childrens Research Institute, and Western Health, Melbourne, Vic, Australia. megan.mathers@mcri.edu.au
Insights
Children's vision screening, particularly between 18 months and 5 years, can improve visual outcomes and educational attainment. However, evidence quality is low, and cost-effectiveness requires further study on quality of life impacts.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Early identification of health conditions through screening programs is crucial for timely interventions.
- Childhood vision impairment can impact development and educational outcomes.
- Existing vision screening programs for children vary widely in their components and effectiveness.
Purpose of the Study:
- To evaluate the effectiveness of children's vision screening programs.
- To determine the optimal age for vision screening in children.
- To identify the most effective components of vision screening programs.
Main Methods:
- A comprehensive literature review was conducted on vision screening programs for children aged 0-16 years.
- Studies were identified through clinical databases, hand searches, and expert consultations.
- Methodological quality was assessed using National Health and Medical Research Council (NHMRC) guidelines.
Main Results:
- Screening children aged 18 months to 5 years, followed by early treatment, improved visual acuity, primarily for amblyopia.
- Evidence suggests screening is most beneficial during the preschool years.
- Orthoptists were preferred screening personnel, but trained nurses also demonstrated high sensitivity and specificity.
Conclusions:
- Childhood vision screening appears beneficial, particularly for treating amblyopia and uncorrected refractive errors, potentially improving educational outcomes.
- The overall quality of evidence is low, and the cost-effectiveness is questionable without considering quality of life impacts.
- Further research is needed on neonatal screening effectiveness, quality of life improvements, and economic benefits to optimize programs.
Abstract:
Screening programmes enable health conditions to be identified so that effective interventions can be offered. The aim of this review was to determine: (1) the effectiveness of children's vision screening programmes; (2) at what age children should attend vision screening; and (3) what form vision screening programmes should take to be most effective. A literature review on the effectiveness of vision screening programmes in children aged 0-16 years was undertaken. Eligible studies/reviews were identified through clinical databases, hand searches and consultation with expert reviewers. The methodological quality of papers was rated using National Health and Medical Research Council (NHMRC) guidelines. Screening of children 18 months to 5 years, and subsequent early treatment, led to improved visual outcomes. The benefit was primarily through treatment of amblyopia, with improved visual acuity of the amblyopic eye. However, the overall quality of the evidence was low. The implication of improved visual acuity (e.g. any potential impact on quality of life) was not considered. Without consideration of 'quality of life' values, such as loss of vision in one eye or possibility of future bilateral vision loss, the cost-effectiveness of screening is questionable. Screening and treating children with uncorrected refractive error can improve educational outcomes. Evidence suggested that screening occur in the preschool years. Orthoptists were favoured as screening personnel; however, nurses could achieve high sensitivity and specificity with appropriate training. Further research is required to assess the effectiveness of neonatal screening. Most studies suggested that children's vision screening was beneficial, although programme components varied widely (e.g. tests used, screening personnel and age at testing). Research is required to clearly define any improvements to quality of life and any related economic benefits resulting from childhood vision screening. The evidence could be used to guide optimization of existing programmes.
