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Screening for visual impairment in children ages 1-5 years: update for the USPSTF
Roger Chou1, Tracy Dana, Christina Bougatsos
1Oregon Evidence-Based Practice Center and Department of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA. chour@ohsu.edu
Insights
Preschool vision screening can identify children with vision problems, and treatments improve visual acuity. However, more research is needed to confirm screening effectiveness compared to no screening.
Area of Science:
- Ophthalmology
- Pediatrics
- Public Health
Background:
- Early identification of vision problems in preschool children is crucial for visual development.
- Screening aims to detect visual acuity impairments during a critical developmental period.
Purpose of the Study:
- To evaluate the effectiveness of preschool vision screening for improving health outcomes.
- To assess the impact of screening on visual acuity and other clinical results.
Main Methods:
- Systematic review of randomized trials and observational studies (1950-2009).
- Searched Medline and Cochrane Library, reviewed reference lists, and consulted experts.
- Assessed diagnostic accuracy of screening tests and effectiveness of treatments.
Main Results:
- Limited direct evidence exists on the effectiveness of preschool vision screening versus no screening.
- Screening tests are useful for identifying vision problems, with lower testability in younger children (1-3 years).
- Treatments for amblyopia and refractive errors showed mild visual acuity improvements; functional outcomes were not evaluated.
Conclusions:
- Treatments for specific vision conditions can enhance visual acuity in preschoolers.
- While screening identifies issues, further studies are required to establish its comparative effectiveness against no screening.
- More research is needed on the overall impact of preschool vision screening programs.
Context:
Screening could identify preschool-aged children with vision problems at a critical period of visual development and lead to treatments that could improve vision.
Objective:
To determine the effectiveness of screening preschool-aged children for impaired visual acuity on health outcomes.
Methods:
We searched Medline from 1950 to July 2009 and the Cochrane Library through the third quarter of 2009, reviewed reference lists, and consulted experts. We selected randomized trials and controlled observational studies on preschool vision screening and treatments, and studies of diagnostic accuracy of screening tests. One investigator abstracted relevant data, and a second investigator checked data abstraction and quality assessments.
Results:
Direct evidence on the effectiveness of preschool vision screening for improving visual acuity or other clinical outcomes remains limited and does not adequately address whether screening is more effective than no screening. Regarding indirect evidence, a number of screening tests have utility for identification of preschool-aged children with vision problems. Diagnostic accuracy did not clearly differ for children stratified according to age, although testability rates were generally lower in children 1 to 3 years of age. Treatments for amblyopia or unilateral refractive error were associated with mild improvements in visual acuity compared with no treatment. No study has evaluated school performance or other functional outcomes.
Conclusions:
Although treatments for amblyopia or unilateral refractive error can improve vision in preschool-aged children and screening tests have utility for identifying vision problems, additional studies are needed to better understand the effects of screening compared with no screening.
