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Photoscreening for amblyopia risk factors assessment in young children: A systematic review with meta-analysis
André Ferreira1,2, Rita Vieira1, Sofia Maia1
1Service of Ophthalmology, 112085Centro Hospitalar Universitário do Porto, Porto, Portugal.
Insights
Instrument-based photoscreening for amblyopia risk factors in young children shows a 13% referral rate. Optimization of referral criteria is needed due to lack of consensus on screening parameters.
Area of Science:
- Ophthalmology
- Pediatric Vision Screening
Background:
- Amblyopia is a primary cause of vision loss in children, often preventable and treatable.
- Instrument-based screening for amblyopia risk factors is increasingly used, but outcomes require evaluation.
Approach:
- A systematic review and meta-analysis of studies on photoscreening for amblyopia risk factors in children under three years old.
- Searched PubMed, ISI Web of Science, and Scopus databases from inception to March 2021.
- Analyzed referral rates, untestable rates, and positive predictive values (PPV).
Key Points:
- Thirteen studies involving 64,041 children were analyzed.
- The pooled referral rate was 13% (95% CI: 7-19%), with astigmatism being the most common diagnosis.
- The pooled untestable rate was 8% (95% CI: 3-15%), and the PPV was 56% (95% CI: 40-71%).
Conclusions:
- Current guidelines lack consensus on optimal screening age, frequency, and refractive error thresholds.
- Refining referral criteria for photoscreening in young children is necessary for improved outcomes.
Purpose:
Amblyopia is a leading cause of preventable and treatable vision loss in the pediatric population. Instrument-based screening of amblyopia-risk factors is being widely adopted but the audit of its results is still lacking. We sought to review the existing evidence regarding the outcomes of photoscreening applied to children under the age of three years.
Methods:
A three-database search (Pubmed, ISI Web of Science, and Scopus) was performed from inception to March 2021. A meta-analysis of proportions was conducted to summarize the referral rate, untestable rate and positive predictive value (PPV).
Results:
Thirteen studies were selected among 705 original abstracts. The quantitative analysis included twelve studies enrolling 64,041 children. Of these, 13% (95%CI: 7-19%) were referred for further confirmation of the screening result. Astigmatism was the most common diagnosis both after screening and after ophthalmologic assessment of referred children. The pooled untestable rate and PPV were 8% (95%CI: 3-15%) and 56% (95%CI: 40-71%), respectively.
Conclusion:
There is no global consensus on the optimal age, frequency or what magnitude of refractive error must be considered an amblyopia-risk factor. Optimization of referral criteria is therefore warranted.
