学龄前儿童弱视筛查的有效性：一项系统评价。
Effectiveness of screening preschool children for amblyopia: a systematic review.
作者信息
Schmucker Christine, Grosselfinger Robert, Riemsma Rob, Antes Gerd, Lange Stefan, Lagrèze Wolf, Kleijnen Jos
机构信息
Department of Medical Biometry and Statistics (German Cochrane Center), Institute of Medical Biometry and Medical Informatics, University Medical Center, Freiburg, Germany.
出版信息
BMC Ophthalmol. 2009 Jul 16;9:3. doi: 10.1186/1471-2415-9-3.
BACKGROUND
Amblyopia and amblyogenic factors like strabismus and refractive errors are the most common vision disorders in children. Although different studies suggest that preschool vision screening is associated with a reduced prevalence rate of amblyopia, the value of these programmes is the subject of a continuing scientific and health policy discussion. Therefore, this systematic review focuses on the question of whether screening for amblyopia in children up to the age of six years leads to better vision outcomes.
METHODS
Ten bibliographic databases were searched for randomised controlled trials, non-randomised controlled trials and cohort studies with no limitations to a specific year of publication and language. The searches were supplemented by handsearching the bibliographies of included studies and reviews to identify articles not captured through our main search strategy.
RESULTS
Five studies met the inclusion criteria. Of these, three studies suggested that screening is associated with an absolute reduction in the prevalence of amblyopia between 0.9% and 1.6% (relative reduction: between 45% and 62%). However, the studies showed weaknesses, limiting the validity and reliability of their findings. The main limitation was that studies with significant results considered only a proportion of the originally recruited children in their analysis. On the other hand, retrospective sample size calculation indicated that the power based on the cohort size was not sufficient to detect small changes between the groups. Outcome parameters such as quality of life or adverse effects of screening have not been adequately investigated in the literature currently available.
CONCLUSION
Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available. However, it is most likely that the present systematic review contains the most detailed description of the main limitations in current available literature evaluating these programmes. Therefore, future research work should be guided by the findings of this publication.
背景
弱视以及斜视和屈光不正等致弱视因素是儿童中最常见的视力障碍。尽管不同研究表明学龄前视力筛查与弱视患病率降低相关，但这些项目的价值仍是持续的科学和卫生政策讨论的主题。因此，本系统评价聚焦于6岁以下儿童弱视筛查是否能带来更好视力结果这一问题。
方法
检索了10个文献数据库，查找随机对照试验、非随机对照试验和队列研究，对发表年份和语言无特定限制。通过手工检索纳入研究和综述的参考文献来补充搜索，以识别未通过主要搜索策略获取的文章。
结果
5项研究符合纳入标准。其中，3项研究表明筛查与弱视患病率绝对降低0.9%至1.6%相关（相对降低：45%至62%）。然而，这些研究存在缺陷，限制了其结果的有效性和可靠性。主要限制在于，结果显著的研究在分析中仅考虑了最初招募儿童的一部分。另一方面，回顾性样本量计算表明，基于队列规模的检验效能不足以检测组间的微小变化。生活质量或筛查不良反应等结局参数在现有文献中尚未得到充分研究。
结论
现有文献无法充分评估基于人群的学龄前视力筛查项目。然而，本系统评价很可能包含了当前评估这些项目的现有文献中对主要局限性最详细的描述。因此，未来的研究工作应以本出版物的研究结果为指导。
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