Mathers M, Keyes M, Wright M
Centre for Community Health, Royal Children's Hospital Murdoch Childrens Research Institute, and Western Health, Melbourne, Vic, Australia.
Child Care Health Dev. 2010 Nov;36(6):756-80. doi: 10.1111/j.1365-2214.2010.01109.x.
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.
筛查项目能够识别健康状况，从而提供有效的干预措施。本综述的目的是确定：（1）儿童视力筛查项目的有效性；（2）儿童应在什么年龄接受视力筛查；以及（3）视力筛查项目应采取何种形式才能最有效。我们对0至16岁儿童视力筛查项目的有效性进行了文献综述。通过临床数据库、手工检索以及与专家评审员协商，确定了符合条件的研究/综述。使用澳大利亚国家卫生与医学研究委员会（NHMRC）的指南对论文的方法学质量进行评分。对18个月至5岁的儿童进行筛查并随后进行早期治疗，可改善视力结果。益处主要来自于弱视治疗，弱视眼的视力得到了提高。然而，证据的总体质量较低。未考虑视力提高的影响（例如对生活质量的任何潜在影响）。如果不考虑“生活质量”因素，如单眼失明或未来双眼失明的可能性，筛查的成本效益值得怀疑。对未矫正屈光不正的儿童进行筛查和治疗可以改善教育成果。有证据表明筛查应在学龄前进行。眼科视光师被认为是理想的筛查人员；然而，护士经过适当培训也能达到较高的灵敏度和特异性。需要进一步研究以评估新生儿筛查的有效性。大多数研究表明儿童视力筛查是有益的，尽管项目组成部分差异很大（例如使用的测试、筛查人员和测试年龄）。需要开展研究以明确界定儿童视力筛查对生活质量的任何改善以及任何相关的经济效益。这些证据可用于指导优化现有项目。
