RTI International-University of North Carolina at Chapel Hill Evidence-based Practice Center (RTI-UNC EPC).
Department of Medicine, University of North Carolina at Chapel Hill.
JAMA. 2017 Sep 5;318(9):845-858. doi: 10.1001/jama.2017.9900.
Preschool vision screening could allow detection and treatment of vision abnormalities during a critical developmental stage, preserving function and quality of life.
To review the evidence on screening for and treatment of amblyopia, its risk factors, and refractive error in children aged 6 months to 5 years to inform the US Preventive Services Task Force.
MEDLINE, Cochrane Library, CINAHL, and trial registries through June 2016; references; and experts, with surveillance of the literature through June 7, 2017.
English-language randomized clinical trials (RCTs) or prospective cohort studies that evaluated screening, studies evaluating test accuracy, RCTs of treatment vs inactive controls, and cohort studies or case-control studies assessing harms.
Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings. Studies were not quantitatively pooled because of clinical and methodological heterogeneity.
Visual acuity, amblyopia, school performance, functioning, quality of life, test accuracy, testability, and harms.
Forty studies were included (N = 34 709); 34 evaluated test accuracy. No RCTs compared screening with no screening, and no studies evaluated school performance, function, or quality of life. Studies directly assessing earlier or more intensive screening were limited by high attrition. Positive likelihood ratios were between 5 and 10 for amblyopia risk factors or nonamblyogenic refractive error in most studies of test accuracy and were greater than 10 in most studies evaluating combinations of clinical tests. Inability to cooperate may limit use of some tests in children younger than 3 years. Studies with low prevalence (<10%) of vision abnormalities showed high false-positive rates (usually >75%). Among children with amblyopia risk factors (eg, strabismus or anisometropia), patching improved visual acuity of the amblyopic eye by a mean of less than 1 line on a standard chart after 5 to 12 weeks for children pretreated with glasses (2 RCTs, 240 participants); more children treated with patching than with no patching experienced improvement of at least 2 lines (45% vs 21%; P = .003; 1 RCT, 180 participants). Patching plus glasses improved visual acuity by about 1 line after 1 year (0.11 logMAR [95% CI, 0.05-0.17]) for children not pretreated with glasses (1 RCT, 177 participants). Glasses alone improved visual acuity by less than 1 line after 1 year (0.08 logMAR [95% CI, 0.02-0.15], 1 RCT, 177 participants).
Studies directly evaluating the effectiveness of screening were limited and do not establish whether vision screening in preschool children is better than no screening. Indirect evidence supports the utility of multiple screening tests for identifying preschool children at higher risk for vision problems and the effectiveness of some treatments for improving visual acuity outcomes.
学龄前视力筛查可以在关键发育阶段发现和治疗视力异常，从而保持功能和生活质量。
回顾有关弱视、危险因素和屈光不正筛查和治疗的证据，以告知美国预防服务工作组。
通过 2016 年 6 月的 MEDLINE、Cochrane 图书馆、CINAHL 和试验登记处、参考文献和专家检索。通过 2017 年 6 月 7 日的文献监测。
评估筛查的英语随机临床试验 (RCT) 或前瞻性队列研究，评估测试准确性的研究，治疗与非活性对照的 RCT，以及评估危害的队列研究或病例对照研究。
对摘要、全文文章和研究质量进行双重审查；对研究结果进行定性综合。由于临床和方法学的异质性，研究没有进行定量合并。
视力、弱视、学业成绩、功能、生活质量、测试准确性、可测试性和危害。
纳入 40 项研究（N=34709）；34 项评估了测试的准确性。没有 RCT 比较筛查与不筛查，也没有研究评估学业成绩、功能或生活质量。直接评估更早或更密集筛查的研究受到高流失率的限制。在大多数评估测试准确性的研究中，弱视危险因素或非弱视性屈光不正的阳性似然比为 5 到 10，在大多数评估联合临床测试的研究中，阳性似然比大于 10。在年龄小于 3 岁的儿童中，无法配合可能限制了一些测试的使用。在患病率（<10%）较低的视力异常研究中，高假阳性率（通常>75%）。在有弱视危险因素（如斜视或屈光参差）的儿童中，与预先戴眼镜的儿童相比，在 5 至 12 周内，遮盖治疗可使弱视眼的视力提高不到 1 行（2 项 RCT，240 名参与者）；接受遮盖治疗的儿童中有更多的人视力至少提高 2 行（45%比 21%；P=0.003；1 项 RCT，180 名参与者）。对于未预先戴眼镜的儿童，在 1 年内，遮盖加眼镜可使视力提高约 1 行（0.11 logMAR [95%CI，0.05-0.17]）（1 项 RCT，177 名参与者）。在 1 年内，单独戴眼镜可使视力提高不到 1 行（0.08 logMAR [95%CI，0.02-0.15]）（1 项 RCT，177 名参与者）。
直接评估筛查有效性的研究受到限制，不能确定学龄前儿童的视力筛查是否优于不筛查。间接证据支持多种筛查测试用于识别学龄前儿童视力问题风险较高的儿童的有效性，以及一些治疗方法改善视力结果的有效性。
