Kaiser Permanente Washington Health Research Institute, Seattle.
University of Iowa, Iowa City.
JAMA. 2017 Sep 5;318(9):836-844. doi: 10.1001/jama.2017.11260.
One of the most important causes of vision abnormalities in children is amblyopia (also known as "lazy eye"). Amblyopia is an alteration in the visual neural pathway in a child's developing brain that can lead to permanent vision loss in the affected eye. Among children younger than 6 years, 1% to 6% have amblyopia or its risk factors (strabismus, anisometropia, or both). Early identification of vision abnormalities could prevent the development of amblyopia.
Studies show that screening rates among children vary by race/ethnicity and family income. Data based on parent reports from 2009-2010 indicated identical screening rates among black non-Hispanic children and white non-Hispanic children (80.7%); however, Hispanic children were less likely than non-Hispanic children to report vision screening (69.8%). Children whose families earned 200% or more above the federal poverty level were more likely to report vision screening than families with lower incomes.
To update the 2011 US Preventive Services Task Force (USPSTF) recommendation on screening for amblyopia and its risk factors in children.
The USPSTF reviewed the evidence on the accuracy of vision screening tests and the benefits and harms of vision screening and treatment. Surgical interventions were considered to be out of scope for this review.
Treatment of amblyopia is associated with moderate improvements in visual acuity in children aged 3 to 5 years, which are likely to result in permanent improvements in vision throughout life. The USPSTF concluded that the benefits are moderate because untreated amblyopia results in permanent, uncorrectable vision loss, and the benefits of screening and treatment potentially can be experienced over a child's lifetime. The USPSTF found adequate evidence to bound the potential harms of treatment (ie, higher false-positive rates in low-prevalence populations) as small. Therefore, the USPSTF concluded with moderate certainty that the overall net benefit is moderate for children aged 3 to 5 years.
The USPSTF recommends vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of vision screening in children younger than 3 years. (I statement).
儿童视力异常的最重要原因之一是弱视（也称为“懒眼”）。弱视是儿童发育大脑中的视觉神经通路的改变，可导致受影响眼睛永久性视力丧失。在 6 岁以下的儿童中，有 1%至 6%患有弱视或其危险因素（斜视、屈光不正或两者兼有）。早期发现视力异常可预防弱视的发生。
研究表明，不同种族/族裔和家庭收入的儿童筛查率存在差异。基于 2009-2010 年父母报告的数据，黑人非西班牙裔儿童和白人非西班牙裔儿童的筛查率相同（80.7%）；然而，西班牙裔儿童报告视力筛查的可能性低于非西班牙裔儿童（69.8%）。家庭收入超过联邦贫困线 200%的儿童比收入较低的家庭更有可能报告视力筛查。
更新 2011 年美国预防服务工作组（USPSTF）关于弱视及其危险因素筛查的建议，适用于儿童。
USPSTF 审查了视力筛查测试准确性的证据，以及视力筛查和治疗的益处和危害。手术干预被认为超出了本审查范围。
3 至 5 岁儿童弱视治疗与视力显著提高相关，这可能会导致终生视力永久性提高。USPSTF 得出结论，其益处是中度的，因为未经治疗的弱视会导致永久性、不可矫正的视力丧失，并且筛查和治疗的益处可能会在儿童的一生中得到体验。USPSTF 发现有足够的证据来限制治疗的潜在危害（即，低患病率人群中假阳性率较高）为小。因此，USPSTF 得出结论，对于 3 至 5 岁儿童，总体净收益为中度。
USPSTF 建议对所有 3 至 5 岁儿童进行至少一次视力筛查，以发现弱视或其危险因素。（B 级推荐）USPSTF 得出结论，目前的证据不足以评估 3 岁以下儿童视力筛查的利弊平衡。（I 声明）。
