Guimaraes Sandra, Soares Andreia, Freitas Cristina, Barros Pedro, Leite Ricardo Dourado, Costa Patrício Soares, Silva Eduardo D
Ophthalmology, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Porto, Portugal
Ophthalmology, Hospital de Braga, Braga, Portugal.
BMJ Open Ophthalmol. 2021 Jan 4;6(1):e000599. doi: 10.1136/bmjophth-2020-000599. eCollection 2021.
To study the effectiveness of amblyopia screening at ages 3-4.
From a population with no previous screening, a cohort of 2300 children with 3-4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated.
Past/present history of amblyopia was higher than 3.1%-4.2%, depending on amblyopia definition normatives. Screening at age 3-4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3-4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia.
Screening amblyopia in a whole-population setting at age 3-4 is highly effective. For each 48 children screened at age 3-4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3-4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3-4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3-4 seems a rational/effective way of controlling amblyopia.
研究3 - 4岁儿童弱视筛查的效果。
从之前未进行过筛查的人群中，选取2300名3 - 4岁的在校儿童（在葡萄牙，这个年龄段91%的儿童上学），对其进行全面的眼科评估。对弱视进行诊断、治疗及随访。估算弱视患病率、治疗效果、绝对风险降低率（ARR）、需筛查人数（NNS）及相对风险降低率（RRR）。
根据弱视定义标准，弱视既往/现患率高于3.1% - 4.2%。3 - 4岁进行筛查，估算ARR = 2.09%（95%可信区间1.50%至2.68%），成年后患弱视风险降低87%（RRR）。NNS为47.8（95%可信区间37.3至66.7）。新诊断病例的治疗有效率为88%（若包括已接受随访的儿童则为83%）。91%的新弱视诊断为屈光性弱视（其中100%在治疗后超过弱视多民族儿童眼病研究标准），而大多数斜视性弱视已得到治疗或治疗不足。在未接受眼科医生随访的有屈光性弱视危险因素的儿童中，仅30%在3 - 4岁时最终患弱视。新诊断的屈光性弱视与早期治疗的屈光性弱视使用眼罩的情况相同。
在3 - 4岁对整个人群进行弱视筛查非常有效。在3 - 4岁每筛查48名儿童，预计可预防一例未来的弱视（NNS）。更早进行筛查可能导致过度诊断和过度治疗：在3 - 4岁之前治疗所有新诊断病例，ARR的最大差异为0.3%，可能有多达70%的儿童在3 - 4岁之前接受不必要治疗的负担。让初级保健机构参与，制定针对可疑/高危学前期儿童及时转诊的政策，再加上3 - 4岁时的全面筛查，似乎是控制弱视的合理/有效方式。
