Ferreira André, Vieira Rita, Maia Sofia, Miranda Vasco, Parreira Ricardo, Menéres Pedro
Service of Ophthalmology, 112085Centro Hospitalar Universitário do Porto, Porto, Portugal.
Unit of Anatomy, Department of Biomedicine, Faculty of Medicine of University of Porto, Porto, Portugal.
Eur J Ophthalmol. 2023 Jan;33(1):92-103. doi: 10.1177/11206721221099777. Epub 2022 May 6.
Amblyopia is a leading cause of preventable and treatable vision loss in the pediatric population. Instrument-based screening of amblyopia-risk factors is being widely adopted but the audit of its results is still lacking. We sought to review the existing evidence regarding the outcomes of photoscreening applied to children under the age of three years.
A three-database search (Pubmed, ISI Web of Science, and Scopus) was performed from inception to March 2021. A meta-analysis of proportions was conducted to summarize the referral rate, untestable rate and positive predictive value (PPV).
Thirteen studies were selected among 705 original abstracts. The quantitative analysis included twelve studies enrolling 64,041 children. Of these, 13% (95%CI: 7-19%) were referred for further confirmation of the screening result. Astigmatism was the most common diagnosis both after screening and after ophthalmologic assessment of referred children. The pooled untestable rate and PPV were 8% (95%CI: 3-15%) and 56% (95%CI: 40-71%), respectively.
There is no global consensus on the optimal age, frequency or what magnitude of refractive error must be considered an amblyopia-risk factor. Optimization of referral criteria is therefore warranted.
弱视是导致儿童可预防和可治疗视力丧失的主要原因。基于仪器的弱视危险因素筛查正在广泛应用，但对其结果的审核仍很缺乏。我们试图回顾关于对三岁以下儿童进行照片筛查结果的现有证据。
从数据库建立至2021年3月进行了三个数据库（PubMed、ISI科学网和Scopus）的检索。进行了比例的荟萃分析以总结转诊率、不可检测率和阳性预测值（PPV）。
在705篇原始摘要中筛选出13项研究。定量分析纳入了12项研究，共64,041名儿童。其中，13%（95%CI：7-19%）被转诊以进一步确认筛查结果。散光在转诊儿童的筛查后和眼科评估后都是最常见的诊断。汇总的不可检测率和PPV分别为8%（95%CI：3-15%）和56%（95%CI：40-71%）。
关于最佳年龄、频率或何种程度的屈光不正必须被视为弱视危险因素，目前尚无全球共识。因此，有必要优化转诊标准。
