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Vision Screening in Children Aged 6 Months to 5 Years: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Abstract Preschool vision screening could allow detection and treatment of vision abnormalities during a critical developmental stage, preserving function and quality of life.
PMID
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Authors

Mayor MeshTerms

Vision Screening

Keywords
Journal Title jama
Publication Year Start




PMID- 28873167
OWN - NLM
STAT- MEDLINE
DA  - 20170905
DCOM- 20170912
LR  - 20170912
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 318
IP  - 9
DP  - 2017 Sep 05
TI  - Vision Screening in Children Aged 6 Months to 5 Years: Evidence Report and
      Systematic Review for the US Preventive Services Task Force.
PG  - 845-858
LID - 10.1001/jama.2017.9900 [doi]
AB  - Importance: Preschool vision screening could allow detection and treatment of
      vision abnormalities during a critical developmental stage, preserving function
      and quality of life. Objective: 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. Data Sources: 
      MEDLINE, Cochrane Library, CINAHL, and trial registries through June 2016;
      references; and experts, with surveillance of the literature through June 7,
      2017. Study Selection: 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. Data Extraction and Synthesis: 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. Main Outcomes and Measures: Visual acuity,
      amblyopia, school performance, functioning, quality of life, test accuracy,
      testability, and harms. Results: Forty studies were included (N = 34709); 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). Conclusions and Relevance: 
      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.
FAU - Jonas, Daniel E
AU  - Jonas DE
AD  - RTI International-University of North Carolina at Chapel Hill Evidence-based
      Practice Center (RTI-UNC EPC).
AD  - Department of Medicine, University of North Carolina at Chapel Hill.
AD  - Cecil G. Sheps Center for Health Services Research, University of North Carolina 
      at Chapel Hill.
FAU - Amick, Halle R
AU  - Amick HR
AD  - Venebio Group, Richmond, Virginia.
FAU - Wallace, Ina F
AU  - Wallace IF
AD  - RTI International-University of North Carolina at Chapel Hill Evidence-based
      Practice Center (RTI-UNC EPC).
AD  - RTI International, Research Triangle Park, North Carolina.
FAU - Feltner, Cynthia
AU  - Feltner C
AD  - RTI International-University of North Carolina at Chapel Hill Evidence-based
      Practice Center (RTI-UNC EPC).
AD  - Department of Medicine, University of North Carolina at Chapel Hill.
AD  - Cecil G. Sheps Center for Health Services Research, University of North Carolina 
      at Chapel Hill.
FAU - Vander Schaaf, Emily B
AU  - Vander Schaaf EB
AD  - Department of Pediatrics, University of North Carolina at Chapel Hill.
FAU - Brown, Callie L
AU  - Brown CL
AD  - Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina.
FAU - Baker, Claire
AU  - Baker C
AD  - RTI International-University of North Carolina at Chapel Hill Evidence-based
      Practice Center (RTI-UNC EPC).
AD  - Cecil G. Sheps Center for Health Services Research, University of North Carolina 
      at Chapel Hill.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
SB  - AIM
SB  - IM
MH  - Amblyopia/*diagnosis/therapy
MH  - Child, Preschool
MH  - Educational Status
MH  - False Positive Reactions
MH  - Female
MH  - Humans
MH  - Infant
MH  - Male
MH  - Mass Screening
MH  - Refractive Errors/diagnosis
MH  - Risk Assessment
MH  - Risk Factors
MH  - Strabismus/diagnosis
MH  - *Vision Screening
MH  - Visual Acuity
EDAT- 2017/09/06 06:00
MHDA- 2017/09/13 06:00
CRDT- 2017/09/06 06:00
AID - 2652656 [pii]
AID - 10.1001/jama.2017.9900 [doi]
PST - ppublish
SO  - JAMA. 2017 Sep 5;318(9):845-858. doi: 10.1001/jama.2017.9900.