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Vision screening for amblyopia in childhood

  • Review
  • Intervention

Authors


Abstract

Background

Amblyopia is a reversible deficit of vision that has to be treated within the sensitive period for visual development. Screening programmes have been set up to detect this largely asymptomatic condition and refer children for treatment while an improvement in vision is still possible. The value of such programmes and the optimum protocol for administering them remain controversial.

Objectives

The objective of this review was to evaluate the effectiveness of vision screening in reducing the prevalence of amblyopia.

Search methods

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2008), MEDLINE (January 1950 to August 2008) and EMBASE (January 1947 to August 2008). The electronic databases were last searched on 15 August 2008. No language restrictions were placed on these searches. No handsearching was done.

Selection criteria

We planned to analyse data from randomised controlled trials and cluster-randomised trials comparing the prevalence of amblyopia in screened versus unscreened populations.

Data collection and analysis

Two authors independently assessed study abstracts identified by the electronic searches. Full text copies of appropriate studies were obtained and, where necessary, authors were contacted. No data were available for analysis and no meta-analysis was performed.

Main results

Despite the large amount of literature available regarding vision screening no trials designed to compare the prevalence of amblyopia in screened versus unscreened populations were found.

Authors' conclusions

The lack of data from randomised controlled trials makes it difficult to analyse the impact of existing screening programmes on the prevalence of amblyopia. The absence of such evidence cannot be taken to mean that vision screening is not beneficial; simply that this intervention has not yet been tested in robust trials. To facilitate such trials normative data on age-appropriate vision tests need to be available and a consensus reached regarding the definition of amblyopia. In addition, the consequences of living with untreated amblyopia have yet to be quantified and a cost-benefit analysis carried out.

摘要

背景

兒童時期弱視的篩檢

弱視是一種可逆轉的視力缺陷,在視力發展的敏感階段可以治療。已設立的篩檢計畫用來篩檢大部分無症狀的情況,當仍有可能改善視力時把兒童轉交治療。篩檢計畫的價值以及執行的最佳方案,仍有爭議。

目標

這篇論述的目的在於評估視力篩檢在減少弱視盛行的成效

搜尋策略

搜索以下資料庫:Cochrane Central Register of Controlled Trials (CENTRAL), 它包含the Cochrane Eyes and Vision Group Trials Register, on The Cochrane Library Issue 2, 2005、 MEDLINE (1966 to May 2005 week 1) 及 EMBASE (1980 to 2005 week 19)。沒有語言限制,沒有書面檢索。

選擇標準

分析來自隨機對照試驗及群聚隨機試驗的數據,比較有篩檢計畫及無篩檢的人群其弱視盛行率的不同。

資料收集與分析

2位作者獨立評估從電子搜尋所獲得的研究摘要。取得適當研究的全文副本,當有需要時,與研究作者接觸。沒有有效的資料可供分析及沒有執行統合分析。

主要結論

雖然有許多關於視力篩檢的文獻,但是沒有發現比較有篩檢及無篩檢的人群的弱視盛行率的研究設計。目前在準備下的資料,可能對更新評論回顧是有用的。

作者結論

缺乏隨機對照試驗的資料,很難評估現行的篩檢計畫對弱視盛行率的影響。因為實證資料不足,無法斷定視力篩檢計畫沒有利益,即該項介入措施尚未經過嚴謹的研究試驗。還需要有助於建立標準規範的研究,包括適當視力檢查的年齡,以及對弱視的有效及一致性的定義。此外,未治療弱視的後果,尚沒有量化的成本效益分析。

翻譯人

本摘要由高雄榮民總醫院陳淑梅翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

現行對弱視的視力篩檢計畫,還沒有被隨機對照試驗的臨床實驗証實其功效。在大多數的弱視兒童通常只有一個眼睛受到影響,因此不容易被注意到有嚴重弱視。若能即時經過篩檢計畫發現弱視兒童,通常是可以被治療的。這篇評論發現沒有足夠証據可以確認篩檢計畫可以減少較大年齡的弱視兒童人數。

Plain language summary

Vision screening programmes for amblyopia (lazy eye)

Amblyopia, commonly known as “lazy eye”, is the term used to describe a type of reduced vision that develops in childhood. Amblyopia is relatively common, affecting approximately 2% of children. If treated while the visual system is still maturing amblyopia can usually be reversed and normal vision restored. In most cases amblyopia only affects one eye so even quite severe amblyopia may go unnoticed by parents or caregivers. Screening programmes have, therefore, been set up to test children’s vision, in each eye separately, in order to detect the condition while the child is young and treatment is still possible. This review was designed to examine the evidence to see if such screening programmes are effective in reducing the prevalence of untreated amblyopia. The review found that there is currently not enough evidence to determine whether or not screening programmes reduce the proportion of older children and adults with amblyopia. The authors concluded that there is, therefore, a need for some robust evaluation of the screening programmes that are in place to see if they are truly effective or not. Any such evaluation would have to also look at how much screening programmes cost and what effect untreated amblyopia has on quality of life.

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