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Chou R, Dana T, Bougatsos C. Screening for Visual Impairment in Children Ages 1-5 Years: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Feb. (Evidence Syntheses, No. 81.)

Appendix A2Inclusion and Exclusion Criteria for Key Questions

OVERALL

Ages

Include: Children ages 1–5 years

Exclude: Newborns and children younger than age 1 year, children ages 6 years or older

Diseases

Include: Amblyopia, amblyogenic risk factors, refractive error

Exclude: Children with severe congenital conditions or developmental delay, retinopathy of prematurity, glaucoma, congenital cataract, pathologic myopia

Language/publication status

Include: Full-text (i.e., not available only as a conference abstract) journal article published in English

Settings

Include: Studies performed in primary care, community-based, and school settings

Exclude: Countries with populations not similar to the United States

Study designs

Exclude: Systematic reviews

KEY QUESTIONS 1 (Screening and Outcomes) and 1a (Variation in Age Groups)

Interventions/diagnostic tests

Include: Studies of screening tests used or available in primary care settings (e.g., visual acuity tests, tests of stereopsis, tests for strabismus, photoscreeners, autorefractors)

Exclude: Studies of screening tests not used or available in primary care settings (e.g., contrast sensitivity testing, fundoscopic examination, visual acuity testing with cyclopegia) or not intended to detect amblyopia, amblyogenic risk factors, or refractive error (e.g., white reflex screening)

Outcomes

Include: Improved visual acuity, reduced long-term amblyopia, school performance, function, quality of life

Study designs

Include: Randomized controlled trials and controlled observational studies

KEY QUESTION 2 (Accuracy/Reliability of Risk Factor Assessment)

Outcomes

Include: Studies on accuracy or yield of risk factor assessment for targeted screening, or clinical outcomes associated with use of targeted versus universal screening

Study designs

Include: Randomized controlled trials and controlled observational studies

KEY QUESTIONS 3 (Accuracy of Screening Tests) and 3a (Variation in Age Groups)

Diagnostic tests

Include: Studies of screening tests used or available in primary care settings (e.g., visual acuity tests, tests of stereopsis, tests for strabismus, photoscreeners, autorefractors)

Exclude: Studies of screening tests not used or available in primary care settings (e.g., contrast sensitivity testing, fundoscopic examination, visual acuity testing with cyclopegia) or not intended to detect amblyopia, amblyogenic risk factors, or refractive error (e.g., white reflex screening)

Outcomes

Include: Sensitivity, specificity, positive and negative predictive values, likelihood ratios, diagnostic odds ratios (or able to calculate such outcomes from data provided)

Study designs

Include: Studies on diagnostic accuracy of a screening question or diagnostic test compared to a credible reference standard (i.e., cycloplegic refraction)

Exclude: Studies that do not attempt to perform the reference standard in all patients or a random sample

KEY QUESTION 4 (Harms of Screening)

Interventions/diagnostic tests

Include: Studies of screening tests used or available in primary care settings (e.g., visual acuity tests, tests of stereopsis, tests for strabismus, photoscreeners, autorefractors)

Exclude: Studies of screening tests not used or available in primary care settings (e.g., contrast sensitivity testing, fundoscopic examination, visual acuity testing with cyclopegia) or not intended to detect amblyopia, amblyogenic risk factors, or refractive error (e.g., white reflex screening)

Outcomes

Include: Harms, including psychological distress, labeling, anxiety, other psychological effects, false-positives, adverse effects on vision in nonimpaired eye

Study designs

Include: Randomized controlled trials and controlled observational studies

KEY QUESTION 5 (Effectiveness of Treatment)

Interventions/treatments

Include: Correction of refractive error (eyeglasses), patching, and atropine

Outcomes

Include: Improved visual acuity, reduced long-term amblyopia, school performance, function, quality of life

Study designs

Include: Randomized controlled trials

KEY QUESTION 6 (Harms of Treatment)

Interventions/treatments

Include: Correction of refractive error and penalization of the nonamblyogenic eye (patching, atropine)

Outcomes

Include: Harms, including psychological distress, labeling, anxiety, other psychological effects, false-positives, adverse effects on vision in nonimpaired eye

Study designs

Include: Randomized controlled trials and controlled observational studies

Cover of Screening for Visual Impairment in Children Ages 1-5 Years
Screening for Visual Impairment in Children Ages 1-5 Years: Systematic Review to Update the 2004 U.S. Preventive Services Task Force Recommendation [Internet].
Evidence Syntheses, No. 81.
Chou R, Dana T, Bougatsos C.

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