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Discussion

Results of this evidence synthesis, organized by KQ, are summarized in Table 15. Vision impairment and amblyopia or amblyogenic risk factors are relatively common in preschool-aged children ages 1 to 5 years. As in the previous USPSTF review, direct evidence on health outcomes of preschool vision screening remains limited. On the other hand, more evidence is now available on the accuracy and comparative accuracy of common vision screening tests in preschool-aged children, and more evidence is available to understand the effectiveness and comparative effectiveness of various treatment regimens for amblyopia and unilateral refractive error (with or without amblyopia).

Methods

Is vision screening in children ages 1–5 years associated with improved health outcomes?

Introduction

In the United States, common visual problems in young children include refractive error, strabismus, and amblyopia. Vision impairment related to these conditions can reduce quality of life, function, and school performance. In addition, amblyopia and strabismus can affect normal visual development at a critical period of visual development, resulting in irreversible vision loss. Identification of vision problems prior to school entry could help identify children who might benefit from early interventions to correct or improve vision.

Results

No randomized trial evaluated outcomes of preschool vision screening compared with no screening. One large, fair-quality randomized trial nested within a population-based cohort study found that intensive, periodic orthoptist screening from ages 8 to 37 months was associated with reduced likelihood of amblyopia at age 7.5 years compared with one-time orthoptist screening at age 37 months. Intensive orthoptist screening also reduced the likelihood of residual amblyopia among treated children for one of two predefined definitions for amblyopia. A large prospective cohort study from this population found that one-time orthoptist screening at age 37 months was associated with no significant difference in risk for amblyopia at age 7.5 years compared with no screening. Three retrospective cohort studies found that preschool screening was associated with improved school-age vision outcomes compared with no screening, but each had important methodological shortcomings. No study evaluated school performance or other functional outcomes.

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