Amblyopia screening effectiveness at 3–4 years old: a cohort study

Objective To study the effectiveness of amblyopia screening at ages 3–4.Methods and Analysis From a population with no previous screening, a cohort of 2300 children with 3–4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological...

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Autores principales:	Pedro Barros, Sandra Guimaraes, Andreia Soares, Cristina Freitas, Ricardo Dourado Leite, Patrício Soares Costa, Eduardo D Silva
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2021
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/b09bec8f2c924373af61ad416cdc882d
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spelling	oai:doaj.org-article:b09bec8f2c924373af61ad416cdc882d2021-11-08T06:30:05ZAmblyopia screening effectiveness at 3–4 years old: a cohort study10.1136/bmjophth-2020-0005992397-3269https://doaj.org/article/b09bec8f2c924373af61ad416cdc882d2021-11-01T00:00:00Zhttps://bmjophth.bmj.com/content/6/1/e000599.fullhttps://doaj.org/toc/2397-3269Objective To study the effectiveness of amblyopia screening at ages 3–4.Methods and Analysis From a population with no previous screening, a cohort of 2300 children with 3–4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated.Results Past/present history of amblyopia was higher than 3.1%–4.2%, depending on amblyopia definition normatives. Screening at age 3–4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3–4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia.Conclusions Screening amblyopia in a whole-population setting at age 3–4 is highly effective. For each 48 children screened at age 3–4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3–4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3–4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3–4 seems a rational/effective way of controlling amblyopia.Pedro BarrosSandra GuimaraesAndreia SoaresCristina FreitasRicardo Dourado LeitePatrício Soares CostaEduardo D SilvaBMJ Publishing GrouparticleOphthalmologyRE1-994ENBMJ Open Ophthalmology, Vol 6, Iss 1 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Pedro Barros Sandra Guimaraes Andreia Soares Cristina Freitas Ricardo Dourado Leite Patrício Soares Costa Eduardo D Silva Amblyopia screening effectiveness at 3–4 years old: a cohort study
description	Objective To study the effectiveness of amblyopia screening at ages 3–4.Methods and Analysis From a population with no previous screening, a cohort of 2300 children with 3–4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated.Results Past/present history of amblyopia was higher than 3.1%–4.2%, depending on amblyopia definition normatives. Screening at age 3–4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3–4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia.Conclusions Screening amblyopia in a whole-population setting at age 3–4 is highly effective. For each 48 children screened at age 3–4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3–4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3–4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3–4 seems a rational/effective way of controlling amblyopia.
format	article
author	Pedro Barros Sandra Guimaraes Andreia Soares Cristina Freitas Ricardo Dourado Leite Patrício Soares Costa Eduardo D Silva
author_facet	Pedro Barros Sandra Guimaraes Andreia Soares Cristina Freitas Ricardo Dourado Leite Patrício Soares Costa Eduardo D Silva
author_sort	Pedro Barros
title	Amblyopia screening effectiveness at 3–4 years old: a cohort study
title_short	Amblyopia screening effectiveness at 3–4 years old: a cohort study
title_full	Amblyopia screening effectiveness at 3–4 years old: a cohort study
title_fullStr	Amblyopia screening effectiveness at 3–4 years old: a cohort study
title_full_unstemmed	Amblyopia screening effectiveness at 3–4 years old: a cohort study
title_sort	amblyopia screening effectiveness at 3–4 years old: a cohort study
publisher	BMJ Publishing Group
publishDate	2021
url	https://doaj.org/article/b09bec8f2c924373af61ad416cdc882d
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Amblyopia screening effectiveness at 3–4 years old: a cohort study

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