Evidence-based medicine: the value of vision screening.
OBJECTIVE
To review the literature for evidence-based medicine (EBM), to assess the evidence for effectiveness of vision screening, and to propose moving toward value-based medicine (VBM) as a preferred basis for comparative effectiveness research.


METHODS
Literature based evidence is applied to five core questions concerning vision screening: (1) Is vision valuable (an inherent good)?; (2) Is screening effective (finding amblyopia)?; (3) What are the costs of screening?; (4) Is treatment effective?; and (5) Is amblyopia detection beneficial?


RESULTS
Based on EBM literature and clinical experience, the answers to the five questions are: (1) yes; (2) based on literature, not definitively so; (3) relatively inexpensive, although some claim benefits for more expensive options such as mandatory exams; (4) yes, for compliant care, although treatment processes may have negative aspects such as "bullying"; and (5) economic productive values are likely very high, with returns of investment on the order of 10:1, while human value returns need further elucidation.


CONCLUSIONS
Additional evidence is required to ascertain the degree to which vision screening is effective. The processes of screening are multiple, sequential, and complicated. The disease is complex, and good visual outcomes require compliance. The value of outcomes is appropriately analyzed in clinical, human, and economic terms.
Center for Adult Strabismus, Dallas, Texas, USA.
George R
GR
Beauchamp
Chalani
C
Ellepola
Cynthia L
CL
Beauchamp
D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D009988:Orthoptics / Q000379:methods*; D015203:Reproducibility of Results; D015351:Vision Screening / Q000379:methods*