title: Screening for visual impairment in children ages 1-5 years: update for the USPSTF.
abstract: BACKGROUND
  Screening could identify preschool-aged children with vision problems at a critical period of visual development and lead to treatments that could improve vision.
  
  
  OBJECTIVE
  To determine the effectiveness of screening preschool-aged children for impaired visual acuity on health outcomes.
  
  
  METHODS
  We searched Medline from 1950 to July 2009 and the Cochrane Library through the third quarter of 2009, reviewed reference lists, and consulted experts. We selected randomized trials and controlled observational studies on preschool vision screening and treatments, and studies of diagnostic accuracy of screening tests. One investigator abstracted relevant data, and a second investigator checked data abstraction and quality assessments.
  
  
  RESULTS
  Direct evidence on the effectiveness of preschool vision screening for improving visual acuity or other clinical outcomes remains limited and does not adequately address whether screening is more effective than no screening. Regarding indirect evidence, a number of screening tests have utility for identification of preschool-aged children with vision problems. Diagnostic accuracy did not clearly differ for children stratified according to age, although testability rates were generally lower in children 1 to 3 years of age. Treatments for amblyopia or unilateral refractive error were associated with mild improvements in visual acuity compared with no treatment. No study has evaluated school performance or other functional outcomes.
  
  
  CONCLUSIONS
  Although treatments for amblyopia or unilateral refractive error can improve vision in preschool-aged children and screening tests have utility for identifying vision problems, additional studies are needed to better understand the effects of screening compared with no screening.
authors.affiliation: Oregon Evidence-Based Practice Center and Department of Medicine, Oregon Health & Science University, Portland, Oregon 97239, USA. chour@ohsu.edu
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.forename: Tracy
authors.initials: T
authors.lastname: Dana
authors.forename: Christina
authors.initials: C
authors.lastname: Bougatsos
mesh_terms: D026683:Advisory Committees / Q000592:standards*; D000367:Age Factors; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D016032:Randomized Controlled Trials as Topic / Q000592:standards / Q000639:trends; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D014786:Vision Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control*; D015351:Vision Screening / Q000379:methods / Q000592:standards*