Background: Amblyopia screening can target reduced visual acuity (VA), its refractive risk factors, or both. VA testing is imprecise under 4 years of age, so automated risk-factor photoscreening appears an attractive option. This review considers photoscreening used in community services, focusing on costs, cost-effectiveness and scope of use, compared with EUSCREEN project Country Reports describing how photo- and automated screening is used internationally.
Methods: A systematic narrative review was carried out of all English language photoscreening literature to September 10th 2018, using publicly available search terms. Where costs were considered, a CASP economic evaluation checklist was used to assess data quality.
Results: Of 370 abstracts reviewed, 55 reported large-scale community photoscreening projects. Five addressed cost-effectiveness specifically, without original data. Photoscreening was a stand-alone, single, test event in 71% of projects. In contrast, 25 of 45 EUSCREEN Country Reports showed that if adopted, photoscreening often supplements other tests in established programmes and is rarely used as a stand-alone test. Reported costs varied widely and evidence of cost-effectiveness was sparse in the literature, or in international practice. Only eight (13%) papers compared the diagnostic accuracy or cost-effectiveness of photoscreening and VA testing, and when they did, cost-effectiveness of photoscreening compared unfavourably.
Discussion: Evidence that photoscreening reduces amblyopia or strabismus prevalence or improves overall outcomes is weak, as is evidence of cost-effectiveness, compared to later VA screening. Currently, the most cost-effective option seems to be a later, expert VA screening with the opportunity for a re-test before referral.
摘要: 针对视力降低 (VA) 、屈光危险因素或两者可进行弱视筛查。 VA测试在4岁以下是不精确的, 因此自动风险因素照片的筛选似乎是一个可行的选择。与EUSCREEN项目ʻ国别报告’ (该报告描述了国际上如何使用光筛和自动筛查) 相比, 本评论考虑了社区服务中使用的图像筛查方法, 重点关注成本, 成本效益和使用范围。 方法: 截至2018年9月10日, 我们使用搜索词在公众平台对所有英文文献进行了系统性回顾。在考虑成本的情况下, 使用了CASP经济评估清单来评估数据质量。 结果: 在370个摘要中, 有55个报告了大型社区图像筛选项目。没有原始数据的情况下, 有五个考虑了成本效益问题。在71% 的项目中, 图像筛选是一个独立的, 唯一的测试项目。相比之下, EUSCREEN 45个国家报告中的25个表明, 图像筛查通常只对既定程序中的其他测试进行补充, 并且很少将其用作独立测试的项目。成本差异很大, 在文献或国际惯例中, 成本效益的证据很少。只有八篇 (13%) 论文比较了图像筛查和VA测试的诊断准确性或成本效益, 而这样做时, 图像筛查的成本效益却不佳。 讨论: 与后者VA筛查相比, 图像筛查在降低弱视或斜视患病率或改善总体预后的证据方面 薄弱, 成本效益的证据也很少。目前, 最具成本效益的选择似乎是专家VA筛查, 并有机会在转诊前进行重新测试。.