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Scope and costs of autorefraction and photoscreening for childhood amblyopia – a systematic narrative review in relation to the EUSCREEN project data

Horwood, A., Griffiths, H. J., Carlton, J., Mazzone, P., Channa, A., Nordmann, M. and Simonsz, H. J. (2021) Scope and costs of autorefraction and photoscreening for childhood amblyopia – a systematic narrative review in relation to the EUSCREEN project data. Eye, 35 (3). pp. 739-752. ISSN 0950-222X

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To link to this item DOI: 10.1038/s41433-020-01261-8

Abstract/Summary

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 photo-screening 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 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.

Item Type:Article
Refereed:Yes
Divisions:Life Sciences > School of Psychology and Clinical Language Sciences > Department of Psychology
Life Sciences > School of Psychology and Clinical Language Sciences > Development
Life Sciences > School of Psychology and Clinical Language Sciences > Perception and Action
ID Code:93110
Uncontrolled Keywords:Amblyopia, Strabismus, Photoscreening, Autorefraction, Screening, Cost
Publisher:Springer

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