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Horwood, AM; Griffiths, HJ; Carlton, J; Mazzone, P; Channa, A; Nordmann, M; Simonsz, HJ, , EUSCREEN, Foundation, , EUSCREEN, Foundation.
Scope and costs of autorefraction and photoscreening for childhood amblyopia-a systematic narrative review in relation to the EUSCREEN project data.
Eye (Lond). 2021; 35(3): 739-752. Doi: 10.1038/s41433-020-01261-8 [OPEN ACCESS]
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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.
Find related publications in this database (using NLM MeSH Indexing)
Amblyopia - administration & dosage
Child - administration & dosage
Cost-Benefit Analysis - administration & dosage
Humans - administration & dosage
Strabismus - administration & dosage
Vision Disorders - administration & dosage
Vision Screening - administration & dosage

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