Vision screening in preschool-aged children: benefit and harm still unclear

It remains unclear whether a special ophthalmological examination of all children younger than 6 years (and potential follow-up treatments) would reduce the frequency and severity of visual impairment (amblyopia) in the population. An update search conducted for a benefit assessment of the German Institute for Quality and Efficiency in Health Care (IQWiG) from 2008 identified no new screening study. No benefit of vision screening in preschool-aged children could be derived from the only new treatment study. This is the finding of a rapid report prepared by IQWiG on behalf of the Federal Joint Committee (G-BA) and published on 17 June 2015.

New treatment study investigates acupuncture

As no new screening study could be identified, IQWiG additionally searched for treatment studies comparing earlier with later treatment of children. The only new treatment study since 2008 that delivered evaluable results compared earlier versus later acupuncture treatment of amblyopia in children, in each case in combination with occlusion therapy (covering of the stronger eye with a patch).

However, no patient-relevant benefit or harm of earlier treatment compared with later treatment could be determined from the study results. Searches for studies on diagnostic accuracy were therefore superfluous, as their assessment would only have been meaningful if a benefit through earlier treatment had been shown.

No new studies – no evidence of benefit

Therefore, the few studies so far available still do not allow robust conclusions on the benefit of vision screening in preschool-aged children, and potential harm has hardly been investigated. As no ongoing screening studies could be identified, no informative new results can be expected in the foreseeable future.

Process of report production

The G-BA commissioned IQWiG to prepare the report in an accelerated process, known as a "rapid report". In contrast to the usual procedure, no preliminary reports are published here. Although a draft version of the report is reviewed by external experts, no hearing at which all interested parties can comment takes place.

IQWiG sent the first benefit assessment to the contracting agency (G-BA) in April 2008 and published it in June 2008. In October 2014 the G-BA commissioned IQWiG to update its report using the same methodology. The present rapid report was sent to the G-BA in May 2015.

An overview of the background, methods and further results of the report is provided in the following executive summary.