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

Horwood, A. ORCID: https://orcid.org/0000-0003-0886-9686, 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 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.