Is photoscreening for amblyopia in children cost-effective?

What is it about?

Photorefraction can detect amblyopia risk factors earlier and more easily than methods such as visual acuity screening, which needs skilled testers and co-operative children. Published evidence suggests photoscreening is often used as a stand alone test, but this systematic literature review shows that most countries which have adopted photoscreening often add it to current screening tests. This may increase costs without clear evidence of better long-term outcomes. Evidence of cost-effectiveness across the whole patient journey from screening to post-treatment discharge is poor.

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Why is it important?

Photoscreening appears superficially to be an attractive way to screen young children for poor vision, but costs are often incurred much later in their eye care (more visits, more false referrals), so may be hidden. There is not clear evidence that early detection of refractive error leads to much better long-term outcomes on a population level, than an accurate visual acuity test a year or two later.