Preschool Vision Screening by Parental Risk Factor Questionnaire

描述(由申请人提供)：视力障碍，如严重屈光不正、弱视和斜视，影响2%至5%学龄前儿童发育中的视觉系统。这些疾病的长期后遗症会降低视力(VA)和/或双眼视觉，通过早期发现和治疗可以将其降至最低。虽然通过对每个婴儿进行全面的眼睛检查来及早发现是理想的，但绝大多数婴儿和幼儿没有明显的视力问题。通过视力筛查将有限的卫生保健资源引导到那些有问题或有可能出现未来视力问题的人身上，是一种更合理和更可行的方法。目前，筛查学龄前儿童视力异常的主要责任落在儿科医生和家庭医生身上，他们依赖于对视力的一个或多个方面的直接测量。筛查指南建议在出生时和6个月至1岁时检查眼睛健康和红色反射，并在3至3.5岁时添加VA和对齐。尽管红色反射试验在筛查中的应用很普遍，但它的有效性还没有得到评估，对于非眼科医生或婴儿和8个月大的婴儿使用红色反射试验时的高假阳性率的担忧表明了显著的局限性。缺乏证据支持对3岁以下儿童进行常规视力筛查，这反映在美国预防服务工作组(USPSTF)2011年的建议中，该建议排除了2004年建议中先前包括的3岁以下儿童。这项研究的长期目标是提供足够的证据来调整目前针对3岁以下儿童的视力筛查建议。迈向这一目标的第一步，也是这一应用程序的目的，是开发和验证父母可以轻松完成的风险因素筛查问卷。该问卷将把孩子分成三类，指导家长：1)尽快安排视力检查，2)安排训练有素的人员使用现有/发展中的技术进行额外的筛查，或3)推迟3至5岁的检查。家长填写的调查问卷将减轻目前儿科医生和家庭医生进行视力筛查的时间负担，并将减少忙碌的医生经常提到的实施视力筛查的障碍之一。这种有针对性的分级视力筛查方法将提高我们目前通常粗略和零散的筛查工作的效率和准确性。及早确定需要额外评估和/或护理的人，通过一份低成本或免费、可广泛获得、有效和可靠的问卷，将更有效地利用紧张的医疗保健系统有限的人力和财政资源。

DESCRIPTION (provided by applicant): Vision disorders such as significant refractive errors, amblyopia, and strabismus impact the developing visual system of 2 to 5% of preschool children. The long-term sequelae of these conditions that degrade visual acuity (VA) and/or binocular vision can be minimized by early detection and treatment. While early detection through a comprehensive eye examination of every infant is the ideal, the vast majority of infants and young children are without significant vision problems. Directing the limited health care resources towards those with problems or who are at risk for developing future vision problems through vision screening is a more reasoned and attainable approach. Currently, the primary responsibility for screening preschoolers for vision anomalies falls to pediatricians and family practitioners who rely on the direct measurement of one or more aspects of vision. Screening guidelines suggest inspection of eye health and red reflex at birth and 6 months to 1 year of age with VA and alignment added to the screening at age 3 to 3.5 years. Despite its common use, the efficacy of the red reflex test in screening has not been evaluated and concern over high false positive rates when used by non-ophthalmologist or in infants < 8 months suggest significant limitations. The lack of evidence to support routine vision screening in children less than 3 is reflected in the 2011 recommendations of the US Preventive Services Task Force (USPSTF) that excludes children less than 3 previously included in the 2004 recommendations. The long-term objective of this research is to provide sufficient evidence to restructure the current vision screening recommendations for children less than 3 years. The first step towards this goal and the aim of this application is to develop and validate a risk factors screening questionnaire that can be easily completed by a parent. The questionnaire will triage children into one of 3 categories that will direct the parent to: 1) schedule an eye examination as soon as possible, 2) schedule additional screening by trained personnel using existing/evolving technologies or 3) defer examination at age 3 to 5 years. A parent completed questionnaire will ease the time burden vision screening currently places on pediatricians and family practitioners and will reduce one of the often cited barriers to implementing vision screening by busy physicians. This targeted and tiered approach to vision screening will improve the efficiency and accuracy of our current, often cursory and fragmented, screening efforts. Early identification of those in need of additional assessment and/or care, through a low or no cost, widely accessible, valid and reliable questionnaire, will more effectively utilize the limited manpower and financial resources of the strained health care system.