Open Access Highly Accessed Research article

Effectiveness of screening preschool children for amblyopia: a systematic review

Christine Schmucker1*, Robert Grosselfinger2, Rob Riemsma3, Gerd Antes1, Stefan Lange2, Wolf Lagrèze4 and Jos Kleijnen35

Author Affiliations

1 Department of Medical Biometry and Statistics (German Cochrane Center), Institute of Medical Biometry and Medical Informatics, University Medical Center, 79104 Freiburg, Germany

2 Department of Non-drug Interventions, Institute for Quality and Efficiency in Health Care, 51105 Cologne, Germany

3 Kleijnen Systematic Reviews Ltd, York YO26 6RB, UK

4 University Eye Hospital, University Medical Center, 79106 Freiburg, Germany

5 The School for Public Health and Primary Care (Caphri), Maastricht University, 6200 MD Maastricht, Netherlands

For all author emails, please log on.

BMC Ophthalmology 2009, 9:3  doi:10.1186/1471-2415-9-3

Published: 16 July 2009



Amblyopia and amblyogenic factors like strabismus and refractive errors are the most common vision disorders in children. Although different studies suggest that preschool vision screening is associated with a reduced prevalence rate of amblyopia, the value of these programmes is the subject of a continuing scientific and health policy discussion. Therefore, this systematic review focuses on the question of whether screening for amblyopia in children up to the age of six years leads to better vision outcomes.


Ten bibliographic databases were searched for randomised controlled trials, non-randomised controlled trials and cohort studies with no limitations to a specific year of publication and language. The searches were supplemented by handsearching the bibliographies of included studies and reviews to identify articles not captured through our main search strategy.


Five studies met the inclusion criteria. Of these, three studies suggested that screening is associated with an absolute reduction in the prevalence of amblyopia between 0.9% and 1.6% (relative reduction: between 45% and 62%). However, the studies showed weaknesses, limiting the validity and reliability of their findings. The main limitation was that studies with significant results considered only a proportion of the originally recruited children in their analysis. On the other hand, retrospective sample size calculation indicated that the power based on the cohort size was not sufficient to detect small changes between the groups. Outcome parameters such as quality of life or adverse effects of screening have not been adequately investigated in the literature currently available.


Population based preschool vision screening programmes cannot be sufficiently assessed by the literature currently available. However, it is most likely that the present systematic review contains the most detailed description of the main limitations in current available literature evaluating these programmes. Therefore, future research work should be guided by the findings of this publication.