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What Age Is the "Best Buy" for Preschool Vision Screening?

Considering the issues discussed in the sections above, it does not seem possible to find an age that is optimal in all aspects. Put together, with a major emphasis on reaching a high participation frequency, preschool vision screening at age 4-5 years seems to be the "best buy." At this age, a majority of children are reliably testable with visual acuity charts, which have shown to be sensitive and cost-effective. There is a very small risk of new cases developing after vision screening, and monitoring after treatment and possible maintenance therapy will be needed for a minimal time period. Moreover, many countries can combine vision screening with other services with high participation frequen-cies,such as child health care programs (including vaccination) or school entry. Recent reports (see Sect. 2.4.1) have demonstrated a possible age effect for amblyopia treatment, with better outcome for younger children. The effect shown has not been very large though, and the dividing line between "young" and "old" children seems to be around 5 years of age.

• Vision screening for amblyopia at more than one occasion during the preschool years does not seem plausible due to increasing costs per detected case

• Visual acuity testing has a high sensitivity and specificity for amblyopia. Visual acuity testing can be reliably performed from age 4-5 years; it is safe and repeatable.Visual acuity testing is relatively easy to perform, it can carried out by nonophthalmologic personnel. Charts in logMAR steps and crowded optotypes are recommended. Visual acuity screening has also been shown to be favorable from a cost-benefit point of view

• At age 4-5 years, a majority of children are reliably testable with visual acuity charts. There is a very small risk of new cases developing after vision screening, and surveillance after treatment and possible mainte nance therapy will be needed a minimal time period. The possible age-effect for amblyopia treatment has been small, and the dividing line seems to be around 5 years of age

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