{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T21:09:18Z","timestamp":1766178558368,"version":"3.44.0"},"reference-count":32,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T00:00:00Z","timestamp":1609718400000},"content-version":"unspecified","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Ophth"],"accepted":{"date-parts":[[2020,12,14]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To study the effectiveness of amblyopia screening at ages 3\u20134.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and Analysis<\/jats:title>\n                  <jats:p>From a population with no previous screening, a cohort of 2300 children with 3\u20134 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Past\/present history of amblyopia was higher than 3.1%\u20134.2%, depending on amblyopia definition normatives. Screening at age 3\u20134, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3\u20134. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Screening amblyopia in a whole-population setting at age 3\u20134 is highly effective. For each 48 children screened at age 3\u20134, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3\u20134 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3\u20134.<\/jats:p>\n                  <jats:p>Involving primary care, with policies for timely referral of suspicious\/high-risk preverbal children, plus whole screening at age 3\u20134 seems a rational\/effective way of controlling amblyopia.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjophth-2020-000599","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T11:18:31Z","timestamp":1609759111000},"page":"e000599","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":10,"title":["Amblyopia screening effectiveness at 3\u20134 years old: a cohort study"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8143-641X","authenticated-orcid":false,"given":"Sandra","family":"Guimaraes","sequence":"first","affiliation":[{"name":"Ophthalmology, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Porto, Portugal"},{"name":"Ophthalmology, Hospital de Braga, Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4043-006X","authenticated-orcid":false,"given":"Andreia","family":"Soares","sequence":"additional","affiliation":[{"name":"Ophthalmology, Hospital-Escola da Universidade Fernando Pessoa, Gondomar, Porto, Portugal"},{"name":"Ophthalmology, Hospital de Braga, Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0462-3366","authenticated-orcid":false,"given":"Cristina","family":"Freitas","sequence":"additional","affiliation":[{"name":"Ophthalmology, Hospital de Braga, Braga, Portugal"}]},{"given":"Pedro","family":"Barros","sequence":"additional","affiliation":[{"name":"Ophthalmology, Hospital de Braga, Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4090-8473","authenticated-orcid":false,"given":"Ricardo Dourado","family":"Leite","sequence":"additional","affiliation":[{"name":"Ophthalmology, Hospital de Braga, Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1201-9177","authenticated-orcid":false,"given":"Patr\u00edcio Soares","family":"Costa","sequence":"additional","affiliation":[{"name":"School Of Medicine - University Of Minho, Universidade do Minho Instituto de Investigacao em Ciencias da Vida e Saude, Braga, Braga, Portugal"},{"name":"School Of Medicine - University Of Minho, ICVS 3B's Associate Laboratory, Braga, Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2739-9854","authenticated-orcid":false,"given":"Eduardo D","family":"Silva","sequence":"additional","affiliation":[{"name":"Ophthalmology, Centro Cirurgico de Coimbra, Coimbra, Portugal"}]}],"member":"239","published-online":{"date-parts":[[2021,1,4]]},"reference":[{"key":"2025090109450027000_6.1.e000599.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(02)01286-1"},{"key":"2025090109450027000_6.1.e000599.2","doi-asserted-by":"publisher","DOI":"10.1136\/bjo.2003.028712"},{"key":"2025090109450027000_6.1.e000599.3","doi-asserted-by":"crossref","first-page":"1021","DOI":"10.1001\/jamaophthalmol.2017.3373","article-title":"The 2017 us preventive services Task force report on preschool vision screening","volume":"135","author":"Donahue","year":"2017","journal-title":"JAMA Ophthalmol"},{"key":"2025090109450027000_6.1.e000599.4","doi-asserted-by":"publisher","DOI":"10.3928\/01913913-20110823-02"},{"key":"2025090109450027000_6.1.e000599.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-017-0875-8","article-title":"Number needed to treat (NNT) in clinical literature: an appraisal","volume":"15","author":"Mendes","year":"2017","journal-title":"BMC Med"},{"key":"2025090109450027000_6.1.e000599.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.317.7154.307"},{"key":"2025090109450027000_6.1.e000599.7","unstructured":"OECD . 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