The positive predictive value (PPV) of vision screening is similar between children younger than 3 years and between 3 and 5 years of age, according to research results published in Ophthalmology. Researchers suggest the report’s findings support instrument-based vision testing in preschool age children.

Because traditional vision screening can be difficult for children younger than 3 years of age, researchers set out to evaluate the effectiveness of vision screening in young preschool children through a comparison of PPVs of vision screening in detecting Amblyopia Risk Factors for children younger than 3 years and between 3 and 5 years of age. 

Investigators performed a retrospective chart review of children between 0 and 5 years of age at a single institute in Tennessee between 2017 and 2020. Keywords including vision screen, photoscreen, or FVS were used to identify and extract data from the electronic health record. After manual chart review, children were included if they had presented for a first comprehensive eye exam following a failed vision screening. 

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American Academy of Pediatric Ophthalmology and Strabismus (AAPOS) Vision Screening Committee 2003 exam failure criteria for amblyopia risk factors were used to determine the prevalence of amblyopia risk factors and the PPV of vision screening. 

A total of 3970 children were identified, of whom 3114 met inclusion criteria. In terms of demographic data, children who were 3 years or younger had more cases of unreported race and ethnicity data vs children between 3 and 5 years; younger children were also more likely to be White. 

For children younger than 3, the PPV of vision screening was 60.5% (95% CI, 58.1%-63%). PPV was 59.5% (95% CI, 51.7%=62%) for children between 3 and 5, for a difference of 1% (95% CI, -2.5% to 4.4%). Odds ratio (OR) between the prevalence of any amblyopia risk factor for children younger than 3 and between 3 and 5 years was not statistically significant (OR, 1.043; 95% CI, 0.903-1.203). 

Results remained the same even after adjustments were made for race, ethnicity, and gender (OR, 0.973; 95% CI, 0.794-1.192) and after multiple imputation was used to replace unreported race and ethnicity (OR, 1.014; 95% CI, 0.876-1.175). 

The prevalence of both myopia and hyperopia were significantly higher in younger children compared with older children (18.4% and 2.7% vs 14.1% and 1.7%), while astigmatism and strabismus prevalence was significantly higher in older children (46% and 8.1% vs 41.7% and 5.5%). 

The prevalence of anisometropia was not significantly different between groups (9.1% and 9.0% in younger vs older children). 

According to researchers, a 2017 statement from the US Preventive Services Task Force recommended vision screening for children between 3 and 5 years of age, but the evidence was insufficient for children younger than 3 years. Results of the current study show no meaningful difference in the PPV of vision screening between the age groups.

“These results support previous studies that have demonstrated the effectiveness of vision screening for young preschool children,” according to the study. 


Zhou R, Pfister T, Liu Y, Chen Q, Donahue S. Age does not influence the PPV of vision screening to detect ARF. Ophthalmology. Published online September 7, 2021. doi:10.1016/j.ophtha.2021.08.026