Abstract：
As instrument-based pediatric vision screening technology has evolved, the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) has developed uniform guidelines (2003, updated 2013) to inform the development of devices that can detect specified target levels of amblyopia risk factors (ARFs) and visually significant refractive error. Clinical experience with the established guidelines has revealed an apparent high level of over-referral for non-amblyopic, symmetric astigmatism, prompting the current revision.
The revised guidelines reflect the expert consensus of the AAPOS Vision Screening and Research Committees.
For studies of automated screening devices, AAPOS in 2021 recommends that the gold-standard confirmatory comprehensive examination failure levels include anisometropia >1.25 D and hyperopia >4.0 D. Astigmatism >3.0 D in any meridian and myopia < -3 D should be detected in children <48 months, whereas astigmatism >1.75 D and myopia < -2 D should be detected after 48 months. Any media opacity >1 mm and manifest strabismus of >8Δ should also be identified. Along with performance in detecting ARFs and refractive error, validation studies should also report screening instrument performance with regard to presence or absence of amblyopia. Instrument receiver operating characteristic curves and Bland-Altman analysis are suggested to improve comparability of validation studies.
Examination failure criteria have been simplified and the threshold for symmetric astigmatism raised compared to the 2013 guidelines, whereas the threshold for amblyogenic anisometropia has been decreased. After age 4 years, lower magnitudes of symmetric astigmatism and myopia are also targeted despite a low risk of amblyopia, because they can influence school performance and may warrant consideration of myopia prevention therapy.
The revised guidelines reflect the expert consensus of the AAPOS Vision Screening and Research Committees.
For studies of automated screening devices, AAPOS in 2021 recommends that the gold-standard confirmatory comprehensive examination failure levels include anisometropia >1.25 D and hyperopia >4.0 D. Astigmatism >3.0 D in any meridian and myopia < -3 D should be detected in children <48 months, whereas astigmatism >1.75 D and myopia < -2 D should be detected after 48 months. Any media opacity >1 mm and manifest strabismus of >8Δ should also be identified. Along with performance in detecting ARFs and refractive error, validation studies should also report screening instrument performance with regard to presence or absence of amblyopia. Instrument receiver operating characteristic curves and Bland-Altman analysis are suggested to improve comparability of validation studies.
Examination failure criteria have been simplified and the threshold for symmetric astigmatism raised compared to the 2013 guidelines, whereas the threshold for amblyogenic anisometropia has been decreased. After age 4 years, lower magnitudes of symmetric astigmatism and myopia are also targeted despite a low risk of amblyopia, because they can influence school performance and may warrant consideration of myopia prevention therapy.
摘要：
随着基于仪器的儿科视力筛查技术的发展，美国儿科眼科和斜视协会(AAPOS)制定了统一的指南(2003年,2013年更新),旨在为能够检测特定弱视危险因素(ARFs)目标水平和视觉显著屈光不正的器械的开发提供信息.已建立的指南的临床经验表明，非弱视患者的过度转诊水平明显较高，对称散光，提示当前修订。
修订后的指南反映了AAPOS视力筛查和研究委员会的专家共识。
对于自动筛查设备的研究，AAPOS在2021年建议金标准验证性综合检查失败水平包括屈光参差>1.25D和远视>4.0D。任何子午线散光>3.0D，近视<-3D应在<48个月的儿童中检测到，而散光>1.75D和近视<-2D应在48个月后检测到。任何介质不透明度>1mm和明显斜视>8Δ也应被识别。除了检测ARFs和屈光不正的性能外，验证研究还应报告是否存在弱视的筛查仪器性能.建议使用仪器接收器工作特性曲线和Bland-Altman分析来提高验证研究的可比性。
与2013年指南相比，简化了检查失败标准，提高了对称散光的阈值，而弱性屈光参差的阈值已降低。4岁以后,尽管弱视风险较低，但仍有较低幅度的对称散光和近视的目标。因为它们会影响学校的表现，并且可能需要考虑近视预防治疗。
修订后的指南反映了AAPOS视力筛查和研究委员会的专家共识。
对于自动筛查设备的研究，AAPOS在2021年建议金标准验证性综合检查失败水平包括屈光参差>1.25D和远视>4.0D。任何子午线散光>3.0D，近视<-3D应在<48个月的儿童中检测到，而散光>1.75D和近视<-2D应在48个月后检测到。任何介质不透明度>1mm和明显斜视>8Δ也应被识别。除了检测ARFs和屈光不正的性能外，验证研究还应报告是否存在弱视的筛查仪器性能.建议使用仪器接收器工作特性曲线和Bland-Altman分析来提高验证研究的可比性。
与2013年指南相比，简化了检查失败标准，提高了对称散光的阈值，而弱性屈光参差的阈值已降低。4岁以后,尽管弱视风险较低，但仍有较低幅度的对称散光和近视的目标。因为它们会影响学校的表现，并且可能需要考虑近视预防治疗。
