What is a sensible screening program in paediatric ophthalmology?

Chapter 123 What is a sensible screening program in paediatric ophthalmology?

When is screening appropriate?

Criteria for the value and feasibility of screening programs were created by the World Health Organization (Box 123.1)3,5. These fall into groups:

Is screening feasible and acceptable to those being screened? (criteria 4,5,6). A test is required that can be performed prior to the development of symptomatic disease that might detect a risk factor for the disease or allow diagnosis at a symptomless stage. The test requires sufficient sensitivity and specificity to be useful, validated, and safe.

Is the disease understood, is treatment possible, is there consensus on who to treat and how, and are facilities in place for investigation and treatment? (2,3,7,8) Understanding of and consensus on the natural history of the disease is necessary to judge the chance of the disease progressing from the asymptomatic screened stage to symptomatic disease. Treatment should be possible, available, and agreed widely. Screening for untreatable disease, especially in children too young to give consent, carries the risk of significant harm.

Is there a program for widespread and continuing implementation of screening? (1) Screening is complex and it creates expectations of availability. Inequality of access leads to non-participation of those most likely to benefit.

What is the cost utility of the whole program, including subsequent investigations and treatments, and how does this relate to resources available for other medical conditions? (1,9) Cost-utility analysis is required. Cost-benefit should exceed that of alternatives − public education via awareness campaigns, medical surveillance to facilitate early detection of symptomatic disease, or increased treatment resources.

Jun 4, 2016 | Posted by in OPHTHALMOLOGY | Comments Off on What is a sensible screening program in paediatric ophthalmology?

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