Update of the Evidence From Randomized Controlled Trials, 1999-2003: Screening for Visual Impairment in Children Younger than Age 5 Years: Table 4. Summary Table of Targeted Review of RCTs Addressing Screening and Treatment for Visual Impairment in Children Younger than Age 5 Years

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Issue	Previous Assessment	Current Update
Is treatment for amblyopia effective?	Most children in treatment show improvement, although the literature is poor. There have not been RCTs looking at efficacy of different forms of treatment.	The Amblyopia Treatment Study, a good-quality head-to-head comparison RCT, indicated that 79% of children with moderate amblyopia treated with patching and 74% treated with atropine achieved visual improvement meeting criteria for treatment success. Treatment was well-tolerated and acceptable, and adherence was good.
Do formal screening programs identify cases earlier than they would come to clinical diagnosis?	No direct studies on this, but screening programs have substantial yields of previously undiagnosed cases.	A fair-quality nested RCT comparing intensive screening with usual care in the UK indicated higher detection rates and fewer false-positive rates among children aged 0 to 3 years in the intensive screening group.
Does early treatment improve outcomes?	Animal data indicates sensitive period and case series provides conflicting information.	Long-term followup of children in the nested RCT, comparing intensive screening with usual care and 1-time orthopic screening at age 37 months, in the UK, indicated improved treatment outcomes for those in the intensive group; this group received treatment at earlier ages.