Amblyopia risk factors among pediatric patients in a hospital-based setting using photoscreening

Christiane Al-Haddad,Nasrine Anais El Salloukh,Karine Ismail,Carl-Joe Mehanna,Rose-Mary N Boustany,Mona Hnaini,Zeinab El Moussawi,Stephanie Hoyeck,Ahmed Awadein

doi:10.1371/journal.pone.0254831

Christiane Al-Haddad, Nasrine Anais El Salloukh + Show 7 more

Open Access

https://doi.org/10.1371/journal.pone.0254831

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Abstract

The aim of our study was to determine the prevalence of amblyopia risk factors in children visiting the American University of Beirut Medical Center (AUBMC) using automated vision screening. This was a hospital-based screening of 1102 children aged between 2 and 6 years. Vision screening was performed using PlusoptiX S12 over 2 years (2018-2020). The need for referral to a pediatric ophthalmologist was based on the amblyopia risk factors set forth by the American Association for Pediatric Ophthalmology and Strabismus. Referred patients underwent a comprehensive eye examination. A total of 1102 children were screened, 63 were referred for amblyopia risk factors (5.7%); 37/63 (59%) underwent comprehensive eye examination and 73% were prescribed glasses. Of the non-referred group of children, 6.35% had astigmatism, 6.25% were hyperopic and 3.27% were myopic. The refractive errors observed among the examined patients were distributed as follows: 41% astigmatism, 51% hyperopia, and 8% myopia; amblyopia was not detected. Refractive amblyopia risk factors were associated with the presence of systemic disorders. Bland-Altman plots showed most of the differences to be within limits of agreement. Using an automated vision screener in a hospital-based cohort of children aged 2 to 6 years, the rate of refractive amblyopia risk factors was 5.7%. Hyperopia was the most commonly encountered refractive error and children with systemic disorders were at higher risk.

Highlights

Childhood vision screening is recommended for detecting preventable and treatable vision disorders [1,2,3]
The refractive errors observed among the examined patients were distributed as follows: 41% astigmatism, 51% hyperopia, and 8% myopia; amblyopia was not detected
Refractive amblyopia risk factors were associated with the presence of systemic disorders

Summary

Introduction

Childhood vision screening is recommended for detecting preventable and treatable vision disorders [1,2,3]. Amblyopia is a common cause of decreased vision in children [4,5,6,7,8,9,10,11]. The US Preventive Services Task Force recommends vision screening at least once in all children aged 3 to 5 years to detect amblyopia or its risk factors [2]. Instrument-based screening is recommended for all children aged 12 months and above undergo [3, 13]. In one study, photoscreening was superior to optotype-based screening for children between the ages of 3 and 6 years [14]. Children screened and referred before the age of 2 years were more likely to reach a visual acuity of 20/ 40, as compared to those screened after age 2 [15]

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