Amblyogenic Refractive Errors Research Articles

Evaluation of cycloplegic and noncycloplegic performance of spot vision screener in detection of amblyopia risk factors using 2021 AAPOS guidelines

PurposeThis research evaluates the effectiveness of the Spot Vision Screener (SVS) before and after cycloplegia to detect amblyogenic refractive errors in children. MethodsChildren ages 3 to 10 years old were screened by the SVS before and after cycloplegia. Sensitivity, specificity, positive and negative predictive value, paired t-test, Bland-Altman plot and receiver operating characteristic area under the curve were evaluated by comparing the results of the SVS (v3.0.05) measurements with the results of the cycloplegic Topcon autorefractometer according to the 2021 guidelines of the American Association for Pediatric Ophthalmology and Strabismus. ResultsBoth eyes of 211 patients aged 3 to 10 years old were included. Regarding the amblyopia risk factors, the noncycloplegic SVS had 65.7 % sensitivity, 94.9 % specificity, 81.2 % positive predictive value and 89.3 % negative predictive value. The SVS's sensitivity increased from 65.7 % to 81.9 % with cycloplegia compared to noncycloplegic SVS results. The sensitivity detection of hyperopia was improved from 4.2 % to 100 % after cycloplegia. Areas under the receiver operator characteristic curve for noncycloplegic SVS and cycloplegic SVS were 0.506 (95 % CI, 0.395 to 0.646, p = 0737) and 0.905 (95 % CI, 0.915 to 0.971, p < 0.001) for hyperopia, respectively. Using the +1.64 D revised cutoff criteria for hyperopia increased sensitivity from 4.2 % to 78 %. ConclusionNoncycloplegic SVS measurements showed relatively high specificity in detecting amblyopia risk factors. The fact that noncycloplegic measurements have a very low sensitivity for hyperopia is an important weakness of the SVS, especially because hyperopia is the most frequently encountered refractive error in very young children. It should be noted that amblyogenic hyperopia may be overlooked by an SVS without cycloplegia.

Detection of Amblyogenic Refractive Error Using the Spot Vision Screener in Children.

Vision screenings are conducted to detect significant refractive errors, amblyopia, and ocular diseases. Vision screening devices are desired to have high testability, sensitivity, and specificity. Spot has demonstrated high testability, but previous reports suggest that the Spot has low sensitivity for detecting amblyogenic hyperopia and moderate sensitivity for amblyogenic astigmatism. This study assessed the concurrent validity of detecting amblyogenic refractive errors by the Spot (v.1.1.50; Welch Allyn Inc., Skaneateles Falls, NY) compared with cycloplegic retinoscopy. A total of 475 subjects (24 to 96 months) were screened by Spot and then received a masked comprehensive examination. Sensitivity and specificity, Bland-Altman plot, receiver operating characteristic area under the curve, and paired t test were evaluated by comparing the results of the Spot (v1.1.50) using the manufacturer referral criteria with the results of the comprehensive examination using the 2013 American Association for Pediatric Ophthalmology and Strabismus criteria. The Spot (v.1.1.50) referred 107 subjects (22.53%) for the following: 18.73% (89/475) astigmatism, 4.63% (22/475) myopia, 0.42% (2/475) hyperopia, and 2.11% (10/475) anisometropia. The sensitivity and specificity of the Spot vision screener for detecting amblyogenic risk factors were 86.08% (95% confidence interval [CI], 76.45 to 92.84%) and 90.15% (95% CI, 86.78 to 92.90%). Areas under the curve were 0.906 (95% CI, 0.836 to 0.976) for hyperopia, 0.887 (95% CI, 0.803 to 0.972) for spherical equivalent, and 0.914 (95% CI, 0.866 to 0.962) for astigmatism. A modified hyperopia criteria cutoff of greater than +1.06 D improved the sensitivity from 25 to 80% with 90% specificity. The current cutoff criterion, greater than -1.75 D, for astigmatism seemed optimal. This study shows that the Spot vision screener accurately detects low spherical refractive errors and astigmatism. Lowering the hyperopia cutoff criteria from the current Spot screener referral criteria improves the sensitivity with desired (high) specificity.

Amblyopia risk factors in congenital nasolacrimal duct obstruction: A longitudinal case-control study.

PurposeTo investigate longitudinal changes in risk factors for amblyopia in children treated with congenital nasolacrimal duct obstruction (CNLDO).MethodsRetrospective observational case control study. A total of 446 children under 4 years of age who underwent probing and/or intubation for CNLDO between January 2004 and January 2018, and 446 age-matched controls were included. Cycloplegic refraction and ocular alignment were investigated at the time of treatment and after at least one year of symptom improvement. Children were classified as having amblyopia risk factors on the basis of the American Association for Pediatric Ophthalmology and Strabismus guideline in 2013.Main outcome measuresThe prevalence of amblyogenic refractive errors, and determinants associated with the presence of amblyogenic refractive errors in CNLDO patients.ResultsThe prevalence of amblyogenic refractive errors in CNLDO patients (5.4%) was similar to that of the control group (6.5%) (P = 0.571). After one year of symptom improvement in CNLDO patients, the prevalence of amblyogenic refractive errors was 4.7%. There was no difference in the prevalence of amblyogenic refractive errors between unilateral and bilateral CNLDO patients. Multivariate analysis revealed that manifest strabismus was the only risk factor related with the presence of amblyogenic refractive errors (odds ratio = 6.383, confidence interval = 1.205–33.826, P = 0.029).ConclusionsThis study found no evidence to suggest that the prevalence of amblyopia risk factors is higher in CNLDO patients compared with normal controls. Manifest strabismus was the only determinant associated with the presence of amblyogenic refractive errors.

Objective vision screening using PlusoptiX for children aged 3\u201311 years in rural Turkey

BackgroundThis population based cross sectional study was conducted to detect amblyopia risk factors and myopia in a rural district of Northwestern Turkey by using PlusoptiX S12R (Photoscreener PlusoptiX Inc., Nuremberg, Germany).MethodsChildren from 38 rural schools in Caycuma district of Zonguldak Turkey underwent vision screening in their school using PlusoptiX S12 photoscreener. Data were analyzed using the factory default level 5 referral criteria targeting 80% sensitivity and 95% specificity. Referral, unable readings, and positive predictive value (PPV) were reported.ResultsData from 2846 children were analyzed. Mean age was 7.9 years (±0.8) (range 36 months to 11 years). Three hundred ten (11%) were referred of whom 32% were read as ‘unable’. 150 children (48% of the referred) received a gold standard examination. Positive predictive value of PlusoptiX was 69%. PPV was 83% when unable readings were excluded. 93 children with amblyopia risk factors were identified. Only 26% (n = 25) had received glasses priorly. 49 children had amblyopia of whom 33 were newly diagnosed.ConclusionsPlusoptiX showed a reasonable level of positive predictive value in community setting and the device could be a useful tool for vision screening in preschoolers and schoolers. We found most of the amblyogenic refractive errors were underdiagnosed in rural school children leading to a call for action on vision screening.

Prevalence of amblyopia in children undergoing nasolacrimal duct irrigation and probing

Purpose:To investigate ambylopia and amblyopia risk factors of children who underwent nasolacrimal duct (NLD) irrigation and probing for congenital nasolacrimal duct obstruction (CNLDO).Materials and Methods:The medical records of patients who had undergone NLD irrigation and probing for CNLDO at an age of 3 years or younger were reviewed, and 51 of the patients were recalled between October 1 and December 31, 2011 for a detailed ophthalmic examination to determinate amblyopia or amblyopia risk factors. Amblyopia was accepted as difference in visual acuity of two or more Snellen lines between the two eyes or visual acuity of 20/30 or worse in either eye.Results:The median age of the 51 patients to whom NLD irrigation and probing were attempted for CNLDO was 23 months. CNLDO affected a total of 70 eyes. All patients were reviewed for best-corrected visual acuity, refractive errors, and strabismus at a median age of 70.5 months (range 31-95 months). Amblyopia or amblyopia risk factors were identified in 14 patients (27.5%). One child (7.15%) had only strabismus, six children (42.8%) had only amblyogenic refractive errors, two (14.3%) had a combination of two, one child (7.15%) had a family history for amblyopia, but four children (28.6%) had no amblyopia risk factors but had amblyopia.Conclusion:Amblyogenic risk factors are found higher in patients with CNLDO and patients undergoing NLD irrigation and probing in comparison to normal population. Therefore, we recommend these children to routinely undergo cycloplegic refractions and full ophthalmic examinations.

Detektion amblyogener Risikofaktoren mit dem Vision Screener S 04

The Vision Screener® (Plusoptix) was developed for the recognition of amblyogenic refractive errors without cycloplegia. The aim of this study was to evaluate the sensitivity and specitifity for the detection of amblygenic refractive errors in preschool children. Furthermore it was investigated whether small angle strabismus as another cause for amblyopia could be detected by manual evaluation of corneal reflex images on printouts. 83 children aged between 0.5 and 6 years without strabismus had undergone 3 measurements without cycloplegia with the Vision Screener before cyclplegic retinoscopy was performed. In a second group of 72 children with orthotropia or a manifest strabismus < 10° the position of the eyes without correction was evaluated in a complete orthoptic and ophthalmological examination. Three measurements with the Vision Screener were performed in non-cycloplegic status. The centre of the "cloud of viewing directions" was determined on print-outs and the distance to the points of origin (middle of pupil) measured for each eye. The sum of distances of right and left eyes was taken for determination of total deviation and the assymetry was calculated by the difference of distances of the right and left eyes. There was a total sensitivity of 75% (specifity 91%) for amblyogenic refractive error (prevalence: astigmatism 22%, hyperopia 6%, anisometropia 6%). A change of threshold criteria increased the total sensitivity to 86% and 93%, whereas specifity was lowered to 80% and 76%, respectively. Eight children showed a manifest strabismus. In 75% of these cases the determined deviation of corneal reflex images in the horizontal direction was outside of the normal range; analysis of asymmetry showed an abnormal result in 37.5% of the cases. The examination using the Vision Screener may detect refractive errors and partially small angle strabismus as amblyogenic risk factors; however, additional tests should be added for screening examinations. An ophthalmological examination including cycloplegic retinoscopy cannot be replaced. Despite acceptable sensitivity and specifity the major portion of positively screened children will be without pathological findings at cycloplegic controls, because the amount of "false-positive" results exceeds the amount of "true-positive" results based on a prevalence of 5% for amblyopia.

Prevalence of amblyopia risk factors in congenital nasolacrimal duct obstruction

To determine whether children who present to an ophthalmology practice for nasolacrimal duct obstruction are more likely to have risk factors for amblyopia. A retrospective chart review was conducted on all patients presenting to a pediatric oculoplastic specialist between January 1, 2001, and August 8, 2009. The review yielded 402 pediatric patients diagnosed with nasolacrimal duct obstruction. Children were classified as having amblyopia risk factors on the basis of the American Association for Pediatric Ophthalmology and Strabismus referral criteria. Of 402 patients with nasolacrimal duct obstruction, 100% received a cyclopegic refraction. Of these, 88 patients (22%) were found to have amblyogenic risk factors; 65 of these patients had amblyogenic refractive errors, 9 had strabismus, and 14 had a combination of the two. Of the 88 patients with amblyopia risk factors, 11% had a family history of strabismus compared with 9% of patients without amblyopia risk factors, which was not a statistically significant difference. There was no other significant pathology found on the dilated fundus examinations except for one child known to have persistent hyperplastic primary vitreous and a congenital cataract and one child with previously known CHARGE syndrome before the examination for nasolacrimal duct obstruction. Children who present with nasolacromal duct obstructions seem to be more likely to have amblyopia risk factors and therefore should have a full comprehensive pediatric ophthalmological examination, including cycloplegic refraction.

Refractive Errors and Amblyopia in Children Entering School: Shahrood, Iran

To determine the prevalence of amblyopia, strabismus, and refractive errors in children entering school. In this cross-sectional population-based study, 6-year-old children enrolling in Shahrood schools were randomly sampled. Those with organic blindness or mental retardation were excluded. Ocular alignment, visual acuity, stereopsis, cover testing, and cycloplegic refraction were recorded for all children by an optometrist. A diagnosis of amblyopia was based on a best-corrected visual acuity of 6/12 or less in one or both eyes, or a bilateral difference of at least two best-corrected visual acuity lines. A total of 902 children were invited for optometry examinations, among which 827 (91.7%) responded and 815 children (98.5%) were included in the study. The prevalence of significantly reduced visual acuity (uncorrected VA < or = 6/12 in either eye) and amblyopia was 3.6 and 1.7%, respectively. The prevalence of hyperopia (+2.00 D or worse), myopia (-0.50 D or worse), astigmatism (0.75 D or worse), and anisometropia (1.00 D or more) were 20.5, 1.7, 19.6, and 2.2%, respectively. Significant refractive error, defined as hyperopia >+3.50 D, myopia >-3.00 D, astigmatism >1.50 D in the orthogonal meridian or >1.00 D in the oblique meridian, or anisometropia (hyperopic >1.00 D, myopic >3.00 D) was detected in 2.1, 0.1, 5.0, and 0.9% of the sample, respectively. Strabismus was diagnosed in 1.2% of children. Overall, 52 children (6.4%; 95% confidence interval [CI], 4.7-8.1%) were at risk of amblyopia; of these, 81% had significant refractive errors, 11% had strabismus, and 8% had both. A considerable proportion of 6-year-old children have strabismus and/or significant, potentially amblyogenic refractive errors. The relatively high rate of hyperopia and astigmatism in the studied population needs more attention. The results of the study emphasize the need for adequate diagnostic and therapeutic eye care services for preschool children.

113: Setting threshold levels for the plusoptiX S08: A comparison of screening photorefractions to cycloplegic retinoscopy

Introduction: Photoscreening is a useful and rapidly evolving tool to detect amblyogenic refractive errors. The PlusoptiX S08 infrared photoscreener is well-suited for use by lay personnel in public vision screenings as well as in the offices of pediatricians.

Screening for Refractive Errors in Preschool Children with the Vision Screener

Background: The Vision Screener® is a new, commercial version of the Power Refractor, an off-axis, hand-held video refractor to screen for amblyogenic refractive errors. The aim of our study was to determine the reproducibility of the measurements, compare them to cycloplegic refraction, and evaluate the sensitivity and specificity for the detection of amblyogenic refractive errors. Patients and Methods: Included in the study were 161 preschool children, age 0.5–7.2 years without manifest strabismus > 10°, who attended the outpatient clinic. After three measurements with the Vision Screener (version 4.3.15) and one measurement with +3 dpt glasses, the child underwent cycloplegic refraction. Results: The reproducibility of the three non-cycloplegic measurements was ± 0.5 dpt in 85% and ± 1 dpt in more than 95% of the children. Accommodation reduced the manifest hyperopia that could be measured with the Vision Screener by up to 3 dpt in some children. Compliance with the +3 dpt glasses increased from 20% in those under one year of age to > 75 % in those over three. The glasses did increase the sensitivity from 70% to 80% but decreased the specificity from 80% to 65%. Conclusion: The Vision Screener is easy to handle and gives reproducible results. The sensitivity and specificity are between 70 and 80%. The +3 dpt glasses are only helpful in a few patients. The latest software version with a new algorithm is now under evaluation.

Evaluation of the Accuracy of Estimation Retinoscopy

Some children are unable to cooperate for retinoscopy because they object strongly to the placement of lenses close to their faces. For these children, it would be ideal to obtain an accurate estimate of refractive error without using lenses. Techniques of estimation retinoscopy include sliding the sleeve of the Copeland retinoscope downward or moving closer to the patient until neutrality is achieved. The purpose of this study was to evaluate the accuracy of estimation techniques by comparing results to standard retinoscopy with loose lenses in cooperative children. A Copeland retinoscope was calibrated using a schematic eye and loose lenses. A scale was created adjacent to the sleeve of the retinoscope which allowed an estimate of refractive error based on the position of the top of the sleeve. Estimation retinoscopy followed by standard retinoscopy with loose lenses was done on 100 eyes of 50 children after cycloplegia. Estimation of spherical equivalent for myopia less than 4 D and hyperopia less than 2 D correlated strongly with results obtained by standard retinoscopy with loose lenses (r = 0.87). Estimation retinoscopy had a sensitivity of 88%, specificity of 67%, positive-predictive value of 58%, and negative-predictive value of 92% in the detection of amblyogenic refractive errors. Estimation retinoscopy has very good accuracy for low levels of myopia, hyperopia, and astigmatism. Techniques of estimation may be useful in excluding amblyogenic refractive errors, particularly in children who object to loose lenses held close to them.

Correction of large amblyogenic refractive errors in children using the excimer laser

Correction of large amblyogenic refractive errors in children using the excimer laser

Risk of strabismus and ambylopia in children with hydrocephalus

The present study was undertaken to determine the risk of strabismus and ambylopia in children who underwent operation for hydrocephalus and to compare our results with those in previous studies. Full orthoptic and ophthalmological examinations, including cycloplegic refraction, were performed in all subjects. Ten of 25 patients (40%) were found to have manifest squint. Four of these had esotropia and six had exotropia. No paretic squint or alphabetic pattern strabismus was determined. Refraction measurements revealed amblyogenic refractive errors (significant refractive errors that cause amblyopia) in five of the 25 (20%) patients in this study. Strabismus and the risk of amblyopia were found to be significantly higher in patients who experienced shunt revision than those who had not (P<0.05). Amblyopia, strabismus, and other acquired defects in the visual system related to hydrocephalus should be closely monitored and treated when indicated. Regular ophthalmic supervision will provide and help to maintain the best possible standard of vision in children with hydrocephalus.

Vision screening for children: current trends, technology, and legislative issues

The purpose of this review is to examine current trends in vision screening for children. Literature within the past year regarding children's vision screening has been dominated by clinical validation studies of autorefractors or photoscreeners that allow the detection of amblyogenic refractive errors, misalignment of the eyes, or media opacities. New technologies reported include wave-front analysis for amblyogenic factors and a visual evoked potentials-based screening tool for the preverbal child. Studies evaluating the goals of the screening program, the target population, and the physical limitations of the screening environment have prompted multipronged or hybrid studies designed to more accurately detect vision problems, particularly in the preschool child, in whom cooperation and cognitive development affect reliability of results. State and federal legislation in the United States has been proposed or adopted to regulate and partially fund pediatric vision screening and comprehensive examinations. Through improvements and new developments in technology, study design, the efforts of organized medicine, and legislative initiatives, vision screening for children continues toward the goal of bringing all children with eye disease or vision problems to treatment in a timely fashion.

Congenital ptosis: amblyogenic refractive errors, amblyopia, manifest strabismus and stereopsis related to the types of ptosis. Data on 77 patients and review of the literature

Former reports on amblyogenic refractive errors, amblyopia and binocular vision in congenital ptosis usually comprise all forms of ptosis without any differentiation. This study is an analysis of different kinds of ptosis. 154 eyes (98 ptotic eyes) of 77 patients with congenital ptosis aged > or = 1 year (56 unilateral ptoses: 45 simple, 1 with rectus superior paresis, 7 with Marcus Gunn's syndrome, 2 congenital oculomotor palsies, 1 unilateral fibrosis syndrome; 21 bilateral ptoses: 10 simple, 2 with bilateral double elevator paresis, 7 blepharophimosis syndromes and 2 bilateral fibrosis syndromes) were investigated concerning visual acuity, refractive error (94 % in cycloplegy), strabismus and stereo acuity. As amblyogenic refractive errors were defined: astigmatism > or = ldpt, anisometropia > or = 1 dpt (spherical equivalent) and hyperopia > or = 3 dpt; amblyopia was defined as visual acuity less than 1.0 or a difference between both eyes of at least 0.2. Altogether were found: Hyperopia > or = 3 dpt in 28.6 % (n = 28); astigmatism > or = 1 dpt in 63.3 % (n = 62), anisometropia in 27.3 % (n = 21), amblyopia in 65.3 % (n = 64), strabismus in 29.9 % (n = 23) and stereopsis in 76.6 % (n = 59). In unilateral simple ptosis, astigmatism of the fellow eye was found in 26.8 % (n = 14). In unilateral ptosis, esotropia was 21.4 % (n = 12), in bilateral ptosis, exotropia 19 % (n = 4), as well as astigmatism > or = 3 dpt 26.2 % (n = 11). As was to be expected, ptosis groups with motility disorders were associated with higher rates of strabismus and amblyopia. The blepharophimosis syndrome could be differentiated by the typical lid anomalies. The subgroups of congenital ptosis differ in frequency of amblyogenic factors. In unilateral ptosis these are also frequent in the fellow eye.

Cost-effectiveness of orthoptic screening in kindergarten: A decision-analytic model

The purpose of this study was to analyze the cost-effectiveness of orthoptic screening for amblyopia in kindergarten. A decision-analytic model was used. In this model all kindergarten children in Germany aged 3 years were examined by an orthoptist. Children with positive screening results were referred to an ophthalmologist for diagnosis. The number of newly diagnosed cases of amblyopia, amblyogenic non-obvious strabismus and amblyogenic refractive errors was used as the measure of effectiveness. Direct costs were measured form a third-party payer perspective. Data for model parameters were obtained from the literature and from own measurements in kindergartens. A base analysis was performed using median parameter values. The influence of uncertain parameters was tested in sensitivity analyses. According to the base analysis, the cost of one orthoptic screening test was 7.87 euro. One ophthalmologic examination cost 36.40 euro. The total cost of the screening program in all kindergartens was 3.1 million euro. A total of 4,261 new cases would be detected. The cost-effectiveness ratio was 727 euro per case detected. Sensitivity analysis showed considerable influence of the prevalence rate of target conditions and of the specificity of the orthopic examination on the cost-effectiveness ratio. This analysis provides information which is useful for discussion about the implementation of orthoptic screening and for planning a field study.

Cost effectiveness of mass orthoptic screening in kindergarten for early detection of developmental vision disorders

Orthoptic screening in the kindergarten is one option to improve early detection of amblyopia in children aged 3 years. The purpose of this study was to analyse the cost-effectiveness of such a screening programme in Germany. Based on data from the literature and own experience gained from orthoptic screening in kindergarten a decision-analytic model was developed. According to the model, all children in kindergarten, aged 3 years, who had not been treated for amblyopia before, were subjected to an orthoptic examination. Non-cooperative children were reexamined in kindergarten after one year. Children with positive test results were examined by an ophthalmologist for diagnosis. Effects were measured by the number of newly diagnosed cases of amblyopia, non-obvious strabismus and amblyogenic refractive errors. Direct costs were estimated from a third-party payer perspective. The influence of uncertain model parameters was tested by sensitivity analysis. In the base analysis the cost per orthoptic screening test was DM 15.39. Examination by an ophthalmologist cost DM 71.20. The total cost of the screening programme in all German kindergartens was DM 6.1 million. With a 1.5% age-specific prevalence of undiagnosed cases, a sensitivity of 95% and a specificity of 98%, a total of 4,261 new cases would be detected. The cost-effectiveness ratio was DM 1,421 per case detected. Sensitivity analysis showed considerable influence of prevalence and specificity on the cost-effectiveness ratio. It was more cost-effective to re-screen non-cooperative children in kindergarten than to have them examined by an ophthalmologist straight-away. The decision-analytic model showed stable results which may serve as a basis for discussion on the implementation of orthoptic screening and for planning a field study.

Cost-effectiveness of orthoptic screening in kindergarten: A decision-analytic model

purpose The purpose of this study was to analyze the cost-effectiveness of orthoptic screening for amblyopia in kindergarten. METHODS. A decision-analytic model was used. In this model all kindergarten children in Germany aged 3 years were examined by an orthoptist. Children with positive screening results were referred to an ophthalmologist for diagnosis. The number of newly diagnosed cases of amblyopia, amblyogenic non-obvious strabismus and amblyogenic refractive errors was used as the measure of effectiveness. Direct costs were measured form a third-party payer perspective. Data for model parameters were obtained from the literature and from own measurements in kindergartens. A base analysis was performed using median parameter values. The influence of uncertain parameters was tested in sensitivity analyses. RESULTS. According to the base analysis, the cost of one orthoptic screening test was 7.87 euro. One ophthalmologic examination cost 36.40 euro. The total cost of the screening program in all kindergartens was 3.1 million euro. A total of 4,261 new cases would be detected. The cost-effectiveness ratio was 727 euro per case detected. Sensitivity analysis showed considerable influence of the prevalence rate of target conditions and of the specificity of the orthopic examination on the cost-effectiveness ratio. CONCLUSIONS. This analysis provides information which is useful for discussion about the implementation of orthoptic screening and for planning a field study.

Two-flash Photorefraction in Screening of Amblyogenic Refractive Errors

A selection of amblyopic (n = 14) and nonamblyopic (n = 18) children with different ametropias, anisometropias, and astigmatisms was photorefracted without cycloplegia by two-flash photorefraction (T-FP) in which refractions in both horizontal and vertical meridians of both eyes are measured simultaneously. The results were compared to conventional cycloplegic retinoscopy in a blind study. Significant amblyogenic conditions, such as hyperopic anisometropias of more than 1.0 diopter (D), high ametropias, or astigmatism and strabismus cases of 2° to 3° or more are detectable. The technique provides a simple and useful tool for mass screening of infants. The sensitivity of the method for detecting amblyopia seems to be at least as high as in visual checking. Media opacities are recordable, and a permanent document is obtained.