Amblyopia Risk Factors Research Articles

Performance of Photoscreener in Detection of Refractive Error in All Age Groups and Amblyopia Risk Factors in Children in a Tribal District of Odisha: The Tribal Odisha Eye Disease Study (TOES) # 3.

PurposeTo evaluate effectiveness of Welch Allyn Spot Vision Screener in detecting refractive error in all age groups and amblyopia risk factors in children in a tribal district of India.MethodsAll participants received dry retinoscopy and photorefraction; children also received cycloplegic retinoscopy. Statistical analysis included Bland-Altman and coefficient of determination (R2).ResultsPhotoscreener could not elicit a response in 113 adults and 5 children of 580 recruited participants. In Bland-Altman analysis mean difference of Spot screener spherical equivalent (SSSE) and dry retinoscopy spherical equivalent (DRSE) was 0.32 diopters (D) in adults and 0.18 D in children; this was an overestimation of hyperopia and underestimation of myopia. In Bland-Altman analysis of SSSE and cycloplegic retinoscopy spherical equivalent (CRSE) the mean difference was −0.30 D in children; this was an overestimation of myopia and underestimation of hyperopia. In regression analysis the relationship between SSSE and DRSE was poor in adults (R2 = 0.50) and good in children (R2 = 0.92). Cubic regression model for Spot versus cycloretinoscopy in children was: CRSE = 0.34 + 0.85 SSSE − 0.01 SSSE2 + 0.006 SSSE3. It was 87% accurate. Sensitivity and specificity of Spot in detecting amblyopia risk factors (2013 American Association for Pediatric Ophthalmology and Strabismus [AAPOS] criteria) was 93.3% and 96.9% respectively. Sensitivity of Spot screener in detection of amblyopia was 72%.ConclusionsPhotoscreener has 87% accuracy in refraction in children. Its value could be used for subjective correction tests.Translational RelevancePhotoscreening could complement traditional retinoscopy to address refractive error in children in a resource-limited facility region.

Critical Assessment of an Ocular Photoscreener.

To determine the accuracy of the PlusoptiX A12 photoscreener (PlusoptiX, Inc., Atlanta, GA) in detecting amblyopia or ambylogenic risk factors in pediatric patients in Nebraska. Using the PlusoptiX A12 photoscreener, data were collected from pediatric patients seen at a single pediatric ophthalmology practice. Each patient was screened using the device and also received a comprehensive ophthalmic examination. The results of the PlusoptiX A12 photoscreener were compared to the gold standard, comprehensive ophthalmic examination findings. The assessment of amblyopia or amblyogenic risk factors in the patients was based on the updated American Association for Pediatric Ophthalmology and Strabismus (AAPOS) referral criteria guidelines. Data were collected from 219 consecutive pediatric patients (438 eyes) during the 3-month study period. Among the patients, 87 (40%) children were determined to have amblyopia or ambylogenic risk factors after the comprehensive pediatric ophthalmology examination based on the AAPOS guidelines. The PlusoptiX A12 photoscreener was found to have a sensitivity of 93.02%, specificity of 84.96%, false-positive rate of 9.13%, false-negative rate of 2.74%, positive predictive value of 80.00%, and negative predictive value of 94.96%. The PlusoptiX A12 photoscreener is viable and comparable to various commercially available devices in the detection of refractive amblyogenic risk factors based on the Nebraska pediatric patient population. Future studies may show increased sensitivity by combining the use of the PlusoptiX A12 photoscreener with an alternate cover test. [J Pediatr Ophthalmol Strabismus. 2018;55(3):194-199.].

PMD68 - The Cost-Effectiveness of a Public Health Nurse Program to Screen for Amblyopia in Ontario

To examine the cost-effectiveness of screening for amblyopia risk factors by a public health nurse compared to screening by a physician at Well Baby Visits for children aged 4 years in Ontario. This study was conducted from the perspective of the Ontario Ministry of Health and Long-Term Care. A combined decision tree and Markov model was constructed to simulate a cohort of 4-year-old children over a lifetime horizon. The model structure, costs, health utilities and probabilities were informed by the literature and clinical experts. Future costs and health utilities were discounted to the present at a rate of 1.5%. Deterministic one-way and two-way sensitivity analysis were conducted to assess the robustness of the results. The public health nurse screening strategy was less costly ($861 less) and more effective (0.03 QALYs more) than the paediatrician Well Baby Visit screening strategy. The public health nurse screening strategy dominated the Well Baby Visit screening strategy in most of the sensitivity analyses. The results were sensitive to the health utility of amblyopia patients aged 10-64 years and the sensitivity of public health nurse screening. At a sensitivity of at least 0.42 the public health nurse screening strategy was no longer dominant and resulted in an ICER of $27,169 per QALY gained. If the health utility of having amblyopia at age 10-64 years increased to 0.94, then the intervention was no longer dominant and results in an ICER of $68,030 per QALY gained. Based on our model, screening for amblyopia by a public health nurse at age 4 years is cost-effective. Further research needs to be conducted on the costs of amblyopia as well as the health-related quality of life of vision impairment.

The PlusoptiX Photoscreener and the Retinomax Autorefractor as Community-based Screening Devices for Preschool Children

ABSTRACTPurpose: To compare the performance of the PlusoptiX S12 mobile photoscreener and the Retinomax K+3 Autorefractor as screening devices in preschool children.Methods: Children ranging from 3 to 5 years of age from 11 San Diego County preschools underwent vision screening in their schools where ambient light could not always be controlled using both the Retinomax and the PlusoptiX. Cycloplegic refraction on the consented children was subsequently performed on the UCSD EyeMobile for children on-site at the school locations.Results: A total of 321 children were screened with the PlusoptiX and Retinomax. The PlusoptiX referred 22% of children, of whom 70% of the referrals were read as “unable”. The Retinomax referred 13% and there were no “unables”. Similar results occurred in the cycloplegic-refracted 182 consented children—64% of the PlusoptiX referrals were read as “unable” . Only one third of these “unables” required glasses. Both devices referred the four children with amblyopia and one case of strabismus. However, PlusoptiX’s 3 false negatives had amblyopia risk factors (ARFs) while the one Retinomax’s false negative did not have ARFs.The Retinomax screening had 95% sensitivity and 94% specificity. The PlusoptiX screening had 86% sensitivity and 84% specificity.Conclusion: In this preschool population and environment, the PlusoptiX referred 63% more than the Retinomax in addition to a lower specificity and sensitivity. Adjusting PlusoptiX referral criteria might not substantially improve the specificity of the PlusoptiX due to the high numbers of “unables”.

Effectiveness of the GoCheck Kids Vision Screener in Detecting Amblyopia Risk Factors

The GoCheck Kids smartphone photoscreening app (Gobiquity Mobile Health, Scottsdale, Arizona, USA), introduced in 2014, is marketed to pediatricians with little published validation. We wished to evaluate the GoCheck Kids Screener for accuracy in detecting amblyopia risk factors (ARF) using 2013 American Association for Pediatric Ophthalmology and Strabismus guidelines. Validity assessment. Children 6months to 6 years of age presenting from October 2016 to August 2017 were included. Children were screened with the GoCheck preloaded Nokia Lumia 1020, software version 4.6 with image processing version R4d, prior to undergoing a comprehensive eye examination by a pediatric ophthalmologist masked to the screener results. Determination of the presence of age-specific ARF was made based upon the examination and compared with the GoCheck recommendation. A total of 206 children were included (average age 43months). When compared to examination, GoCheck had a sensitivity of 76.0% and specificity of 67.2% in detecting ARF. Positive predictive value was 57.0% and negative predictive value 83.0%. The screener results of 13 children were changed from "no risk factors" to "risk factors identified" based on the GoCheck remote review process. Four images remained "not gradable" and screening was unsuccessful in 3 children. In our high-risk population, this version of the Gocheck Kids smartphone app was useful in identifying ARF in children who are often not able to cooperate with visual acuity testing. This study informs pediatricians about the efficacy of this new screener as they make decisions about how to best detect vision problems in young children.

Unilateral Congenital Nasolacrimal Duct Obstruction, Is It An Amblyogenic Factor?

BACKGROUND/AIMS:To evaluate the refractive status, axial length, and prevalence of amblyopia among Saudi children with unilateral congenital nasolacrimal duct obstruction (UCNLDO) compared to the unaffected fellow eye.METHODS:A retrospective chart review was performed for children with UCNLDO at two eye institutes in Eastern Saudi Arabia from 2009 to 2015. The outcomes of syringing determined UNCLDO. The risk factors for amblyopia were defined as anisometropia of (spherical equivalent) >1.5 D, hyperopia >3.5 D, myopia >3.0 D, astigmatism >1.5 D at 90° or 180°, >1.0 D, any manifest strabismus, any media opacity >1 mm, or ptosis 1 mm or less margin reflex distance 1 along with blunting of vision in that eye. Matched-pair analysis was performed to correlate variables. P < 0.05 was considered statistically significant.RESULTS:We included 39 children with UNCLDO. The mean axial length was 21.4 ± 1.3 mm for the eyes with UCNLDO and 21.6 ± 1.0 mm for the fellow eye (P = 0.4). Hyperopia >+2 D was present in 17 (44%) eyes with UCNLDO and none of the fellow eyes. None of the participants had strabismus.CONCLUSION:Axial length and risk factors of amblyopia such as anisometropia, hyperopia, and strabismus were not associated with UCNLDO. UCNLDO is likely an isolated defect.

Preverbal visual photo screening Project implementation in Portugal

Abstract Purpose: To present the design and implementation of an amblyopia risk factors screening project, in a large based Portuguese population. Methods: Two referral centers have been enrolled to assess all children aged 2 under their direct referral area. The photoscreener used was PlusOptix ® A09. At this age, the cut-off defined for referral was: ≥1 Diopter (D) of anisometropia, ≥1.5D of astigmatism, ≥2D of myopia and ≥1.5D of hyperopia. The results were reported to a reading platform that allowed the ophthalmologist to see all exams, and provide timely appointment with a complete ophthalmologic assessment for those who needed. Results: A total of 2867 photo screens were made to the population eligible to both referral centers, which comprises a coverage rate of 55%. Out of 2611 children under one of the referral area, 53% (n=1395) adhered to the screening. Within these children, 17.5% (n=245) were referred and 15.3 % (n=214) appointments were performed. The comparison of refraction between PlusOptix ® and cycloplegic refraction showed a strong correlation regarding the sphere and cylinder values. From the 214 children observed in consultation, glasses were prescribed in 25.7% (n=55), corresponding to 3.9% of all screened children under one of the referral area. This screening method showed a positive predictive value of 58.4%. Conclusion: This screening program may be highly relevant to eradicate untreated amblyopia from our population. The results may lead to the implementation of this project to the whole country.

Refractive Status and Amblyopia Risk Factors in Chinese Children with Autism Spectrum Disorder.

Amblyopia risk factors in children with autism spectrum disorders (ASD) are usually hard to detect in early childhood due to poor cooperation and has not been reported in the Chinese population. We screened 168 Chinese children with ASD, aged between 3 and 8years, and 264 age-matched neurotypical children with Spot photoscreener and basic ophthalmologic examinations. Children with ASD were found to have normal refractive status but significantly higher incidence of strabismus (16.1%), compared with control children (1.5%) (p < 0.01). Most of the cases of strabismus found in children with ASD were classified as esodeviation. Strabismus in children with ASD should be considered more seriously as an amblyopia risk factor by ophthalmologists and other healthcare professionals.

Prevalence of amblyopia and its association with refraction in Chinese preschool children aged 36–48 months

PurposeTo determine the prevalence of amblyopia and its association with refraction in Chinese preschool children.MethodsThe Yuhuatai Pediatric Eye Disease Study, a cross-sectional, population-based study, was conducted in children aged 36–48...

Amblyopia and strabismus: trends in prevalence and risk factors among young adults in Israel

AimsTo estimate the prevalence of amblyopia, present strabismus and amblyopia risk factors (ARFs) among young adults in Israel and to analyse trends over time of prevalence rates.MethodsWe conducted a cross-sectional...

Amblyopia and strabismus decreased over the last decade among young adults in Israel

To estimate the prevalence of amblyopia, strabismus and amblyopia risk factors (ARFs) among young adults in Israel, and analyze secular trends.

Use of the Spot Vision Screener for patients with developmental disability

To determine whether the Spot Vision Screener effectively detects amblyopia risk factors (ARFs) in patients with developmental disability using the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Children with developmental disability presenting for complete pediatric ophthalmologic examination were prospectively enrolled between June 2012 and March 2016. The following data were analyzed: presence of ARFs according to the AAPOS guidelines, refraction, eye alignment, and other ocular pathology. A total of 100 children (average age, 5.7years; range, 2.2- 9.2years) were included. The prevalence of ARFs in this cohort was 38%. The sensitivity of the Spot Vision Screener in detecting amblyopia risk factors was 84%; the specificity, 62%. The positive predictive value was 58%; the negative predictive value, 86%. In our study cohort the Spot Vision Screener provided good sensitivity and adequate specificity for a screening examination. Automated screeners may be useful in screening children with developmental disability.

Pediatric vision screening using the plusoptiX A12C photoscreener in Chinese preschool children aged 3 to 4 years

This study evaluated the performance of plusoptiX A12C in detecting amblyopia risk factors (ARFs) in Chinese children aged 3-to-4-year. PlusoptiX examination was successfully conducted among 1,766 subjects without cycloplegia to detect refractive error, asymmetry and media opacity. Cycloplegic retinoscopy (CR) was conducted on 357 children suspected of having vision abnormalities. Statistical differences between CR and the device were confirmed using the mean spherical value (+1.41 ± 0.87 D versus +1.14 ± 0.81 D), cylindrical value (−0.47 ± 0.64 versus −0.84 ± 0.78) and spherical equivalent (SE) value (+1.17 ± 0.84 D versus +0.72 ± 0.64 D) (all P < 0.0001). In the emmetropia group, the differences were statistically significant for the cylinder and SE (all P < 0.0001) but not the sphere (P = 0.33). In the hyperopia group, the differences were statistically significant for the sphere, cylinder and SE (all P < 0.0001). For refractive and strabismic ARFs detection, the sensitivity, specificity, positive predictive value, and negative predictive value were calculated, respectively.

Observations on the relationship between anisometropia, amblyopia and strabismus

We investigated the potential causal relationships between anisometropia, amblyopia and strabismus, specifically to determine whether either amblyopia or strabismus interfered with emmetropization. We analyzed data from non-human primates that were relevant to the co-existence of anisometropia, amblyopia and strabismus in children. We relied on interocular comparisons of spatial vision and refractive development in animals reared with 1) monocular form deprivation; 2) anisometropia optically imposed by either contact lenses or spectacle lenses; 3) organic amblyopia produced by laser ablation of the fovea; and 4) strabismus that was either optically imposed with prisms or produced by either surgical or pharmacological manipulation of the extraocular muscles. Hyperopic anisometropia imposed early in life produced amblyopia in a dose-dependent manner. However, when potential methodological confounds were taken into account, there was no support for the hypothesis that the presence of amblyopia interferes with emmetropization or promotes hyperopia or that the degree of image degradation determines the direction of eye growth. To the contrary, there was strong evidence that amblyopic eyes were able to detect the presence of a refractive error and alter ocular growth to eliminate the ametropia. On the other hand, early onset strabismus, both optically and surgically imposed, disrupted the emmetropization process producing anisometropia. In surgical strabismus, the deviating eyes were typically more hyperopic than their fellow fixating eyes. The results show that early hyperopic anisometropia is a significant risk factor for amblyopia. Early esotropia can trigger the onset of both anisometropia and amblyopia. However, amblyopia, in isolation, does not pose a significant risk for the development of hyperopia or anisometropia.

Performance of the Spot Vision Screener in Children Younger Than 3 Years of Age

To evaluate the use of the Spot Vision Screener (Spot; Welch Allyn, Skaneateles Falls, New York, USA) for detection of amblyopia risk factors in children aged 6months to 3 years, as defined by the 2013 guidelines of the American Association for Pediatric Ophthalmology and Strabismus. Reliability analysis. In this study, children seen from June 1, 2012, to April 30, 2016 were tested with the Spot during a routine visit. Enrolled children underwent a comprehensive eye examination including cycloplegic refraction and sensorimotor testing within 6months of the testing date by a pediatric ophthalmologist masked to the Spot results. A total of 184 children were included. The Spot successfully obtained readings in 89.7% of patients. Compared with the ophthalmologist's examination, the Spot had an overall sensitivity of 89.8% and a specificity of 70.4%. The Spot achieved good sensitivity and specificity for detection of amblyopia risk factors in this young cohort, particularly in the older subgroup. Our data offer support for automated vision screening in young children.

Treatment of Amblyopia and Amblyopia Risk Factors Based on Current Evidence

ABSTRACTPurpose: Amblyopia is a leading cause of low vision and warrants timely management during childhood. We performed a literature review of the management of amblyopia and potential risk factors for amblyopia. Methods: Literature review of the management of amblyopia and risk factors for amblyopia. Results: Common amblyopia risk factors include anisometropic or high refractive error, strabismus, cataract, and ptosis. Often a conservative approach with spectacles is enough to prevent amblyopia. However, surgery may be necessary to clear the visual axis or align the eyes. Conclusion: Amblyopia risk factors should be managed early. Though amblyopia treatment is more likely to be successful at a younger age, those who are older but treatment-naïve may still respond to treatment. Promoting binocular or dichoptic experiences may be the future direction of amblyopia management.

The performance of Plusoptix A09 in detection of Refractive Amblyopia Risk Factors

Purpose: To assess the accuracy of the Plusoptix A09 noncycloplegic photorefraction for detection of refractive amblyopia risk factors (RARFs) in children and determine cutoff points. Methods: This study included 402 children observed in Pediatric Ophthalmology Clinic between June and December 2014. All children underwent initially photorefraction using Plusoptix A09 followed by cycloplegic retinoscopy (obtained during a complete ophthalmologic examination). Patients were considered to have RARFs based on American Association for Pediatric Ophthalmology and Strabismus 2013 guidelines. Considering cycloplegic retinoscopy as the gold standard, accuracy parameters of noncycloplegic photorefraction were calculated for detection of RARFs. Results: RARFs were found in 148 (36.8%) and 151 (37.6%) cases by cycloplegic retinoscopy and photorefraction, respectively. Plusoptix showed an overall 85.1% sensitivity for 90% specificity, 83.4% positive predictive value and 91.2% negative predictive value for detection of RARFs. Plusoptix had good specificity for detection of all specific types of RARFs (between 93.0 and 98.1%), and good sensitivity for detection of myopia (96.6%) and astigmatism (91.0%), however its sensitivity for detecting hyperopia RARFs was only 48.9%. Using a cutoff point of +1,5D for hyperopia instead of +3.5D (in children > 48 months), sensitivity can be improved to 88.6% in this group. Conclusions: The Plusoptix A09 is a useful, portable and accurate tool for the detection of RARFs in pediatric populations. However, in hyperopic RARFs an alternative cutoff value should be used.

Instrument-based pediatric vision screening

The purpose is to review currently available instruments for vision screening in young children. Instrumentation continues to evolve. Although the current generation of photoscreeners and autorefractors strive to identify amblyopia risk factors, newer technology aims to directly identify amblyopia in young children. Acceptance of instrument-based vision screening for this population has led to increased reimbursement for the procedure in primary care practices. Instrument-based vision screening in the young child is an accepted method of screening for amblyopia. Innovations in instrumentation will continue to improve its implementation.

Validation of photoscreening technology in the general pediatrics office: a prospective study

Photoscreening instruments have been widely validated in pediatric ophthalmology clinics and field studies; however, validation by general pediatricians is lacking. We performed the first prospective, multisite evaluation of a commercially available photoscreener in the medical home. Eleven practices in Middle Tennessee recruited over 3,100 children between 12months and 5years to be screened at well-child examinations. Participants were those who received a "refer" result; controls received a "pass." Referred children received a comprehensive eye examination with cycloplegic retinoscopy. A subset of control children underwent eye examinations in an attempt to determine sensitivity and specificity. The overall referral rate was 10%. Amblyopia risk factors (ARFs) were confirmed in 47% of referred children, with positive predictive values (PPVs) of 77.8% for suspected hyperopia, 60% for myopia, 50% for anisometropia, and 44.8% for astigmatism by the 2013 guidelines of the American Association of Pediatric Ophthalmology and Strabismus Vision Screening Committee. Using the 2003 guidelines, the overall PPV was 60.3%; PPVs were determined for suspected hyperopia (77.8%), myopia (60%), anisometropia (67.6%), and astigmatism (61.2%). Of referred children who received follow-up, 18 (13.2%) had amblyopia. PPVs for children ≤36months (n=79) did not differ from those 37-72months (n=57). No child who passed screening and had a follow-up examination had any ARFs. Our results replicate those of previously published field studies and support recent United States Preventive Services Task Force and American Academy of Pediatrics position statements. They provide prospective evidence that photoscreening is an effective tool for children aged 12-72months.

Saccadic latency in amblyopia.

We measured saccadic latencies in a large sample (total n = 459) of individuals with amblyopia or risk factors for amblyopia, e.g., strabismus or anisometropia, and normal control subjects. We presented an easily visible target randomly to the left or right, 3.5° from fixation. The interocular difference in saccadic latency is highly correlated with the interocular difference in LogMAR (Snellen) acuity—as the acuity difference increases, so does the latency difference. Strabismic and strabismic-anisometropic amblyopes have, on average, a larger difference between their eyes in LogMAR acuity than anisometropic amblyopes and thus their interocular latency difference is, on average, significantly larger than anisometropic amblyopes. Despite its relation to LogMAR acuity, the longer latency in strabismic amblyopes cannot be attributed either to poor resolution or to reduced contrast sensitivity, because their interocular differences in grating acuity and in contrast sensitivity are roughly the same as for anisometropic amblyopes. The correlation between LogMAR acuity and saccadic latency arises because of the confluence of two separable effects in the strabismic amblyopic eye—poor letter recognition impairs LogMAR acuity while an intrinsic sluggishness delays reaction time. We speculate that the frequent microsaccades and the accompanying attentional shifts, made while strabismic amblyopes struggle to maintain fixation with their amblyopic eyes, result in all types of reactions being irreducibly delayed.