Amblyopia Risk Factors Research Articles

Evaluation of the diagnostic parameters of the amblyopia and risk factors for amblyopia screening protocol in 3-year-olds according to recommendations from the French Association for Pediatric Ophthalmology and Strabismus (AFSOP) compared with reference ophthalmological examination: the ORTHOPHTALMO study

ABSTRACT Introduction: The ORTHOPHTALMO study aims to evaluate the diagnostic parameters of the screening protocol for amblyopia and risk factors for amblyopia in 3-year-olds recommended in 2019 by the French Association for Pediatric Ophthalmology and Strabismus (AFSOP). This protocol uses visual acuity, photoscreening refraction, and cover test examination performed by an orthoptist. Patient referral to an ophthalmologist is only according to recommended referral criteria. Methods: A prospective, single-center study was performed between September 2020 and June 2021 on a consecutive series of 3-year-olds consulting the Ophthalmology Centre of Clinique Rive Gauche, Toulouse, France, for vision screening. Patients were first examined by an orthoptist following the screening protocol recommended by AFSOP. All patients were then systematically examined by an ophthalmologist for cycloplegic refraction measurement (reference examination). The ophthalmologist was blinded to the referral conclusion and refraction measurements of the orthoptist. Results: A total of 300 patients (149 girls and 151 boys) were included. Examination by an orthoptist was unreliable/incomplete in 7% of cases. An abnormality was detected by the orthoptist in ≥1 of the screening tests among 42% of patients; these patients were thus considered as requiring referral to an ophthalmologist. Reference ophthalmological examination found 41% of patients required treatment. The diagnostic parameters of this screening protocol were 90% for sensitivity and 89% for specificity. Discussion: We validate the effectiveness and feasibility of the AFSOP screening protocol for detection of amblyopia and risk factors for amblyopia in 3-year-olds as well as the recommended criteria for referral to an ophthalmologist. ClinicalTrials.gov https://clinicaltrials.gov/ct2/show/NCT04395560. Number: NCT04395560.

Comparison of the GoCheck Kids and Spot Screener photoscreening devices for the detection of amblyopia risk factors using 2021 AAPOS recommendations

PurposeTo compare the Spot Vision Screener (SPOT) to the GoCheck Kids mobile application (GCK) in the evaluation of amblyopia risk factors (ARFs), according to updated 2021 AAPOS guidelines for instrument-based pediatric vision screening. MethodsSPOT, GCK using horizontal and vertical images (two-photo mode), and a complete eye examination (CEE) were performed on children ages ≥1 to <7 years referred to a pediatric ophthalmologist from October 2020 to December 2022 for a failed vision screen based on manufacturer guidelines. The primary outcomes were sensitivity, specificity, and positive predictive value (PPV) for each photoscreener. ResultsOf 267 subjects included, 42% had one or more 2021 guideline ARFs after CEE. Overall, for SPOT and GCK, respectively, the sensitivity was 0.765 and 0.748, specificity was 0.769 and 0.755, and PPV was 0.728 and 0.712 (P > 0.05 for all). In participants ≥4 years old, SPOT had higher ARF sensitivity than GCK (0.900 and 0.750, resp.; P = 0.005), while among participants <4 years old, SPOT had lower sensitivity than GCK (0.487 and 0.744 respectively; P = 0.004). There were no statistically significant differences between SPOT and GCK in specificity among the younger (0.750 and 0.676 resp.) or older (0.785 and 0.823, resp.) cohorts, or in strabismus detection. The performance of the SPOT and GCK were evaluated using receiver operating characteristics (ROC) curves. Area under the curve (AUC) ranged from 0.857 to 0.980 for SPOT and 0.809-0.931 for GCK. ConclusionsOverall, SPOT, and GCK had similar values for sensitivity, specificity, and PPV to identify patients with ARFs using the 2021 AAPOS guidelines.

Refractive errors, amblyopia risk factors and vision screening in children aged 7–10 years in Aotearoa New Zealand

ABSTRACT Clinical relevance Vision screening is important for detecting undiagnosed vision conditions that are common in school-aged children. However, current vision screening protocols are poor at detecting vision conditions that are most common in the Aotearoa New Zealand paediatric population. Background Uncorrected refractive error and amblyopia are the most common causes of visual impairment in children. The most appropriate vision screening method depends on the refractive error profile of the population. This study aimed to: estimate the prevalence of refractive errors and amblyopia risk factors among children living in Aotearoa New Zealand; describe previous participation in preschool vision screening and determine the diagnostic accuracy of potential screening methods. Methods Children aged 7–10 years received comprehensive eye examinations, including cycloplegic refraction, in their school. Eye examination results were assessed for refractive error and amblyopia risk factors. The sensitivity and specificity of individual vision tests for detecting any vision conditions was calculated to assess the most effective tests for vision screening. Results Eye examinations were completed for 237 children and cycloplegic refraction data was available for 220 of these children. Significant refractive error (need for glasses) was detected in 23.6% of children (7.7% myopia, 7.7% hyperopia, 15.0% astigmatism). Amblyopia risk factors were detected in 9.1% of children. Preschool vision screening had been completed by 78.5% of children. Distance visual acuity screening alone had a sensitivity of 39% for detecting vision conditions, with addition of the Spot Vision Screener improving sensitivity to 65%. Conclusion Astigmatism is the most frequent refractive error among children aged 7–10 years living in Aotearoa New Zealand. Distance visual acuity screening alone is ineffective in detecting refractive error in children in Aotearoa New Zealand. Further research investigating refractive errors across the paediatric population in Aotearoa New Zealand is required to determine the optimal timing and appropriate protocols for school-aged vision screening.

A retinal detachment based strabismus detection through FEDCNN

Ocular strabismus, a common condition in the present generation is an absolute risk factor for amblyopia and blinding premorbid visual loss. Despite the availability of new optometry tools with eye-tracking data, the issues persist in attaining accuracy and reliability in diagnosing strabismus. These two concerns are specifically accommodated in this study by the proposed novel approach that involves CNNs with eye-tracking datasets from subjects. The presented work aims to improve the accuracy of diagnostics in ophthalmology utilizing the integration of the further proposed algorithms into an automatic strabismus detection system. For this purpose, the proposed FedCNN model combines the CNN with eXtreme Gradient Boosting (XGBoost) and uses the Gaze deviation (GaDe) images to capture dynamic eye movements. This method tries to make the feature extraction as accurate as possible in its best working state to enhance the diagnosis precision. The model proves to be accurate, reaching 95.2%, which is even more prominent because of the more or less detailed connection layer of the CNN, which is used for the selection of features designated for such tasks of strabismus recognition. The presented method has the potential of shifting the approach to diagnosing diseases of the eyes in more or less half of the patients.

Poverty and Vision: The Effect of Title 1 Status on Vision Screening Referral Rates in School-Aged Children in Western South Dakota

ABSTRACT Purpose Interventions such as eye exams and glasses are used to correct visual problems that may lead to amblyopia, an irreversible decrease in visual acuity. Children with limited access to these interventions are more likely to have unaddressed visual problems that can lead to amblyopia or negatively impact school performance. This study compared vision screening results of children in schools with Title 1 or Non-Title 1 designation to investigate the link between poverty and vision. Methods Data from KidsFIRST vision screenings conducted with the SPOTTM photoscreener performed in Rapid City Area elementary schools were compared across multiple parameters. Students were referred for eye examinations based on identifying the following problems: anisometropia, anisocoria, astigmatism, myopia, hyperopia, gaze misalignment, or a combination. Results Overall, eye exam referral rates have increased since 2012 (11.9% in 2012, 19.7% in 2023), with a disproportionate increase in referrals from Title 1 schools (25.2% in 2023) vs. Non-Title 1 schools (11.9% in 2023) (p < 0.001). This is largely due to a significantly higher prevalence of astigmatism referrals in Title 1 students (20.9%) compared to Non-Title 1 students (7.5%). Although a higher percentage of Title 1 students are reported to have eye correction (24.4% vs 16.6%), only a slightly higher percentage of Title 1 students wore eye correction during screening (11.5% vs 10.5%). Conclusion Students at Title 1 schools may have a higher rate of amblyopia risk factors. Additional eye care-based interventions should be taken to reduce the risk of amblyopia in this population.

Validation of the eye screening tool GoCheck Kids for the detection of amblyopia risk factors in toddlers in Flanders

PurposeTo assess the validity of the GoCheck Kids photoscreening application (Gobiquity Mobile Health, Scottdale, AZ) on iPhone, which was used (2018-2022) as standard of care by Child and Family (Kind en Gezin) to detect amblyopia risk factors in children 12-30 months of age. MethodsBetween August 2021 and May 2022, 453 children 11-16 months of age underwent a confirmatory ophthalmic examination within 2 months of GoCheck Kids photoscreening at Child and Family, Flanders, Belgium. Additionally, manual review was performed by specialists of GoCheck Kids. Diagnostic metrics were assessed using the 2013 criteria of the American Association for Pediatric Ophthalmology and Strabismus as reference. ResultsSpecificity was similar for automatic screening with or without manual review: 90.0% (95% CI, 87.6%-92.3%) and 90.3% (95% CI, 88.0%-92.7%), respectively. Sensitivity was estimated at 52.0% (95% CI, 35.6%-68.4%) for automatic grading and 56.0% (95% CI, 39.7%-72.3%) after manual review. Positive predictive values for automatic screening and manual review were, respectively, 23.2% (95% CI, 13.9-32.5) and 25.5% (95% CI, 15.8-35.1). Negative predictive values for automatic screening and manual review were, respectively, 97.0% (95% CI, 95.6-98.4) and 97.2 (95% CI, 95.8-98.6). ConclusionsIn our study cohort of children around 12 months of age, the GoCheck Kids application had a specificity of 90% for the targeted amblyopia risk factors, with sensitivity just over 50%.

Prevalence of Amblyogenic Risk Factors Among School Children in India Using the Spot Vision Screener.

Amblyopia is a common cause of preventable visual impairment in children, affecting 1% to 6% globally. This study assesses amblyopia prevalence and risk factors among school children in rural Telangana, India, using the Spot Vision Screener (Welch Allyn, Inc., Skaneateles Falls, New York, USA), a portable, noninvasive device recommended for automated vision screening. A cross-sectional study was conducted on 714 schoolchildren aged 5-10 years. Screening was performed using the Spot Vision Screener, evaluating refractive errors, ocular alignment, and other amblyopia risk factors. Children identified with potential amblyogenic factors were referred for comprehensive ophthalmological evaluation to confirm diagnosis. Out of 714 children screened, 84 were referred by the Spot Vision Screener for further evaluation. Subsequent examination by ophthalmologists confirmed amblyopia in 65 children, resulting in a prevalence of 9.10%. Myopic refractive error was the most prevalent (69.23%), followed by astigmatism (21.53%) and hypermetropia (9.23%) among amblyopia cases. The Spot Vision Screener proved to be a reliable tool for identifying amblyopia risk factors in school children, facilitating early detection and referral for appropriate management. This study underscores the importance of implementing effective vision screening programs in rural settings to mitigate preventable childhood blindness.

Risk Factors for Amblyopia

Amblyopia is characterized by loss of visual acuity without visible organic cause, although it is attributed to abnormal brain development. It is prevalent in children from zero to 8 years, but there are cases of older patients and even adults. This article aims to systematize the main risk factors for amblyopia in studies carried out in ophthalmic care centers. For this purpose, a documentary review of academic and scientific material was carried out. Two risk factors were identified, ocular type such as strabismus, myopia, isolated or combined astigmatism, refractive errors, and non-ocular such as prematurity, low birth weight, and maternal smoking. Risk factors are genetic risk factors, failure to detect and treat early, due to socio-environmental factors like poverty and lack of ophthalmic services, or extraordinary situations such as the COVID-19 pandemic.

Characteristics of refractive development in children aged 4 months to 8 years in urban China: A retrospective screening analysis.

To conduct a large retrospective study of screening refractive error in young children. This retrospective study included children aged from 4 months to 8 years in Daxing District, Beijing, who underwent refractive examinations without cycloplegia. It included a cross-sectional assessment of refractive error screening for all children, and a longitudinal component for a subgroup with data available for two to five visits. A total of 14,987 children were included in the cross-sectional study. In the group <1 year of age, the percentage of children with a spherical equivalent (SE) >+2.00 D or with cylinder <-1.50 D was 15.25% and 33.24%, respectively. These were significantly higher than for the 1- to 4-year-old group (SE 8.1% higher, cylinder 13.2% higher) (χ2 = 53.57, p < 0.001; χ2 = 790.39, p < 0.001). Furthermore, 34.83% of children in the 0-year-old group had amblyopia risk factors (ARFs). In the 4-year-old group, boys had a significantly longer axial length (AL) than girls (differences in the right and left eyes were 0.53 and 0.56 mm, respectively; z = 5.48 p < 0.001, z = 5.80, p < 0.001). AL increased with age, while the AL difference between boys and girls remained stable at 4-8 years of age. The percentage of children aged 5-8 years with myopia in 2020-2021 was significantly higher than that in 2018-2019 (H = 12.44, p = 0.006). In the longitudinal study of 4406 children (up to 12-month follow-up), annual changes in SE were -0.27, -0.06, 0.19 and 0.13 D between 0 and 3 years, and -0.38, -0.58, -0.70 and -0.75 D between 5 and 8 years. Children's refractive error varied significantly from ages 4 months to 1 year, with a high proportion having ARFs. Children aged 5-8 years showed a trend towards myopia. The prevalence of myopia in the cross-sectional analysis in 2020-2021 was greater than in 2018-2019. Screening refraction changed minimally over a 12-month period for children aged 1-3 years, but became more myopic for children aged 5-8 years.

Using Smartphones to Enhance Vision Screening in Rural Areas: Pilot Study.

While it is treatable, uncorrected refractive error is the number one cause of visual impairment worldwide. This eye condition alone, or together with ocular misalignment, can also cause amblyopia, which is also treatable if detected early but still occurs in about 4% of the population. Mass vision screening is the first and most critical step to address these issues, but due to limited resources, vision screening in many rural areas remains a major challenge. We aimed to pilot-test the feasibility of using smartphone apps to enhance vision screening in areas where access to eye care is limited. A vision screening program was piggybacked on a charity summer camp program in a rural county in Sichuan, China. A total of 73 fourth and fifth graders were tested for visual acuity using a standard eye chart and were then tested for refractive error and heterophoria using 2 smartphone apps (a refraction app and a strabismus app, respectively) by nonprofessional personnel. A total of 5 of 73 (6.8%, 95% CI 2.3%-15.3%) students were found to have visual acuity worse than 20/20 (logarithm of minimal angle of resolution [logMAR] 0) in at least one eye. Among the 5 students, 3 primarily had refractive error according to the refraction app. The other 2 students had manifest strabismus (one with 72-prism diopter [PD] esotropia and one with 33-PD exotropia) according to the strabismus app. Students without manifest strabismus were also measured for phoria using the strabismus app in cover/uncover mode. The median phoria was 0.0-PD (IQR 2.9-PD esophoria to 2.2-PD exophoria). The results from this vision screening study are consistent with findings from other population-based vision screening studies in which conventional tools were used by ophthalmic professionals. The smartphone apps are promising and have the potential to be used in mass vision screenings for identifying risk factors for amblyopia and for myopia control. The smartphone apps may have significant implications for the future of low-cost vision care, particularly in resource-constrained and geographically remote areas.

Effectiveness of the Spot tm Vision Screener With Variations in Ocular Pigments

PurposeTo evaluate Spot in detecting AAPOS Amblyopia risk factors (ARF) and for ARF myopia and hyperopia with variations in ocular pigments. DesignDiagnostic screening test evaluationMethods: Study populationChildren presented for a complete eye examination in pediatric clinic. The study population included 1040 participants, of whom 273 had darkly pigmented eyes, 303 were medium pigmented, and 464 were light pigmented. InterventionChildren were screened with the Spot vision screener before the complete eye examination. A pediatric ophthalmologist then completed an eye examination, including cycloplegic refraction. The pediatric ophthalmologist was blinded to the result of the spot vision screener. Main outcomeThe association between Spot screening recommendation and meeting one or more ARF/ARF + Amblyopia criterion, Spot measured spherical equivalent, and ARF myopia and hyperopia detection. ResultsThe area under the receiver operative characteristic curve (AUC) for myopia was excellent for all. The AUC for hyperopia was good (darker-pigmented: 0.92, medium-pigmented: 0.81, and lighter-pigmented: 0.86 eyes). The Spot was most sensitive for ARF myopia (lighter-pigmented: 0.78, medium-pigmented: 0.52, darker-pigmented: 0.49). The reverse is found for hyperopia; however, sensitivity was relatively poor. The Spot was found most sensitive for hyperopia in the darker-pigment group (0.46), 0.27 for medium-pigment, and 0.23 for the lighter-pigment cohort. ConclusionsWhile the Spot was confirmed as a sensitive screening test with good specificity in our large cohort, the sensitivity of the Spot in detecting AAPOS guidelines for myopia and hyperopia differed with variations in skin pigment. Our results support the consideration of ethnic and racial diversity in future advances in photorefractor technology.

Preschool Vision Screening: Prevalence and Associated Factors of Amblyopia among School Going Children in Dhaka City

Background: Amblyopia is a decrease in best-corrected visual acuity in one or both eyes due to form deficiency or abnormal binocular interaction. It affects infancy and adulthood for the individual and society as a whole. Amblyopia affects academic success, career choice, visuomotor skills, social interaction, psychological development, and economic participation. Unilateral amblyopia increases the likelihood of bilateral vision loss. Ocular media opacity, strabismus, anisometropia, hypermetropia, astigmatism, myopia, and blepharoptosis are risk factors for amblyopia. Ocular screening programs in young children, primarily preschoolers, may detect amblyopia and amblyogenic risk factors like as strabismus, refractive errors, and media opacities early. It prevents and treats amblyopia. It helps children's emotional growth. Diagnosis and treatment of amblyopia at a younger age may result in a better and more stable final VA because to shorter treatment durations, faster VA improvement, and greater treatment adherence. Objective: The purpose of this study was to determine Preschool vision screening, prevalence and associated factors of amblyopia among school going children in Dhaka city. Methods and Material: Between January 1 and June 30, 2022, a cross-sectional survey of a community of Dhaka city residents in the school age range was carried out. Through interviews and physical exams, data were gathered using a pretested structured questionnaire and checklist. Using SPSS 23, descriptive and inferential analysis was performed, and variables with a p value of less than 0.2 were included into multivariate logistic regression. In the multivariable binary logistic regression, significant predictors were defined as variables with a p value of &lt; 0.05. Result: Majority of the student are of 4-5 years age, among the participant 50.8% were male and 45.8% were female. Study showed that majority of the family has 1-2 (49.5%) and 3-4 (45.3%) children. Majority of the mother .......

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.

Performance of the Spot Vision Screener in children with Down syndrome and other special needs

Amblyopia is a common cause of monocular vision impairment and disproportionally affects developmentally delayed children. Photoscreeners have been suggested as a method to detect amblyopia risk factors (ARFs) in children with developmental disabilities who may not be amenable to traditional vision screening methods. The Spot Vision Screener is a commonly used photoscreener for detecting ARF and has shown excellent sensitivity and accuracy in the general pediatric population. The purpose of this study was to evaluate its accuracy in children with Down syndrome and other special needs. Children with various disabilities or delays were recruited from outpatient clinics at the Children's Hospital of Colorado. Participants had their photograph taken with Spot before and after pupil dilation and cycloplegia. Images were compared to results of a comprehensive clinical eye examination. A total of 100 children participated in the study. Images could not be obtained in 12 children; 5 children did not attend their clinical examination. The overall sensitivity of Spot was 90%, with a positive predictive value of 80% in undilated subjects. The area under the receiver operator curve (AUROC) was 0.68 (95% CI, 0.57-0.79), which did not differ significantly from the AUROC after dilation/cycloplegia (0.68; 95% CI, 0.54-0.81). The Spot Vision Screener could be used by primary care clinics and vision screening programs with a high sensitivity to determine which patients with Down syndrome and special needs should be referred for clinical examination.

Anisometropia and Amblyopia Outcomes in Early Versus Late Resolution of Congenital Nasolacrimal Duct Obstruction in Older Infants.

Congenital nasolacrimal duct obstruction is a known risk factor for amblyopia and anisometropia. The purpose of this study was to investigate whether the rate of anisometropia and amblyopia development differed based on the age at CNLDO resolution in older infants. This retrospective chart review at a single tertiary children's hospital from 2007 to 2017 compared early versus late spontaneous resolution (cutoff 12 months) and intervention (cutoff 15 months) groups presenting at ≥9 months of age, comparing visual outcomes, including anisometropia (≥1 D of sphere or cylinder) and amblyopia (≥2 levels difference in Teller acuity or optotype testing). Parents/guardians were contacted by phone for missing data on spontaneous resolution or intervention status. A total of 462 patients were included (152 early; 310 late group). The early group presented at a median age of 12.0 (interquartile range: 10.0, 13.0) months, while the late group presented at 21.0 (interquartile range: 15.0, 32.0) months. Unilateral disease occurred in 62% and 59%, respectively. Anisometropia was seen in (12/102) 12% of early versus (25/243) 10% of late patients (p = 0.686, 95% CI: -0.059, 0.088), and amblyopia in (4/131) 3% of early versus (14/286) 5% of late patients (p = 0.322, 95% CI: -0.061, 0.018). In patients presenting <24 months without undergoing surgery, spontaneous resolution occurred in 76% between 12 and 24 months (n = 41). Anisometropia and amblyopia rates did not significantly differ between early and delayed intervention for congenital nasolacrimal duct obstruction in this retrospective cohort presenting beyond 9 months of age to a children's hospital. This study found frequent late spontaneous resolution.

A population-level post-screening treatment cost framework to help inform vision screening choices for children under the age of seven

ABSTRACT Purpose/Background Visual acuity (VA) screening in children primarily detects low VA and amblyopia between 3 and 6 years of age. Photoscreening is a low-cost, lower-expertise alternative which can be carried out on younger children and looks instead for refractive amblyopia risk factors so that early glasses may prevent or mitigate the conditions. The long-term benefits and costs of providing many children with glasses in an attempt to avoid development of amblyopia for some of them needs clarification. This paper presents a framework for modeling potential post-referral costs of different screening models once referred children reach specialist services. Methods The EUSCREEN Screening Cost-Effectiveness Model was used together with published literature to estimate referral rates and case mix of referrals from different screening modalities (photoscreening and VA screening at 2, 3–4 years and 4–5 years). UK 2019–20 published National Health Service (NHS) costings were used across all scenarios to model the comparative post-referral costs to the point of discharge from specialist services. Potential costs were compared between a) orthoptist, b) state funded ophthalmologist and c) private ophthalmologist care. Results Earlier VA screening and photoscreening yield higher numbers of referrals because of lower sensitivity and specificity for disease, and a different case mix, compared to later VA screening. Photoscreening referrals are a mixture of reduced VA caused by amblyopia and refractive error, and children with amblyopia risk factors, most of which are treated with glasses. Costs relate mainly to the secondary care providers and the number of visits per child. Treatment by an ophthalmologist of a referral at 2 years of age can be more than x10 more expensive than an orthoptist service receiving referrals at 5 years, but outcomes can still be good from referrals aged 5. Conclusions All children should be screened for amblyopia and low vision before the age of 6. Very early detection of amblyopia refractive risk factors may prevent or mitigate amblyopia for some affected children, but population-level outcomes from a single high-quality VA screening at 4–5 years can also be very good. Total patient-journey costs incurred by earlier detection and treatment are much higher than if screening is carried out later because younger children need more professional input before discharge, so early screening is less cost-effective in the long term. Population coverage, local healthcare models, local case-mix, public health awareness, training, data monitoring and audit are critical factors to consider when planning, evaluating, or changing any screening programme.

Analysis of risk factors associated with the high incidence of amblyopia in preterm infants at the corrected gestational age of 12 months

ObjectiveTo investigate the perinatal and in-hospital risk factors associated with the high incidence of amblyopia in preterm infants and to analyze the correlation between the amblyopia and neurodevelopment.MethodsChildren discharged from the neonatal intensive care unit (NICU) at 12 months of corrected gestational age were retrospectively included in this study. Ocular screening was performed in children. At the risk of amblyopia was determined according to the American Academy of Ophthalmology Guidelines for automated preschool vision screening factors. Differences in perinatal characteristics, complications during hospitalization, and treatment modalities between the two groups of children were analyzed, and multifactorial logistic regression analysis was used to identify the independent risk factors for amblyopia. The results of developmental assessment were collected retrospectively to analyze the correlation between amblyopia and various aspects of neurological development.ResultsA total of 128 preterm infants, 30 in the amblyopia risk group and 98 in the non-amblyopia risk group, were included in this study. Univariate analysis showed that the amblyopia risk group had lower birth weights, higher rates of asphyxia, preterm brain white matter injury, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), sepsis during hospitalization, and higher rates of treatment with pulmonary surfactant (PS), blood transfusion, invasive ventilator, and levothyroxine. Logistic regression analysis showed that BPD in the neonatal period (odds ratio [OR] 8.355, 95% confidence interval [CI] 1.492, 46.786), brain white matter injury (OR 16.742, 95% CI 0.684, 409.804), treatment with levothyroxine (OR 2.859, 95% CI 0.946, 8.639), and use of an invasive ventilator (OR 2.983, 95% CI 0.942, 9.445) were independent risk factors for amblyopia at 12 months of corrected gestational age, while the administration of glucocorticoids (OR 0.055, 95% CI 0.004, 0.737) was a protective factor. Regarding neurodevelopmental assessment, the number of infants with lagging fine motor development was greater in the amblyopia risk group.ConclusionThe presence of BPD in the neonatal period, brain white matter damage in preterm infants, and use of levothyroxine and invasive ventilator were high risk factors for amblyopia. The use of glucocorticoids therapy was a protective factor. Children with risk of amblyopia had a higher rate of poor fine motor development.

Effective Detection of Amblyopia Risk Factor Using Smart Phone Eye Testing Application

Amblyopia also called as lazy eye. In this disease there is week communication between human eyes with human brain. Due to this reason one of the eye is not working properly compare to other eye. Amblyopia starts in early childhood, and most of the children are loss his vision. In the world 3 to 4 child’s are affected of amblyopia risk factors out of 100 children. If we give the early treatment on affected eye may be prevents long-term vision problems. This problem is focus in mind and author is doing study to accurately identify children at risk for amblyopia by using existing application from smartphone platforms. This study is not replace the advice of doctors on any condition.&#x0D; Keywords: Amblyopia Risk Factor, Visual Acuity Test,

The blinq™ Vision Screener in Detection of Amblyopia and Strabismus

The blinq (Rebion Inc) is a new screening device designed to directly detect amblyopia and strabismus rather than amblyopia risk factors. We performed an independent assessment of the effectiveness of the blinq in detecting amblyopia and strabismus. Prospective clinical validity analysis of a screening device based on sensitivity and specificity. Children presenting for examination in the pediatric ophthalmology clinic underwent screening with the blinq before examination by a pediatric ophthalmologist blinded to the screening results. Results of the blinq and examination findings of strabismus or amblyopia were compared. In our cohort of 267 children with an average age of 6.3 years, the sensitivity of the blinq to detect amblyopia or any constant strabismus was 87.5% (78.2%-93.8%) and specificity was 51.3% (43.9%-58.7%). Using the previously described "appropriate referral gold standard" criteria, including children with intermittent strabismus and high refractive error, the sensitivity increased to 91.3% and the specificity to 63.2%. We found a high number of children (44 [16%]) upon whom the blinq timed out and were included as automatic referrals. Our results support use of the blinq as a screening device to detect amblyopia and strabismus in children.

Effectiveness of the Spot Vision Screener using updated 2021 AAPOS guidelines

To evaluate the Spot Vision Screener according to updated 2021 AAPOS Vision Screening Committee guidelines for instrument-based pediatric vision screen validation. As part of an IRB-approved ongoing prospective study, children were screened with the Spot prior to a complete examination. Spot screening was successful in 1,036 of 1,090 children (95%). Forty-eight percent of participants were referred for further screening using the Spot manufacturer guidelines, and 40% of all children were found to have a 2021 amblyopia risk factor or visually significant refractive error by gold standard examination. The Spot recommendation compared reasonably well to the 2021 criteria, with an overall sensitivity of 0.88 and a specificity of 0.78. Applying updated guidelines to the Spot for hyperopia, anisometropia, and astigmatism yielded moderate-to-poor sensitivity (0.27-0.77) but excellent specificity (>0.9). The area under the curve of the receiver operating characteristic analysis demonstrates overall good prediction performance for the Spot for each diagnosis-myopia, hyperopia, astigmatism, anisometropia (range, 0.87-0.97). Results of our study suggest increasing the instrument referral criterion for astigmatism from 1.5 D (manufacturer thresholds of the screener used in this study) to 2 D in older children. Decreasing the anisometropia cut-off from 1 D to 0.75 D would improve sensitivity from 0.59 to >0.8. In our study population, the overall predictive ability of the Spot is good, with a sensitivity of 0.88 and a specificity of 0.78. We recommend specific device refractive referral criteria to maximize screening effectiveness using the updated AAPOS guidelines.