Prevalence of Amblyopia After Photoscreening.

PURPOSE: To assess the prevalence of amblyopia in a population of adolescents screened for amblyogenic risk factors at preschool age. METHODS: Data were retrospectively collected from the preschool screening for amblyogenic risk factors routinely performed in the authors' hospital. A stratified random sampling was used. A school from the region was randomly selected and then two grades were randomly selected. All classes from these grades were evaluated and only children who were previously screened for amblyogenic risk factors were included. Ophthalmological examination included best visual acuity (distance and near, Early Treatment of Diabetic Retinopathy Study scale and Jaeger eye chart) and stereopsis (Randot Stereo Test; Stereo Optical Company, Inc). Sample size was estimated as more than 283 participants. Pertinent data were extracted for analysis. RESULTS: A total of 520 children were recruited, and 299 met the inclusion criteria. Fifteen percent of children (n = 46) had results at the screening that prompted a further ophthalmological evaluation and 9% of children (n = 26) had meaningful refractive errors or strabismus. Overall amblyopia prevalence was 1.00%. One of the 3 children who developed amblyopia had microstrabismus, and the remaining 2 children had a previous positive screening result but missed the follow-up evaluations. At the follow-up evaluation, 79.3% (n = 237) of children were not wearing glasses. CONCLUSIONS: A structured screening may allow the early detection of amblyogenic factors and prevent further vision deterioration in children, thus improving their long-term quality of life. The prevalence of amblyopia in this study was lower than that recently stated for Europe. [J Pediatr Ophthalmol Strabismus. 2020;57(6):372-377.].

Long-term refractive outcomes in children with early diagnosis of moderate to high hyperopia.

PURPOSE: The purpose of this study was to investigate the long-term outcome of moderate-to-high hyperopic refractive errors in childhood. METHODS: We reviewed medical records from children diagnosed with hyperopia (≥3D) in the amblyogenic risk factors screening that is performed in a public hospital in Portugal. We included hyperopic children diagnosed between 2001 and 2011 with at least three available ophthalmologic evaluations (including one before the age of 3 years and one after a minimum period of 6 years after the first evaluation). Spherical equivalent (SE) was considered. RESULTS: In total, 78 eyes from 39 children met the inclusion criteria (49% male). Mean age at first and last evaluation was 1.8 ± 0.9 years and 10.6 ± 2.7 years, respectively. Median follow-up was 130 months (range 72-193). At baseline evaluation, the mean SE was 4.5 ± 1.4 diopters, 36% of children had a SE ≥5.0 diopters, 23% had partially accommodative esotropia, 26% had accommodative esotropia and 51% had no eye deviation. At the last evaluation, the mean SE was 4.6 ± 1.7diopters. During follow-up, four children developed unilateral amblyopia (one because of anisometropia, three because of anisometropia and strabismus). From these, three recovered with treatment. Until the age of 10 years, the number of children that presented with strabismus did not decrease. CONCLUSION: In our study, children with moderate to high hyperopia did not experience a significant reduction in the power of the refractive error. Although almost 50% of children had an initial deviation, only one had amblyopia at the end of follow-up. Implementing screening strategies for the early detection of this refractive error may prevent long-term vision morbidity in hyperopic children.

Photoscreening for amblyogenic risk factors in 1-year-olds: results from a single center in Portugal over a 9-year period.

PURPOSE: To report the experience of a single center in photoscreening 1-year-olds for amblyogenic risk factors over a 9-year period and to estimate amblyopia prevalence in this population. METHODS: The records of 11,029 children 11-18 months of age who were screened for amblyogenic risk factors at Centro Hospitalar de Entre o Douro e Vouga between 2004 and 2012 were reviewed. Measurements were performed with MTI (until 2008) and plusoptiX S04 (from 2009). The screening results were evaluated according to criteria adapted from Donahue and colleagues. RESULTS: The screening was negative in 8,985 children (82%), positive in 519 (5%), unreadable in 201 (2%), and borderline in 1,324 (12%). The overall positive predictive value (PPV) for the presence of at least one amblyogenic risk factor was 56.8%. The estimated prevalence of meaningful refractive errors in this population was 2.2%; of strabismus, 0.3%. CONCLUSIONS: The rate of unreadable screenings was low. The overall PPV was lower than other large studies, at older ages, but higher than those of the same-age children. Considering the potential benefits of early intervention in preventing the development of amblyopia, this study demonstrates the feasibility of screening 1-year-olds.