Prediction and cost-effectiveness comparison of amblyopia screening methods at ages 3-4 years.

PURPOSE: Compare the performance of different amblyopia screening tests. METHODS: Based on exploratory factor analyses (EFA) of different screening tests performed in 3295 children, we created models of screening strategies in a matrix with: uncorrected visual acuity (UCVA), Plusoptix measurements (PO), Randot Stereo-test (SR), and Cover-Test (CT). Receiver Operating Characteristic (ROC) curves and confusion matrix were used to compare performance of different model's algorithm to predict new diagnosis of amblyopia. Estimated screening costs per screened and treated child were compared. RESULTS: Regression analyses revealed that, although all models predicted amblyopia (all p < 0.001), only models including PO or UCVA had higher prediction capacity (R2 > 0.4) and better discriminating ROC curves (AUC > 0.95; p < 0.001). For 96% sensitivity, UCVA + PO was the most cost-effective model, since the estimated average screening costs per treated child, almost doubled and tripled if using PO or UCVA alone, respectively, versus using both exams. When UCVA + PO is not possible to implement, adding SR to either UCVA or PO resulted in cost-savings of 28% and 18%, respectively. CONCLUSIONS: In a previous unscreened population, aged 3-4 years, screening programs using either UCVA or PO alone, should reconsider doing both tests simultaneously, since, for a high level of sensitivity, using simultaneously UCVA + PO is more cost-effective, per screened, and treated amblyopia. Concerns relating higher time-consuming exams for the combination of UCVA + PO should be surpassed, since costs per treated child drop considerably. When children benefit from good primary-care routine examinations since birth, no benefit was found for using CT in a screening setting. SR showed little benefit.

Late Ophthalmologic Referral of Anisometropic Amblyopia: A Retrospective Study of Different Amblyopia Subtypes.

INTRODUCTION: Amblyopia requires a timely diagnosis and treatment to attain maximum vision recovery. Specialty literature is lacking on how early amblyopia is referred. We aimed to understand if there are mean age differences at first referral for ophthalmologic tertiary center consultation among non-amblyopic and different types of amblyopia, in a context of lack of population screening. MATERIAL AND METHODS: In this retrospective model, the sample corresponded to all children born in Braga Hospital during 1997 - 2012 (3 - 18 years-old), with an ophthalmologic consultation in 2014. Data was collected from the clinical records and children were divided in a non-amblyopic versus amblyopic group. The amblyopic group was subdivided in strabismic versus refractive (anisometropic/bilateral). RESULTS: The sample had a total of 1665 participants, 1369 (82.2%) without amblyopia and 296 (17.8%) with amblyopia. Among amblyopia: 67.9% (n = 201) refractive, 32.1% (n = 95) strabismic. Within refractive amblyopia: 63.7% (n = 128) anisometropic and 36.3% (n = 73) bilateral. The mean age at first consultation was 6.24 ± 3.90 years-old: 6.39 ± 3.98 for non-amblyopic and 5.76 ± 3.58 for amblyopic. Among amblyopia subgroups, there were significant differences in mean age at first consultation (F3,1250 = 8.45; p < 0.001; Î·2 = 0.020). Strabismic and bilateral refractive amblyopia were referred earlier, when compared to non-amblyopia or anisometropic amblyopia (p < 0.05). Anisometropic amblyopia had the highest first consultation mean age: 6.92 ± 3.57 years-old. DISCUSSION: Without specific pre-school screening, children with amblyopia were referred to their first ophthalmologic evaluation significantly later than desired, especially anisometropic amblyopia, with a postschool mean age for first consultation. CONCLUSION: Recognizing high-risk children is essential for earlier referral and helps minimize future visual handicap.

Introdução: A ambliopia requer uma abordagem atempada para uma máxima recuperação visual. Não existe informação sobre a idade de referenciação da ambliopia. O presente artigo pretende perceber se há diferenças na idade média de referenciação para consulta terciária de Oftalmologia, entre não-amblíopes e amblíopes, num contexto sem rastreio implementado. Material e Métodos: A amostra correspondeu a todas as crianças nascidas no Hospital de Braga entre 1997 - 2012 (3 - 18 anos de idade), com consulta de Oftalmologia em 2014. A informação foi recolhida pelos registos clínicos, tendo sido criado o grupo nãoamblíope e amblíope, dividido em estrábico e refrativo (anisometrópico/bilateral). Resultados: A amostra contemplou 1665 participantes, 1369 (82,2%) não-amblíopes e 296 (17,8%) amblíopes. Dentro das ambliopias: 67,9% (n = 201) refrativas e 32,1% (n = 95) estrábicas. Nas ambliopias refrativas: 63,7% (n = 128) anisometrópicas e 36,3% (n = 73) bilaterais. A média de idades na primeira consulta foi de 6,24 ± 3,90 anos, 6,39 ± 3,98 nos não-amblíopes e 5,76 ± 3,58 nos amblíopes. Dentro dos subgrupos de ambliopia, existiram diferenças significativas na idade na primeira consulta (F3,1250 = 8,45; p < 0,001; η2 = 0,020). As ambliopias estrábicas e as refrativas bilaterais foram referenciadas mais cedo, quando comparadas com não-amblíopes ou ambliopias anisometrópicas (p < 0,05). A ambliopia anisometrópica teve a maior média de idade na primeira consulta: 6,92 ± 3,57 anos de idade. Discussão: Sem um rastreio pré-escolar específico, os amblíopes foram referenciados para a primeira observação oftalmológica significativamente mais tarde do que o desejado, especialmente a ambliopia anisometrópica, com uma idade pós-escolar de média para a primeira avaliação oftalmológica. Conclusão: Identificar crianças de alto risco é essencial para uma referenciação precoce, ajudando a minimizar consequências visuais.