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C.M. Bui, S.P. Donahue; Long–Term Follow–Up of Patients With Amblyopia Initially Identified by Preschool Photoscreening . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2936.
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Amblyopia is a significant public health problem. Treatment of amblyopic patients using occlusion, pharmacologic penalization, and/or spectacles can improve vision. Preschool vision screening can identify patients with amblyopia or amblyogenic risk factors, but its impact on long–term visual outcome is unclear. Our statewide preschool photoscreening program has screened over 140,000 children since 1997. Seventy–five percent of photoscreen–positive patients present for evaluation by optometrists, comprehensive ophthalmologists, and pediatric ophthalmologists. We determined the visual outcome of those patients who were referred to our institution following photoscreening.
To present long–term follow–up data on preschool patients identified with amblyogenic risk factors by photoscreening.
Institutional Review Board approval was obtained. We performed a retrospective chart review of 510 children referred from photoscreening. We recorded age, sex, visual acuity, cycloplegic refraction, and ophthalmologic diagnosis on initial visit. Treatment modality, visual outcome, follow–up duration, and treatment completion status were also recorded. Successful outcome measures were defined as a) greater than or equal to 2 lines of improvement in visual acuity or equal vision in both eyes or b) at least 20/40 distance vision in the amblyopic eye.
Of 510 screen–positive patients, 110 (22%) had amblyopia, and 288 (56%) had amblyogenic risk factors without amblyopia. Eighty–two (16%) were false positives, and 30 (6%) patients with organic eye conditions or developmental delay were excluded. Average age of the 110 amblyopic patients was 41±17 months, and average follow–up duration was 34±23 months. Of the amblyopic patients, there were 61 (55%) anisometropic, 29 (26%) strabismic, 13 (12%) combined anisometropic and strabismic, 6 (5%)refractive, and 1 (1%) undefined type. Of 110 amblyopic patients, 84 (76%) achieved at least 2 lines of improvement in visual acuity or equal vision in both eyes, 84 (76%) achieved at least 20/40 distance vision in the amblyopic eye, 9 (8%) were lost to follow–up, and 1 (0%) had insufficient data. Of the 16 patients who did not meet criteria for success, 12 (75%) had not completed treatment.
Photoscreening can successfully identify children with amblyopia. The vast majority of identified children comply with follow–up and have excellent results from treatment. Photoscreening is an effective large scale screening technique for preschool vision screening.
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