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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. 2005;46(13):689.
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Purpose: To present long–term follow–up data on preschool patients identified with amblyogenic risk factors by positive photoscreening. Background: Amblyopia is a significant public health issue. Treatment of patients having anisometropic and strabismic amblyopia by means of occlusion, pharmacologic penalization, and/or spectacles has been shown to improve vision. We can detect amblyogenic factors by photoscreening and therefore identify and treat amblyopia. However, long term outcome of photoscreening is unclear. Methods: Our statewide preschool vision screening program has screened over 140,000 children since 1997. We performed a retrospective chart review of photoscreen–positive patients at our institution. We reviewed records from a series of over 400 patients in an ongoing study. We recorded age, sex, vision, method of visual acuity assessment, presence of strabismus, cycloplegic refraction, and diagnosis on initial visit. Initial and subsequent treatment, clinical course, visual outcome, and duration of follow–up was also recorded. Amblyogenic factors were as defined by the American Association of Pediatics Ophthalmology Vision Screening Committee. Improvement in vision was defined as either 1) greater than or equal to 20/40 or 2) at least 2 lines of improvement at the last examination. Visual acuity outcome at age 6 years will be determined, if possible. Results: Seventy–five percent of photoscreen–positive patients presented for initial examination by comprehensive ophthalmologists, optometrists, and pediatric ophthalmologists, 15–25% of whom are seen at our institution. We have reviewed over 50 charts from a series of over 400 children, all of whom have been cared for by pediatric ophthalmologists, in an ongoing study. Five patients with organic eye conditions were excluded. Of 50 patients, 18 (36%) were diagnosed with strabismic, anisometropia, or isoametropic amblyopia and treated with spectacles and/or occlusion therapy. Of the amblyopic patients, there were 11/18 (61%) anisometropic, 5/18 (28%) strabismic, 1/18 (6%) hypermetropic, 1/18 (6%) astigmatic patients. Of these amblyopic patients, 10/18 (56%) achieved greater or equal to 20/40 vision and 6/18 (33%) experienced at least 2 lines of improvement. Conclusions: A significant fraction of children identified by photoscreening and then present for physician evaluation have amblyopia; a significant number of these experience an improvement in vision after treatment. Although costly, photoscreening may be an effective screening method for amblyopia in preschool age children.
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