Major Articles
Early screening for amblyogenic risk factors lowers the prevalence and severity of amblyopia*,**,*

Presented as a poster at the 25th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Toronto, Ontario, Canada, April 15–18, 1999. (Screening for amblyopia and amblyogenic conditions in infancy: a longitudinal study.)
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Abstract

Purpose: To evaluate the efficacy of a mass screening program for amblyopia and amblyogenic risk factors in infants. Methods: Since 1968, children between the ages of 1 and 2½ years in the city of Haifa, Israel, have been systematically screened for amblyopia and amblyogenic risk factors. The screening is performed by the Ophthalmology Department of Bnai-Zion Medical Center (formerly known as Rothchild Hospital). In 1995, we compared the prevalence and severity of amblyopia in two populations of 8-year-old children in elementary school: one group was a cohort of 808 children from the city of Haifa and its vicinity, who had been screened in infancy (between 1988 and 1990); and the second group, the control group, was a cohort of 782 children from Hadera and its vicinity, where this early screening program is not conducted. Amblyopia was defined as corrected visual acuity of ≤5/10 (20/40), or >1 line difference in corrected visual acuity between the two eyes. Referral rate, treatment rate, sensitivity, specificity, and positive predictive value and negative predictive value of the screening test in detecting factors that later resulted in the development of amblyopia were examined. Results: The prevalence of amblyopia in the 8-year-old population screened in infancy was found to be 1.0% compared with 2.6% in the 8-year-old population that had not been screened in infancy (P =.0098). The prevalence of amblyopia with visual acuity of ≤5/15 (20/60) in the amblyopic eye was 0.1% in the screened population compared with 1.7% in the non-screened population (P =.00026). In the screened infant population, 3.6% were referred from the screening examination to a confirmatory examination and 2.2% were treated. The screening examination had a sensitivity of 85.7% and a specificity of 98.6% for amblyopia. The positive predictive value of the screening examination was 62.1% and the negative predictive value was 99.6%. Conclusions: The screening program for amblyopia and amblyogenic risk factors in infants, followed by appropriate treatment, is effective in significantly reducing the prevalence and severity of amblyopia in children. (J AAPOS 2000;4:194–9)

Section snippets

Subjects and methods

In Israel, the Ministry of Health, through its child welfare clinics, provides infants with free health care including examinations and immunizations. All children born in Israel are registered at the child welfare clinic nearest their home and attend the clinic periodically for examinations, immunizations, and general supervision. As of 1968, an ophthalmic screening examination for amblyopia and amblyogenic risk factors, in infants between the ages of 1 and 2½ years, has been included as part

Results

At the selected schools in Haifa, 988 children were examined. Of those examined, 808 had attended the screening examination as infants. At the time of the infant screening, amblyopia or risk factors for amblyopia were suspected in 29 of 808 (3.6%) infants. All 29 infants were then referred for a more thorough confirmatory evaluation at the outpatient Ophthalmology Clinic of the Bnai-Zion Medical Center. Of the 29 infants referred for further evaluation, 18 (2.2% of the screened population) were

Discussion

Many cases of amblyopia escape detection without effective screening. All lines of evidence support the concept that there is a limited period of susceptibility (“sensitive period”) for the developing visual system.1, 2, 3, 4, 5, 6, 7, 8 The plasticity and responsiveness of the developing visual system in infants makes this age group ideal for ophthalmologic screening. Early identification and treatment of risk factors for amblyopia enables prevention of amblyopia. Diagnosis and treatment of

Acknowledgements

We thank Monte A. Del Monte, MD, and Steven M. Archer, MD, for invaluable help in writing this article and for reviewing the statistical analysis of the patient data.

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    *

    Supported in part by grant 1815791 from the Technion-Israel Institute of Technology, Haifa, Israel.

    **

    Reprint requests: Maya Eibschitz, MD, The University of Michigan, Kellogg Eye Center, 1000 Wall St, Ann Arbor, MI 48105 (e-mail: [email protected]).

    *

    J AAPOS 2000;4:194–9.

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