“…The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus have incorporated screening based on ARFs into their clinical guidelines ( Arnold et al, 2022 , American Academy of Ophthalmology, 2022 ). However, screening based on ARFs may prolong the observation period, leading to higher referral rates and false positive, and subsequently increased treatment costs ( Horwood et al, 2023 ). Therefore, it is crucial to establish more stringent referral thresholds ( Lowry and de Alba Campomanes, 2015 ).…”