Two infant vision screening programmes: Prediction and prevention of strabismus and amblyopia from photo- and videorefractive screening

Screening for abnormal levels of hyperopia in children: a non-cycloplegic method with a hand held refractor

“…3 Refractive screening therefore constitutes an integral part of several large scale visual testing programmes in preschool children 4-10. Among them, the Cambridge photoscreening programme10 shows that an abnormal level of hyperopia (over +3.5 D in one or more meridians) is the most frequent refractive anomaly (5–6%) found in a population at 9 months of age. It is associated with a higher risk of amblyopia (37.5% versus 5.6% in the control group) and strabismus (21% versus 1.6%) at 4 years of age.…”

“…Cycloplegia is indeed time and energy consuming and, as an invasive act, is not suitable for a screening procedure. Cycloplegia could be avoided if there was a manifest (non-cycloplegic) hyperopia threshold leading, with reasonably good sensitivity and specificity, to an absolute (cycloplegic) hyperopia greater than + 3.5 D. Atkinson et al  10 have already promoted non-cycloplegic videorefractive screening, choosing an accommodative lag of ⩾1.5 D as a good predictor of hyperopic refractive errors under cycloplegia.…”

Effectiveness of Early in Comparison to Late(r) Treatment in Children with Amblyopia or Its Risk Factors: A Systematic Review

“…The remaining studies (two direct comparisons within one study) evaluated treatment in children with amblyogenic risk factors such as hyperopia [20][21][22][23] and esotropia. 24,25 These two studies applied a non-randomized study design.…”

“…28,29 However, the CPIVSP II study showed that emmetropization seems not to be affected by spectacle wear in hyperopic infants up to the age of 3.5 years. [20][21][22][23] In contrast, there are indications that early surgery of children with infantile esotropia (another amblyogenic factor) is connected with a higher risk for re-operations. 24,25 In addition, this study showed that a spontaneous reduction of esotropia to microstrabismus is possible within the first six years of life.…”

“…The main limitation of the two non-randomized studies addressing risk factors for amblyopia was that the comparability of groups in terms of baseline characteristics was either not given 24,25 or not specified. [20][21][22][23] Both studies showed a loss to follow-up of more than 20%. In addition, neither of the two studies described a masked outcome assessment.…”