Editorial: Vision screening in children

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1*Pennsylvania College of Optometry at Salus University, Eye- and Vision Center Optometrie Cagnolati GmbH

Amblyopia is the most common cause of monocular visual impairment in children today. For this reason, the U.S. Preventive Services Task Force recommends vision screening for all children at least once between the ages of three and five to determine the presence of amblyopia or its risk factors.1 Different professions are involved in a variety of childhood amblyopia screening programs around the world. These usually include ophthalmologists, orthoptists, pediatricians and optometrists. The Professional Association of German Ophthalmologists (BVA) and the German Society of Ophthalmology (DOG) describe a detailed procedure for an age-specific amblyopia diagnosis and treatment in its guideline 26a. The American Association for Pediatric Ophthalmology and Strabismus and the American Academy of Pediatrics recommend a routine, age-appropriate red reflex testing, an examination for signs of strabismus and a visual acuity testing in this context.1

An interesting paper regarding automated vision screening in children has recently been published in the UK journal "Eye" (Lond).3 208 children aged 3 to 14 years were included in a prospective study. Quantification of brightness disparity between the two eyes, measurement of monocular visual acuity with and without a pinhole, and colour vision were determined using an iPad. The amblyopia screening was based on the quantification of the brightness difference between two spacecrafts. The study subjects looked through polarizing filters. The brightness disparity was varied using a staircase-algorithm until equal brightness of the image pairs was perceived. Visual acuity was determined using tumbling Es and colour vision using AO-HRR colour charts, which are pseudoisochromatic test charts. Based on the measurement of the brightness differences, a high sensitivity and specificity with respect to amblyopia was shown. The average test time for the determination of brightness difference was 32.7 seconds, for colour vision 52.8 seconds and for visual acuity 88.75 seconds. Due to missing evidence, the management of ametropia, anisometropia and amblyopia is one of the most important and sometimes most difficult questions in pediatric ophthalmology and pediatric optometry. For this reason, the recommendations of the various national and international professional organisations, such as the guidelines of Professional Association of German Ophthalmologists (BVA) and the German Society of Ophthalmology (DOG), the American Academy of Ophthalmology (AAO) as well as the Consilium Strabologicum Austriacum (CSA) and Orthoptic Austria, are of great importance for daily clinical practice.2,4 If amblyopia is detected at an early stage, it is treatable in most cases. The methodology presented by Kayne et al. could become an interesting and inexpensive addition to existing screening procedures.


[1] McConaghy, J. R., McGuirk, R. (2019). Amblyopia: Detection and Treatment. Am. Fam. Physician, 15, 100, 45-750.

[2] Berufsverband der Augenärzte Deutsch-lands (BVA) und Deutsche Ophthalmo­logische Gesellschaft (DOG). (2010). Leitlinie 26a Amblyopie. https://www.dog.org: Referencing 21 March 2023.

[3] Kayne, S. A., Gaspich, M., Kane, J., Weitzman, S. A., Hofeldt, A. (2023). Automated vision screening of children using a mobile graphic device. Eye (Lond). 37, 30-33.

[4] Brandner, M., Lindner, S., Langmann, A. (2012). Amblyopietherapie - Empfeh­lungen des Consilium Strabologicum Austriacum und der Orthoptic Austria. Spektrum der Augenheilkunde, 5.