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Early start of screening.

Lagreze says that studies up to now did not sufficiently prove the benefits of preschool screening. We agree if only one screening is done during or after the maturation of the visual system. However, therapeutic success depends on the age of the child at the onset of treatment. The available studies were published before the age of the internet and therefore unfortunately hardly find any attention today. 
 
Urgently our aim is not therapy but rather prevention on the basis of known risk factors. These are age dependent and well defined for the second half of the first year of life, as shown by British (1) and Swedish (2) studies. 
 
In a pilot project, “prevention of amblyopia and strabismus in infants and toddlers,” we are trying to implement this early detection system. Since 2001, in the obstetric clinic of Kulmbach Medical Center we have measured refraction by skiascopy in neonates under cycloplegia with tropicamide and recommend further investigations on the basis of our findings. This early start of screening is necessary because of the rapid development of the visual system within the first 12 months of life. 
 
In two cross sectional studies in school starters in 2005 (without screening) and in 2008 (with screening) we observed a reduced rate of amblyopia from 6.2% (2005) to 2.6% (2008). In the first longitudinal study (3) we found 5 children with strabismus among 27 children with >3.5 diopters of hyperopia that was not corrected by the 3rd year of life. In a group of 22 children who had started wearing spectacles during the first year of life no child developed strabismus. According to Atkinson et al. these results suggest that it is necessary to correct refraction errors early in the first year of life if we want to prevent amblyopia and strabismus.