pediatrics
Amblyopia
Diagnosis of Amblyopia
Early and periodic vision screenings Photoscreening Additional testing (eg, cover test, cover-uncover test, refraction, ophthalmoscopy, slit lamp) Vision screening for amblyopia (and strabismus) begins immediately after birth with red reflex evaluation and is repeated at annual well-child checkups. Vision screening is most effective when age-appropriate screenings are done periodically throughout childhood. If a child is not able to do subjective vision testing with an eye chart by 3 or 4 years of age, referral to an eye care specialist is recommended ( Diagnosis reference ). Photoscreening is one approach for screening preverbal children and those who are unable to undergo subjective testing because of learning or developmental disorders. Photoscreening involves use of a special camera that analyzes red reflexes during fixation on a visual target to identify risk factors for amblyopia. Screening in older children consists of acuity testing with figures, which do not require knowing the alphabet (eg, tumbling E figures, Allen cards, HOTV figures or characters), or Snellen eye charts. Identifying the underlying cause requires additional testing. Strabismus can be confirmed with the alternate cover test or the cover-uncover test (see Diagnosis ). Ophthalmologists can confirm refractive error by doing a refraction on each eye. Obstruction of the visual axis can be confirmed by ophthalmoscopy or slit-lamp examination. 1.Loh AR, Chiang MF: Pediatric vision screening.Pediatr Rev39(5):225–234, 2018. doi: 10.1542/pir.2016-0191 