Risk Factors to Be Detected By Vision Screening

A consensus regarding the magnitude for each amblyopic risk factor has been established recently.  The Vision Screening Committee of the American Association of Pediatric Opthalmology and Strabismus (AAPOS) has published a policy statement that mandates those refractive errors that should be detected with preschool vision screening.  The factors listed in the table below represent an initial attempt at consensus by pediatric ophthalmologists and optometrists for those amblyopia-producing conditions that should be detected with preschool vision screening instruments.  However, it should be noted that further revisions that take into account child’s age, family history, and other factors need to occur in the future.
 

Table 1 Amblyopia risk factors to be detected by screening

  • Anisometropia (spherical or cylindrical) > 1.5 D
  • Any manifest strabismus
  • Hyperopia > 3.50 D in any meridian
  • Any media opacity > 1 mm in size
  • Astigmatism > 1.5 D at 90 or 180o> 1.0 in oblique axis  (more than 10o  eccentric to 90 or 180o)
  • Ptosis ≤1 mm margin-reflex distance*
  • Visual acuity; per AAP (age-appropriate standards)

* Margin-reflex distance is the distance from the corneal light to the upper lid margin, and is standard objective measurement of Ptosis

 


This policy statement also allows studies of these instruments to report results uniformly allowing for direct comparison of sensitivity and specificity data for these new techniques.  Details of the studies supporting these levels for detection are provided in the policy statement.