The assessment and management of strabismus and amblyopia: a national audit

Abstract

Aims To determine what systems are in place within ophthalmic services for the assessment and management of children suspected of having amblyopia and strabismus. To find out what methods are used for the assessment of these children. Methods A questionnaire-based study auditing 288 orthoptic departments in the UK. Results Responses were received from 75% orthoptic departments. Most hospitals employ more than one system for the assessment of strabismus and amblyopia, which is generally dependent on route of referral. These include 'orthoptic assessment without refraction' (66%), 'combined orthoptist and ophthalmologist assessment' (66%), while 22% have an entirely orthoptist/optometric system.Ophthalmologists are involved in the initial assessment in 145 units (67%), whereas some units involve an ophthalmologist only if response to treatment is poor (15%), or if surgery is required (6%).Fourteen per cent of units reviewed all children, with discharge criteria being based on normal visual acuity (52%), accurate visual acuity (39%) and a normal orthoptic assessment (42%). Seventy-six per cent of units review some children, commonly as a result of family history (55%), parental concern (43%), poor co-operation (30%) and young age (72%). In the absence of squint or amblyopia children are discharged at the first visit, in only 8% of units.There is considerable variation in the tests used to assess visual acuity. LogMAR-based tests (eg EDTRS) are not routinely used in 75% of units. Conclusion Different systems exist for the assessment and management of squint and amblyopia across the country. While much of this variation is to be expected given their possible aetiologies, some could be reduced to produce a more cohesive service. There is also considerable scope for rationalising the tests used to screen infants and children for amblyopia and strabismus.

The effect of the randomized trial of patching regimens for treatment of moderate amblyopia on pediatric ophthalmologists: 3-year outcome

“…Masked surveys posted by mail to study ophthalmic issues have had response rates of 50 to 90%. [11][12][13][14] Our lower (20%) response may be due in part to the fact that no reminder was sent. It is also possible that respondents were those with stronger opinions, which may have skewed the results, although we cannot assess whether the skew might be in favor of those who patch more or less.…”

Decreasing strabismus surgery

“…By 1988, 99% of national health authorities had a screening programme in place. 13 14 Ferguson et al 15 and Carney et al 1 suggested the decline in strabismus surgery was a result of improved health and preschool screening. MacEwan and Chakrabarti 2 disagreed by arguing that if screening had contributed to this decrease its effect would have been noted earlier as preschool screening was established a decade before the noted decrease in the number of surgical episodes.…”

Review of preschool vision screening referrals in South Auckland, New Zealand

“…The New Zealand Vision Hearing Screening program, which has existed for over 40 years, attempts to screen all children at ages four to five and 11 years for vision and hearing problems; however, there is a lack of consistent evidence on the robustness of vision screening programs, 1 the best screening tests to use, the most appropriate referral criteria and which screening personnel to utilise 1,2 . Much of the current research on children's vision screening programs focuses on the efficacy of various screening tools for identifying preschool children with amblyopia, 3,4 strabismus 5 and significant refractive errors 6 . Large population‐based studies of refractive error and visual development from countries such as China, 7 Singapore, 8,9 Australia 10 and the United States 1 have been reported; however, little is known about the prevalence of visual impairment, refractive error, strabismus and amblyopia in the New Zealand population, which includes a significant proportion of Māori and Pacifica populations not sampled elsewhere, 11,12 or the efficacy of the screening methods used in this country 13 …”