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Amblyopia is Still Often Diagnosed Too Late

Moustafa B., Käsmann-Kellner B., Ruprecht K. W.,
Universitätskliniken des Saarlandes, Augenklinik und Poliklinik (Homburg/Saar)

Background: Amblyopia is a unilateral or bilateral functional loss of vision affecting between 2-3% of the population. Amblyopia in preschool children is, if it is not accompanied by strabismus, only detected incidentally unless screened for. The sooner amblyopia is detected, the better is the visual outcome and the treatment prognosis.
Patients: We report about twenty-one patients with late-diagnosed amblyopia, 15 boys and 6 girls, who came to visit our Department of Paediatric Ophthalmology during a time span of 12 months. 13(61%) suffered from unilateral amblyopia and 8(38%) from bilateral amblyopia. The amblyopia of 11(52%) was caused by high refractive anomalies, 8(38%) had a combined strabic and refractive amblyopia, 1 child (4,7%) had a strabic amblyopia and one child (4,7%) had amblyopia caused by undetected cataract and secondary strabismus. 6 children of those with refractive amblyopia had high hyperopic astigmatism, 3 had anisometropia, one suffered from anisomyopia and one from myopia permagna. 7 were detected by state school entry examination. 11(52%) cases of amblyopia were detected by ophthalmologists and then sent to us. Most of the parents however reported that vision screening at the paediatrician had been dissatisfactory (eg visual testing binocularly). 2 cases of amblyopia were found in children already 8 years old.
Conclusions: Amblyopia is a difficult challenge for all physicians. Screening programs to reduce the prevalence of amblyopia in very young children are important and globally accepted. Ideally visual screening in children should take place in the 2nd year of life. Screening assistants should be well trained and especially binocular vision testing should be avoided.