Early detection of amblyopia in Primary Health Care

Introduction: early detection of visual alterations in childhood has special relevance since it can cause problems in visual development, school performance, or even pose a vital risk such as retinoblastoma. The aim of this study was to conduct a traditional review about the diagnostic procedures that can be performed by the Primary Care Pediatrician (PCP) to improve the screening of amblyopia and to identify the most appropriate age for this screening.

Material and methods: a bibliographic search of scientific texts in English and Spanish published in the last 20 years in databases such as PubMed and Google Scholar has been carried out. Some of the key words were: “amblyopia”, “vision screening”, “pediatric”, “retinoscopy” and “photoscreener”.

Results: 376 results were found. 29 articles and 2 books were selected covering diagnostic methods of amblyopia performed by the PCP (Bruckner, Hirschberg, Cover test, stereopsis and visual acuity assessment) and others more advanced (retinoscopy, autorefractometry, photorefractometry and evoked potentials). The screening and ophthalmologist referral programs performed by the PCP are based on traditional methods and are generally not very objective and heterogeneous.

Conclusions: the evidence does not allow to define the optimal age to amblyopia screening or which test or combination of tests could be the most appropriate to avoid unnecessary referrals or unnoticed alterations. However, this screening can be performed easily and quickly from the age of 6 months using diagnostic methods such as photorefractometry. Increasing the available resources in PCP clinic and knowing its applicability and clinical benefits may require further research.