Visual impairment detection (1^st part)

The objective is to review the early detection of the more frequent visual impairment conditions, especially amblyopia and strabismus, with the equipment inherent to Primary Care Paediatrics. The theoretical bases of this intervention are discussed. The usefulness of different optotypes, the stereoscopic vision and chromatic tests are reviewed, as well as the Hirsberg and cover-discover test.

Along the present decade, different studies have lightened on the prevalence, natural history and long term consequences of visual impairments, as well as the validity and precision of screening tests, with the upcoming of a new technology called to make a revolution in the visual screening status quo: the portable automatic refractometers, too expensive so far for the standard equipment of a Primary Care office.

There has also been a great progress in treatment, which proves to be very effective as long as it is correctly followed. It does not seem justified to make great efforts in infant screening, because the outcomes after the three years of age are good or very good, and this good prognosis is maintained even in the first school age years.

There are still doubts about the "preventive" treatment of amblyopia (detecting and treating amblyogenic factors before they produce amblyopia): an important percentage of children carrying these factors would have never developed it and treatment could interfere with emmetropization.

Based on this review, Previnfad recommendations in this field are displayed. They try to adapt to our real situation and are still very far from being a general practice, although the culture of visual screening is extending in Primary Care Paediatrics.