Amblyopia in children: Classification, screening, and evaluation
- David K Coats, MD
David K Coats, MD
- Professor of Ophthalmology
- Baylor College of Medicine
- Evelyn A Paysse, MD
Evelyn A Paysse, MD
- Section Editor — Pediatric Ophthalmology
- Professor of Ophthalmology and Pediatrics
- Baylor College of Medicine
Amblyopia is a functional reduction in visual acuity caused by abnormal visual development early in life. It is the most common cause of pediatric visual impairment, occurring in 1 to 4 percent of children. Early detection of amblyopia and/or amblyopia risk factors improves visual outcomes [1-4]. This is the basis for screening preschool-age children for vision problems and amblyopia (table 1A-B). (See 'Screening' below and "Screening tests in children and adolescents", section on 'Vision screen'.)
The definition, classification, and evaluation for amblyopia is reviewed here. The management and outcome of amblyopia are reviewed separately. (See "Amblyopia in children: Management and outcome".)
Vision assessment, strabismus, and refractive errors in children are also discussed separately:
- Lithander J, Sjöstrand J. Anisometropic and strabismic amblyopia in the age group 2 years and above: a prospective study of the results of treatment. Br J Ophthalmol 1991; 75:111.
- Levartovsky S, Gottesman N, Shimshoni M, Oliver M. Factors affecting long-term results of successfully treated amblyopia: age at beginning of treatment and age at cessation of monitoring. J Pediatr Ophthalmol Strabismus 1992; 29:219.
- Epelbaum M, Milleret C, Buisseret P, Dufier JL. The sensitive period for strabismic amblyopia in humans. Ophthalmology 1993; 100:323.
- Hiscox F, Strong N, Thompson JR, et al. Occlusion for amblyopia: a comprehensive survey of outcome. Eye (Lond) 1992; 6 ( Pt 3):300.
- Solebo AL, Cumberland PM, Rahi JS. Whole-population vision screening in children aged 4-5 years to detect amblyopia. Lancet 2015; 385:2308.
- American Academy of Ophtalmology Pediatric Ophthalmology/Strabismus Panel. Preferred Practice Pattern Guidelines. Amblyopia. American Academy of Ophthalmology, San Francisco, CA: American Academy of Ophthalmology; 2012. Available at: http://www.aao.org/preferred-practice-pattern/amblyopia-ppp--september-2012 (Accessed on August 05, 2015).
- Daw NW. Critical periods and amblyopia. Arch Ophthalmol 1998; 116:502.
- Day S. Normal and abnormal visual development. In: Pediatric Ophthalmology, Taylor D (Ed), Blackwell Scientific Publications, Cambridge, MA 1990. p.7.
- Stein A, Kelly JP, Weiss AH. Congenital eyelid ptosis: onset and prevalence of amblyopia, associations with systemic disorders, and treatment outcomes. J Pediatr 2014; 165:820.
- Mansouri B, Stacy RC, Kruger J, Cestari DM. Deprivation amblyopia and congenital hereditary cataract. Semin Ophthalmol 2013; 28:321.
- Williams C, Northstone K, Howard M, et al. Prevalence and risk factors for common vision problems in children: data from the ALSPAC study. Br J Ophthalmol 2008; 92:959.
- Friedman DS, Repka MX, Katz J, et al. Prevalence of amblyopia and strabismus in white and African American children aged 6 through 71 months the Baltimore Pediatric Eye Disease Study. Ophthalmology 2009; 116:2128.
- Pai AS, Rose KA, Leone JF, et al. Amblyopia prevalence and risk factors in Australian preschool children. Ophthalmology 2012; 119:138.
- McKean-Cowdin R, Cotter SA, Tarczy-Hornoch K, et al. Prevalence of amblyopia or strabismus in asian and non-Hispanic white preschool children: multi-ethnic pediatric eye disease study. Ophthalmology 2013; 120:2117.
- Fu J, Li SM, Li SY, et al. Prevalence, causes and associations of amblyopia in year 1 students in Central China : The Anyang childhood eye study (ACES). Graefes Arch Clin Exp Ophthalmol 2014; 252:137.
- Multi-ethnic Pediatric Eye Disease Study Group. Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study. Ophthalmology 2008; 115:1229.
- Thompson JR, Woodruff G, Hiscox FA, et al. The incidence and prevalence of amblyopia detected in childhood. Public Health 1991; 105:455.
- von Noorden CK. Binocular Vision and Ocular Motility, 5th, Mosby, St. Louis 1996.
- Eibschitz-Tsimhoni M, Friedman T, Naor J, et al. Early screening for amblyogenic risk factors lowers the prevalence and severity of amblyopia. J AAPOS 2000; 4:194.
- Köhler L, Stigmar G. Visual disorders in 7-year-old children with and without previous vision screening. Acta Paediatr Scand 1978; 67:373.
- Kvarnström G, Jakobsson P, Lennerstrand G. Visual screening of Swedish children: an ophthalmological evaluation. Acta Ophthalmol Scand 2001; 79:240.
- de Zárate BR, Tejedor J. Current concepts in the management of amblyopia. Clin Ophthalmol 2007; 1:403.
- Woodruff G, Hiscox F, Thompson JR, Smith LK. The presentation of children with amblyopia. Eye (Lond) 1994; 8 ( Pt 6):623.
- Sjöstrand J, Abrahamsson M. Risk factors in amblyopia. Eye (Lond) 1990; 4 ( Pt 6):787.
- Keech RV, Kutschke PJ. Upper age limit for the development of amblyopia. J Pediatr Ophthalmol Strabismus 1995; 32:89.
- Webber AL, Wood J. Amblyopia: prevalence, natural history, functional effects and treatment. Clin Exp Optom 2005; 88:365.
- American Academy of Family Physicians. Recommendations for Clinical Preventive Services. www.aafp.org/online/en/home/clinical/exam.html (Accessed on August 23, 2011).
- US Preventive Services Task Force. Vision screening for children 1 to 5 years of age: US Preventive Services Task Force Recommendation statement. Pediatrics 2011; 127:340.
- COMMITTEE ON PRACTICE AND AMBULATORY MEDICINE, SECTION ON OPHTHALMOLOGY, AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS, et al. Visual System Assessment in Infants, Children, and Young Adults by Pediatricians. Pediatrics 2016; 137:1.
- Williams C, Northstone K, Harrad RA, et al. Amblyopia treatment outcomes after preschool screening v school entry screening: observational data from a prospective cohort study. Br J Ophthalmol 2003; 87:988.
- Wright KW, Walonker F, Edelman P. 10-Diopter fixation test for amblyopia. Arch Ophthalmol 1981; 99:1242.
- Friedman DS, Katz J, Repka MX, et al. Lack of concordance between fixation preference and HOTV optotype visual acuity in preschool children: the Baltimore Pediatric Eye Disease Study. Ophthalmology 2008; 115:1796.
- Cotter SA, Tarczy-Hornoch K, Song E, et al. Fixation preference and visual acuity testing in a population-based cohort of preschool children with amblyopia risk factors. Ophthalmology 2009; 116:145.
- Morad Y, Werker E, Nemet P. Visual acuity tests using chart, line, and single optotype in healthy and amblyopic children. J AAPOS 1999; 3:94.