Targeting treatable disease--not just risk factors--in pediatric vision screening.

D espite decades of investment in vision screening, hundreds of thousands of children in the United States—andmillions around theworld—continue to suffer preventable vision loss resulting from the lack of early detection and treatment of amblyopia and strabismus. As a result, amblyopia is now the leading cause ofmonocular visual loss in children. This failure to detect amblyopia while it is amenable to treatment is a serious public health problem. We know that early detection and treatment of amblyopia can prevent vision loss. Eibschitz-Tsimhoni and colleagues performed a prospective trial of 1,600 children in two towns in Israel: one town provided expert (ophthalmologist/orthoptist) screening of all children at age 2, whereas the other did not. When all children were reexamined at age 8, those who had not been screened had a 2.6-fold-higher prevalence of in amblyopia. In Scandinavian countries, expert examinations are performed in all children at a young age, resulting in the nearelimination of severe forms of amblyopia. In the United States, such widespread expert screening is not available because of cost constraints, and we rely on pediatricians and pediatric nurses, who have little or no training in ophthalmology, to perform vision-screening examinations. This is not easy to do in a busy pediatric clinic, and only 40% of children ages 2-6 receive any form of vision screening in the United States. Thus some pediatric practices invest hours performing ineffective screenings, whereas others have simply given up. As a result, many children suffer a lifetime of preventable vision loss while many more are referred for unnecessary specialist examinations. In an effort to improve the accuracy of pediatric office– based vision screening, a variety of automated devices have been developed, and the journal Pediatrics has just