Advantages, limitations, and diagnostic accuracy of photoscreeners in early detection of Amblyopia: a review

Irene Sanchez,1,2 Sara Ortiz-Toquero,1,2 Raul Martin,2,3 Victoria de Juan2,4 1Department of Theoretical Physics, Atomic and Optics, School of Optometry, 2Optometry Research Group, IOBA-Eye Institute, University of Valladolid, Valladolid, Spain; 3Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK; 4Department of Ophthalmology, Hospital Ramón y Cajal, Madrid, Spain Abstract: Amblyopia detection is important to ensure proper visual development and avoid permanent decrease of visual acuity. This condition does not produce symptoms, so it is difficult to diagnose if a vision problem actually exists. However, because amblyopia treatment is limited by age, early diagnosis is of paramount relevance. Traditional vision screening (conducted in <3 years) is related with difficulty in getting cooperation from a subject to conduct the eye exam, so accurate objective methods to improve amblyopia detection are necessary. Handheld devices used for photoscreening or autorefraction could offer advantages to improve amblyopia screening because they reduce exploration time to just few seconds, no subject collaboration is needed, and they provide objective information. The purpose of this review is to summarize the main functions and clinical applicability of commercially available devices for early detection of amblyopia and to describe their differences, advantages, and limitations. Although the studies reviewed are heterogeneous (due to wide differences in referral criteria, use of different risk factors, different types of samples studied, etc), these devices provide objective measures in a quick and objective way with a simple outcome report: retest, pass, or refer. However, due to major limitations, these devices are not recommended, and their use in clinical practice is limited. Keywords: handheld photoscreener, photoscreening, binocular autorefraction, amblyopia screenin