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Updated: Oct 26, 2025
Comparison of Three Clinical Stereoscopic Methods for Measuring Binocular Visual Function During Amblyopic Treatment in Unilateral Amblyopia
Published on: September 27, 2024
Prediction and cost-effectiveness comparison of amblyopia screening methods at ages 3-4 years
Sandra Viegas Guimaraes1,2, Paula Alexandra Veiga3, Patrício Soares Costa4,5
1FP-I3ID (Instituto de Investigação, Inovação e Desenvolvimento da UFP)/HE-UFP (Hospital-Escola da UFP).
Insights
Combining uncorrected visual acuity (UCVA) and Plusoptix (PO) measurements is the most cost-effective strategy for amblyopia screening in young children. This combined approach significantly reduces costs per treated child while maintaining high sensitivity for early detection.
Area of Science:
- Ophthalmology
- Pediatric Health
- Public Health Screening
Background:
- Amblyopia, or 'lazy eye,' is a leading cause of preventable vision impairment in children.
- Early detection and intervention are crucial for effective amblyopia treatment.
- Current screening methods vary in performance and cost-effectiveness.
Purpose of the Study:
- To compare the diagnostic performance and cost-effectiveness of different amblyopia screening test combinations.
- To develop optimal screening strategies for early amblyopia detection in children.
Main Methods:
- Exploratory factor analyses (EFA) of screening tests including uncorrected visual acuity (UCVA), Plusoptix (PO), Randot Stereo-test (SR), and Cover-Test (CT) in 3295 children.
- Receiver Operating Characteristic (ROC) curves and confusion matrices were used to evaluate model prediction accuracy.
- Cost-effectiveness analysis was performed for different screening strategies.
Main Results:
- Models incorporating PO or UCVA demonstrated superior prediction capacity (R² > 0.4) and discriminating ability (AUC > 0.95) for amblyopia.
- The combination of UCVA + PO achieved 96% sensitivity and was the most cost-effective strategy, with significantly lower costs per treated child compared to using either test alone.
- Adding SR to UCVA or PO offered cost savings of 28% and 18%, respectively, when the UCVA + PO combination was not feasible.
Conclusions:
- Simultaneous screening with UCVA and PO is recommended for young children (3-4 years) due to its superior cost-effectiveness and high sensitivity in detecting amblyopia.
- The perceived increase in examination time for combined UCVA + PO screening is offset by substantial cost reductions per treated child.
- Cover-Test (CT) showed no benefit in screening settings with good primary care, and the Randot Stereo-test (SR) provided limited added value.
Purpose:
Compare the performance of different amblyopia screening tests.
Methods:
Based on exploratory factor analyses (EFA) of different screening tests performed in 3295 children, we created models of screening strategies in a matrix with: uncorrected visual acuity (UCVA), Plusoptix measurements (PO), Randot Stereo-test (SR), and Cover-Test (CT). Receiver Operating Characteristic (ROC) curves and confusion matrix were used to compare performance of different model's algorithm to predict new diagnosis of amblyopia. Estimated screening costs per screened and treated child were compared.
Results:
Regression analyses revealed that, although all models predicted amblyopia (all p < 0.001), only models including PO or UCVA had higher prediction capacity (R2 > 0.4) and better discriminating ROC curves (AUC > 0.95; p < 0.001). For 96% sensitivity, UCVA + PO was the most cost-effective model, since the estimated average screening costs per treated child, almost doubled and tripled if using PO or UCVA alone, respectively, versus using both exams. When UCVA + PO is not possible to implement, adding SR to either UCVA or PO resulted in cost-savings of 28% and 18%, respectively.
Conclusions:
In a previous unscreened population, aged 3-4 years, screening programs using either UCVA or PO alone, should reconsider doing both tests simultaneously, since, for a high level of sensitivity, using simultaneously UCVA + PO is more cost-effective, per screened, and treated amblyopia. Concerns relating higher time-consuming exams for the combination of UCVA + PO should be surpassed, since costs per treated child drop considerably. When children benefit from good primary-care routine examinations since birth, no benefit was found for using CT in a screening setting. SR showed little benefit.
