Early detection key to treatment of disease that can affect children’s academic achievement and visual acuity throughout life – sciencedaily

“The results suggest that pediatricians and other primary care providers could use the device to detect amblyopia at an early age, when it is easier to treat,” said Michael F. Chiang, MD, director of National Eye Institute (NEI), which supported the research. and the development of the device. NEI is part of the National Institutes of Health.

Amblyopia is an impairment of vision in one eye and is the leading cause of preventable monocular (single eye) vision loss, affecting three in 100 children in the United States.

During early childhood, our developing brains learn to take images of each eye and merge them into a single image to produce a vision. Amblyopia develops when a misalignment of the eyes (strabismus) or decreased acuity in one eye interferes with the brain’s ability to process visual information from both eyes, which favors one eye. Once a child is visually mature, vision lost in the weaker eye cannot be corrected with glasses or contact lenses.

Children with amblyopia may suffer from poor academic performance and impaired depth perception and fine motor skills such as handwriting and other coordinated hand-eye activities.

Treatment for amblyopia usually involves placing a patch over the good eye to improve vision in the weaker eye. The patch is less effective as children get older, making early detection crucial. However, it depends on the timely diagnosis by the child’s doctor, and most pediatricians are only equipped for basic vision screening tests, which are not helpful in detecting amblyopia in very young children.

The screening device works by assessing the ability of the eyes to attach together. Held 14 inches from the eyes, the child focuses on a smiling face as the device scans both retinas simultaneously. The scan involves a polarized laser that probes nerve fibers in a light-sensitive area of ​​the retina called the fovea, which is important for central vision. Even a subtle misalignment of the foveas – called small-angle strabismus – can interfere with the brain’s ability to integrate images from both eyes. The device calculates a binocularity score that indicates whether the child should be referred to an ophthalmologist for further investigation.

For the study, 300 children, aged 2 to 6, with no known eye disorders were recruited during previously scheduled visits to two Kaiser Permanente pediatric clinics in southern California.

Two non-ophthalmic research associates trained in the use of the device examined each child and the results were compared to an eye exam performed by a pediatric ophthalmologist who was unaware of the results of the ‘device. The device detected the six cases (100% sensitivity) of amblyopia and / or strabismus which had been confirmed by the professional ophthalmologic examination. The device also reported 45 other children as possibly having amblyopia and / or strabismus, which were then determined by eye exam to be normal (specificity 85%).

“In the hands of a trained user, it takes 28 seconds to seat the child, perform the test and record the results – provided the child is cooperative – which is an important consideration for adoption in care settings high-traffic pediatric patients, “said study co-principal investigator Shaival S. Shah, MD, a pediatric ophthalmologist at Kaiser Permanente based in Tustin Ranch, Calif. The test itself takes just 2.5 seconds to complete. attention of a child.

One of the main limitations of the study was that the device was not compared to currently available screening cameras. Such devices detect differences in light reflexes in each eye and produce images that can help detect risk factors for amblyopia, but not amblyopia itself, which can lead to both over and under. -detection of amblyopia.

In contrast, the pediatric vision scanner detects the presence of amblyopia as opposed to risk factors for amblyopia, which can lead to fewer unnecessary referrals to pediatric ophthalmologists.

The pediatric vision tester tested in the study is a prototype of blinq. ®, a device that was cleared by the United States Food and Drug Administration in 2016.

The clinical trial identifier is NCT02536963. The study was funded by NEI grant R44EY025926 to Rebiscan, Inc. (doing business as Rebion), the Boston-based company that markets blinq.®. Support was provided through the Small Business Innovation Research (SBIR) program, a funding mechanism that helps independent companies with 500 or fewer employees bring biomedical technologies to market.

Co-founder of Rebion, David Hunter, MD, Ph.D., chief ophthalmologist at Boston Children’s Hospital, co-invented blinq.® with support from NEI grant R01EY012883.