Screening, treating amblyopia can make a difference

Yair Morad, MD, head of the pediatric ophthalmology service at Assaf Harofeh Medical Center, Tel Aviv University, Zrifin, Israel, and colleagues examined records from an extensive military database to compare rates of amblyopia among native Jewish Israelis and those who were born in the Soviet Union but immigrated to Israel after the age of 10 years.

The prevalence of best-corrected visual acuity (BCVA) below 6/12 in one or both eyes was 1.06% in native Israelis versus 1.47% in individuals born in the former Soviet Union (p < 0.0001), Dr. Morad said.

Dr. Morad presented a poster on the study at the meeting of the American Academy of Pediatric Ophthalmology and Strabismus, and a paper is in press.

All of the individuals had been examined between the ages of 16 and 22 years at the Israel Defense Forces Recruiting Office as part of the country's mandatory military service policy. Information on these comprehensive examinations, which include determination of BCVA by a qualified technician using a standard Snellen chart, is stored in a large computerized database. The investigators extracted information for the vision screening study and several other studies from this source.

Records were examined for 370,405 subjects born in Israel and 61,501 immigrants. Only individuals who immigrated after the age of 10 were included in the analysis because treatment is generally not effective after that age, Dr. Morad said, and any treatment they might have received in Israel would not have influenced the outcome of their visual acuity. In addition, immigrants who arrived in Israel under the age of 10 could have been screened and treated in both countries.

About 1 million immigrants from the former Soviet Union arrived in Israel in the 1990s, and this population was ideal for the comparison of visual acuity because they have the same ethnic background as native Israeli Jews, Dr. Morad said.

"The only difference is the medical treatment and screening methods that were employed in both countries," he noted.

In Israel, vision screening is routine and widely available through free government public health clinics. Children are examined by a pediatrician before the age of 6 months, given a verbal examination of visual acuity by a nurse at age 3, and examined by an ophthalmologist or optometrist at the beginning of their first year of elementary school. A child who fails any of these examinations is referred to an ophthalmologist, and follow-up treatment is free for all Israeli citizens.

No uniform screening and treatment system was implemented in the Soviet Union, and the availability and quality of services varied widely in different areas of the country, Dr. Morad said.

He added that to his knowledge, this is the largest population-based study analyzing the effectiveness of vision screening.