A recent study published in JAMA Ophthalmology by the Pediatric Eye Disease Investigator Group (PEDIG) highlighted their free, web-based amblyopia decision support tool for eyecare professionals (ECPs) and summarized the evidence underlying the tool’s algorithm.
Let’s start with amblyopia.
The prevalence of amblyopia in children is estimated to be between 0.7% and 5.6%, making it the leading cause of reduced monocular visual acuity (VA) in children.
- However: Early detection and prevention of visual loss from amblyopia remain challenging due to several factors, including a shortage of pediatric ophthalmologists and optometrists.
As such: Expanding the role of primary ECPs in amblyopia management could enhance access, improve continuity of care, and help alleviate the impact of the current shortage of pediatric eyecare professionals.
Let’s move on to PEDIG.
Over the past several decades, high-quality evidence from the PEDIG and other research groups has established effective treatment regimens for common types of amblyopia (anisometropic, strabismic, combined mechanism, and isoametropic).
- Quick refresh: Established in 1997, PEDIG now includes more than 400 investigators at 110 sites.
- The group has conducted 24 randomized amblyopia trials producing 74 peer-reviewed publications on amblyopia diagnosis and management.
That said: Given the demands of a busy, broad-scope practice, having accessible and practical evidence-based guidance is needed to support translation of research into everyday care.
Enter: ANDI.
To address this need, PEDIG developed the Amblyopia Navigator Decision-Support Instrument (ANDI), a free decision-support tool that synthesizes current evidence for the diagnosis and management of amblyopia.
- The target audience: Comprehensive ophthalmologists, comprehensive optometrists, and orthoptists in the United States
Tell me more.
ANDI was developed by evaluating the available English-language literature combined with panel consensus.
The intent: To support real-time clinical decision-making and facilitate the integration of evidence-based care into routine practice.
For example, the tool provides guidance on:
- Testing methods
- Refractive error correction
- Further treatment options and adjustments
- Monitoring schedules
Talk more about its development
The decisions related to optimal diagnostic measures, pass/refer criteria, and management recommendations were informed by 147 publications.
- Note: Despite many high-quality studies on amblyopia, some areas of clinical practice lack peer-reviewed evidence.
Consequently: ANDI uses expert consensus when evidence is lacking to provide direction, drawing from research study protocols (e.g., inclusion criteria or prescribing directions), professional guidelines, and committee member discussion.
Which patients are ANDI ideal for?
The target population was determined based on participant characteristics in the clinical trials informing the algorithm and included:
- Age range: 3 to 17 years
- VA: Best-corrected visual acuity (BCVA) 20/200 or better in both eyes
- Refractive error: No myopia >6 D spherical equivalent in either eye
- Ocular pathology: No presence or history of cataract, ptosis, or other obstruction of the visual axis or reduced VA due to ocular pathology
- Previous treatment: No history of intraocular or refractive surgery
- Testing: Patient able to complete age-appropriate VA measurement
Any limitations?
A few to note, including:
- This study was not a complete systematic review, so additional relevant studies may not have been included
- Multiple areas of the study lacked direct evidence, though as mentioned earlier, expert consensus was used to to provide direction in these cases
- The evidence was largely based on the U.S. population, and it is unknown if the recommendations can be generalized to children in other environments
Take home.
As amblyopia is common and typically responds well to treatment, decision support tools like ANDI that optimize its management could increase access to pediatric eyecare by facilitating earlier detection, enabling broader participation of primary eyecare professionals, and ultimately improving visual outcomes.
Plus: The initial 2026 version of ANDI has the potential to be expanded and refined as new research and clinical evidence become available.
Next steps?
“Plans are under way to conduct structured testing of an interactive, web-based version of ANDI by eyecare professionals,” the study authors noted.
And in other news: Check out the latest developments in amblyopia treatment.