Amblyopia Screening in Bulgaria

PURPOSE: To determine the prevalence of amblyopia and the average age at first ophthalmological examination of school-aged children from northwestern Bulgaria. METHODS: Visual acuity testing, stereopsis, orthoptics, ocular motility, non-cycloplegic refraction, direct ophthalmoscopy, and external ocular inspection were performed. Cycloplegic refraction and indirect ophthalmoscopy were done as necessary. A total of 2,054 children (1,020 girls and 1,034 boys) were divided into three age groups: 6 to 8 years (803 children), 8 to 10 years (719 children), and 10 to 12 years (530 children). RESULTS: A total of 1,861 children (90.6%) received their first examination: 754 (93.9%) aged 6 to 8 years, 638 (88.7%) aged 8 to 10 years, and 469 (88.2%) aged 10 to 12 years. Amblyopia was detected in 88 children (4.3%): 42 (5.2%) aged 6 to 8 years, 27 (3.8%) aged 8 to 10 years, and 19 (3.6%) aged 10 to 12 years. The first group had higher prevalence compared to countries with well-developed screening programs. Refractive errors were detected in 403 children (19.7%): 125 (15.6%) aged 6 to 8 years, 146 (20.3%) aged 8 to 10 years, and 132 (24.8%) aged 10 to 12 years. The estimated prevalence increases with age. Strabismus was detected in 24 children (1.2%): 8 (1.0%) aged 6 to 8 years, 7 (1.0%) aged 8 to 10 years, and 9 (1.7%) aged 10 to 12 years. CONCLUSIONS: The lack of screening programs in Bulgaria is the main reason for late diagnosis of amblyopia. The "Do Good "project provided eye examination of school-aged children aged 6 to 12 years, when amblyopia is curable. This model could be used in establishing a Bulgarian national screening program.