title: Zagreb Amblyopia Preschool Screening Study: near and distance visual acuity testing increase the diagnostic accuracy of screening for amblyopia.
abstract: OBJECTIVE
  To present and evaluate a new screening protocol for amblyopia in preschool children.
  
  
  METHODS
  Zagreb Amblyopia Preschool Screening (ZAPS) study protocol performed screening for amblyopia by near and distance visual acuity (VA) testing of 15 648 children aged 48-54 months attending kindergartens in the City of Zagreb County between September 2011 and June 2014 using Lea Symbols in lines test. If VA in either eye was >0.1 logMAR, the child was re-tested, if failed at re-test, the child was referred to comprehensive eye examination at the Eye Clinic.
  
  
  RESULTS
  78.04% of children passed the screening test. Estimated prevalence of amblyopia was 8.08%. Testability, sensitivity, and specificity of the ZAPS study protocol were 99.19%, 100.00%, and 96.68% respectively.
  
  
  CONCLUSIONS
  The ZAPS study used the most discriminative VA test with optotypes in line as they do not underestimate amblyopia. The estimated prevalence of amblyopia was considerably higher than reported elsewhere. To the best of our knowledge, the ZAPS study protocol reached the highest sensitivity and specificity when evaluating diagnostic accuracy of VA tests for screening. The pass level defined at ≤0.1 logMAR for 4-year-old children, using Lea Symbols in lines missed no amblyopia cases, advocating that both near and distance VA testing should be performed when screening for amblyopia.
authors.forename: Mladen
authors.initials: M
authors.lastname: Bušić
authors.affiliation: Mirjana Bjeloš, University Eye Clinic, University Hospital "Sveti Duh", Sveti Duh 64, Zagreb, Croatia, mbjelos@mef.hr.
authors.forename: Mirjana
authors.initials: M
authors.lastname: Bjeloš
authors.forename: Mladen
authors.initials: M
authors.lastname: Petrovečki
authors.forename: Biljana
authors.initials: B
authors.lastname: Kuzmanović Elabjer
authors.forename: Damir
authors.initials: D
authors.lastname: Bosnar
authors.forename: Senad
authors.initials: S
authors.lastname: Ramić
authors.forename: Daliborka
authors.initials: D
authors.lastname: Miletić
authors.forename: Lidija
authors.initials: L
authors.lastname: Andrijašević
authors.forename: Edita
authors.initials: E
authors.lastname: Kondža Krstonijević
authors.forename: Vid
authors.initials: V
authors.lastname: Jakovljević
authors.forename: Ana
authors.initials: A
authors.lastname: Bišćan Tvrdi
authors.forename: Jurica
authors.initials: J
authors.lastname: Predović
authors.forename: Antonio
authors.initials: A
authors.lastname: Kokot
authors.forename: Filip
authors.initials: F
authors.lastname: Bišćan
authors.forename: Mirna
authors.initials: M
authors.lastname: Kovačević Ljubić
authors.forename: Ranka
authors.initials: R
authors.lastname: Motušić Aras
mesh_terms: D000550:Amblyopia / Q000175:diagnosis* / Q000453:epidemiology; D002675:Child, Preschool; D017523:Croatia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D015995:Prevalence; D012574:Schools; D012680:Sensitivity and Specificity; D014787:Vision Tests; D014792:Visual Acuity