Key Takeaways

• Researchers supported by the National Eye Institute (NEI) have launched ANDI, a free online decision-support tool that helps eye care providers diagnose and manage amblyopia
• The tool was developed to expand access to evidence-based pediatric eye care in regions facing shortages of pediatric ophthalmologists and optometrists
• ANDI guides providers through the full course of amblyopia care—from selecting the appropriate glasses prescription and monitoring progress to recommending patching, atropine drops, digital therapies, follow-up care, and referral decisions when needed

A team of pediatric eye disease researchers supported by the National Eye Institute (NEI) has launched a new open-access clinical decision-support tool designed to help eye care providers diagnose and manage amblyopia in children.

Known as the "Amblyopia Navigator Decision-Support Instrument (ANDI)," the web-based platform aims to expand access to evidence-based pediatric eye care expertise at a time when many regions of the United States face shortages of pediatric ophthalmologists and pediatric optometrists.

“This online tool quickly distills the relevant literature into individualized treatment advice for busy clinicians anywhere with internet access,” Allison Summers, OD, associate professor at Oregon Health & Science University in Portland and lead author of the study describing the tool, said in an NEI news release. “Those without internet access can utilize the article figures as clinical reference sheets.”

According to the NEI, amblyopia is the leading cause of preventable vision loss in one eye among children, affecting approximately three out of every 100 children nationwide. During early childhood, the brain learns to combine images from both eyes into a single visual experience. Amblyopia can occur when this process is disrupted by conditions such as eye misalignment (strabismus), significant differences in prescription strength between the eyes, uncorrected refractive errors in both eyes, or visual obstruction caused by cataracts or drooping eyelids.

The need for broader access to treatment guidance has become increasingly apparent as workforce studies reveal significant geographic disparities in pediatric eye care availability. Some states have high concentrations of pediatric specialists, while others have few or none.

“We hope that this tool can be leveraged to minimize gaps in access to pediatric ophthalmic care,” said Stacy L. Pineles, MD, of the Jules Stein Eye Institute at the University of California, Los Angeles, and co-chair of the Pediatric Eye Disease Investigator Group (PEDIG).

ANDI is designed to assist any eye care professional through the diagnosis and management of amblyopia. Once a diagnosis is established, the tool provides evidence-based recommendations tailored to a child’s clinical findings. It helps clinicians determine the most appropriate eyeglass prescription and how long to monitor improvement with glasses alone—a strategy the NEI says can successfully treat up to one-third of children without additional interventions.

When glasses are insufficient, ANDI guides clinicians through next-step treatment options, including patching the stronger eye for several hours daily, using atropine eye drops to temporarily blur vision in the stronger eye, or considering newer digital therapies delivered through specially designed games and videos. The platform also offers recommendations for adjusting treatment when progress stalls, including increasing treatment intensity, switching therapies, reassessing prescriptions, or referring patients to specialists. Follow-up care guidance and strategies for monitoring recurrence after treatment completion are also included.

The tool can be used throughout a child’s treatment journey, from the initial visit through long-term follow-up care.

ANDI was developed by the Pediatric Eye Disease Investigator Group (PEDIG), an NIH-funded research network comprising more than 400 investigators. The tool is based on evidence synthesized from 147 published studies and is intended to make decades of amblyopia research readily accessible to clinicians in a practical, point-of-care format.

The tool is available free of charge at: https://public.jaeb.org/pedig/.