👀 Are the eyes straight?
We check whether both eyes point at the same target. Sometimes one eye can drift inward or outward — this is called a squint (strabismus).
🔍 Does one eye see less well?
Each eye is tested on its own, because a child can seem to see perfectly while one eye quietly does most of the work. One eye may currently be providing a clearer image than the other.
👓 Why glasses may be needed
Glasses help both eyes receive the clearest possible image. In many children, straightening the picture with glasses is the first and most important treatment step — sometimes it even straightens an inward squint.
🩹 Why a patch covers the stronger eye
If one eye remains weaker, temporarily covering the stronger eye encourages the brain to use the weaker eye. Patching trains vision — it does not straighten the eye directly.
📅 Why follow-up matters
Children's vision develops quickly. Regular checks make sure the treatment is working and can be adjusted early.
🏥 If surgery is discussed
An operation can straighten the position of the eyes, but it does not replace glasses or patching. Vision training may continue before and after surgery. Surgery may still be needed even when patching has gone well.
💬Please ask your eye-care team anything that is unclear — there are no wrong questions.
⚠️Medical disclaimer. This application is an educational clinical decision-support tool. It does not replace a complete pediatric ophthalmological and orthoptic examination, cycloplegic refraction, age-appropriate monocular visual-acuity testing or an individual treatment decision by a qualified clinician. A negative stereotest alone does not diagnose amblyopia. Occlusion therapy must not be initiated until the fixing eye, the amblyopic eye and the underlying cause have been identified.
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Patient information
▼Age group: —
History
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Red-flag screening
▼Select any urgent warning signs before routine screening.
🚨 Urgent complete pediatric ophthalmological assessment required.
Do not rely on the screening algorithm. Acute, incomitant or neurologically suspicious findings, leukocoria, media opacity or loss of vision need same-day / urgent specialist evaluation. The tool will not produce a routine "no treatment" recommendation while red flags are selected.3
Ocular position and alignment
▼Alignment
Fixation behaviour
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Hirschberg test — interactive
▼Drag the corneal light reflex (✦) in each eye, or use the sliders / numeric fields. The view is drawn as the examiner sees the child: the child's right eye is on the left of the image.
Right eye (OD)
Reflex centred — no deviation suggested.
Left eye (OS)
Reflex centred — no deviation suggested.
ℹ️Remember: a temporal reflex displacement suggests esodeviation; a nasal displacement suggests exodeviation (~2 mm ≈ 30 PD with the default ratio). All conversions are approximate estimates and are not equivalent to prism-cover testing.
Cover testing
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Ocular motility
▼Nine positions of gaze — tap any position with abnormal excursion (as seen from the examiner; child's right on the left).
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Monocular visual acuity
▼| Right eye (OD) | Left eye (OS) | |
|---|---|---|
| Uncorrected | ||
| Corrected / best |
Interocular difference: —
📌Amblyopia suspicion is based on monocular acuity, fixation behaviour, refractive asymmetry, deprivation risk and ocular alignment — never on a stereotest alone.
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Lang stereotest
▼Schematic illustration of a random-dot stereotest of the Lang type (original artwork — hidden shapes only visible with binocular disparity).
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Objective refraction
▼| Sphere (D) | Cylinder (D) | Axis (°) | Sph. equivalent | |
|---|---|---|---|---|
| OD | — | |||
| OS | — |
Transposed prescription: —
Anisometropia: —
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Hyperopia decision module
▼Enter refraction and alignment to activate this module.
👓Esotropia + significant hyperopia: prescribe the cycloplegic hyperopic correction — generally full or close to full — particularly when an accommodative component is suspected. Reassess alignment while wearing the glasses. Do not automatically subtract 2.00 D in a child with esotropia.
🧮Orthotropic symmetrical hyperopia: partial correction may be considered depending on age, symptoms, accommodative function and the magnitude of hyperopia. Suggested (editable, not mandatory thresholds): ~+2.00 D with normal visual function → observation may be reasonable · ~+3.00 D or more → consider glasses depending on age, acuity, symptoms, risk factors · high bilateral hyperopia → prescribe correction (amblyopia + accommodative risk).
🔄Hyperopic anisometropia: optical correction · full or near-full correction of the more hyperopic eye · appropriate astigmatism correction · assessment for amblyopia · reassessment after adaptation to glasses.
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Myopia & astigmatism
▼👁️Myopia is generally fully corrected, particularly when it reduces distance vision or is asymmetric.
🌀Astigmatism: always correct clinically significant astigmatism. In anisometropic or amblyopic eyes, prioritise an accurate optical image and avoid unnecessary undercorrection. Verify axis entry — the transposed prescription is shown above.
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Glasses-first treatment pathway
▼- Prescribe appropriate glasses
- Encourage full-time wear
- Reassess visual acuity and alignment
- Determine whether residual amblyopia or residual strabismus remains
🥇Patching is not started on the same day solely because anisometropia or refractive error was detected — unless the clinician deliberately overrides the glasses-first pathway (e.g. severe amblyopia).
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Amblyopia classification
▼Severity is based primarily on best-corrected monocular visual acuity and interocular difference — not merely on age or stereopsis.
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Occlusion therapy module
▼🔒Prerequisites not yet met. Occlusion is only recommended after identifying: the amblyopic / weaker eye · the stronger eye to be patched · visual-acuity or fixation asymmetry · the underlying cause · the current optical correction.
🩹Patch the stronger eye, not automatically the non-deviating eye.
📋Suggested editable starting schedules — moderate amblyopia: begin with ≈ 2 h/day + visually engaging near/distance activities, glasses worn during treatment. Severe amblyopia: consider ≈ 6 h/day (a shorter start may improve acceptance); increase if response is inadequate. Residual amblyopia despite good compliance with 2 h/day: consider increasing towards 6 h/day, recheck refraction and diagnosis, assess adherence, exclude ocular pathology. Do not automatically prescribe full-time patching. For younger children or poor compliance, fractionate (2×1 h, 2×2 h, 3×2 h).
Monitoring
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Strabismus-surgery pathway
▼Surgery is not merely the final step after patching. Considerations (tick all that apply):
🏥Strabismus surgery corrects ocular alignment. It does not directly cure amblyopia or replace glasses. Amblyopia therapy may need to continue before and after surgery.
🎯Accommodative esotropia: first assess alignment with appropriate hyperopic correction · classify as fully or partially accommodative · consider surgery only for a stable residual non-accommodative component.
⏱️Visual optimisation is desirable, but surgical timing must be individualised. In selected cases, delaying alignment surgery until all amblyopia treatment is completed may not be appropriate.
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Follow-up planning
▼Suggested interval will appear here based on the treatment plan.
📅Editable guidance (no rigid 3-month rule): new glasses without severe amblyopia ≈ 8–12 weeks · active occlusion therapy ≈ 6–8 weeks · very young child / severe amblyopia / intensive patching → earlier review · stable observation ≈ 3–6 months · red flags or acute deviation → urgent.
Repeat at every follow-up
📈
Progress chart across visits
▼VA ODVA OSInterocular diff (lines)Deviation distance (PD)Deviation near (PD)Patch h/day
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Interactive decision tree (live)
▼17
Missing-data protection
▼16
Decision outcome & recommendation
▼19
Clinical summary report
▼22
Educational cases
▼Eight interactive teaching cases. Choose the best next step, then check the explanation.
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Treatment logic — safe hierarchy
▼- Exclude urgent ocular or neurological disease.
- Determine alignment and ocular motility.
- Measure monocular visual acuity whenever possible.
- Perform objective and, when indicated, cycloplegic refraction.
- Correct clinically significant refractive error.
- Reassess vision and alignment after optical adaptation.
- Add amblyopia treatment when a persistent visual or fixation asymmetry is demonstrated.
- Adjust patching according to severity, response, adherence and age.
- Consider strabismus surgery based on residual alignment disorder, stability, binocular function and clinical context.
- Continue amblyopia surveillance before and after surgery.
🚫Never use these unsafe automatic rules: negative Lang = definite amblyopia · negative Lang automatically starts patching · every hyperope gets exactly 2.00 D less than cycloplegia · every child is reviewed only after three months · surgery only after all patching is completed · the non-deviating eye is always the eye to patch · age alone determines patching duration.