Esotropia Missed During Pre-health Checkup Screening With the Spot Vision Screener: A Case Series

The Spot Vision Screener (SVS) is increasingly used for the early detection of amblyopia risk factors in preschool children, particularly during health checkups for three-year-olds. Although SVS demonstrates high sensitivity and specificity for refractive errors and amblyopia risk factors, its ability to detect strabismus, especially accommodative esotropia, remains limited. We present a case of accommodative esotropia in children under three years of age where SVS failed to detect ocular misalignment. In all cases, SVS indicated only mild hyperopia and did not detect strabismus; however, subsequent ophthalmological assessment revealed accommodative esotropia, which was confirmed by cycloplegic refraction. All patients responded well to full hyperopic correction with spectacles, which resulted in improved or normalized ocular alignment. These cases highlight the potential for false-negative strabismus results with SVS, particularly in young children and in cases where esotropia is variable or predominantly manifests at near. Our findings underscore the need for a comprehensive clinical assessment, including careful observation, cycloplegic refraction, and repeated SVS measurements, to ensure timely and accurate referral for ophthalmological evaluation. Enhanced education and training for healthcare professionals involved in vision screening are also essential to maximize the detection rates of amblyopia and strabismus and to prevent missed diagnoses of clinically significant strabismus.