Allison Summers was reviewing the case of a 5-year-old with blurry vision when she realized how uneven access to pediatric eye care really is—some children in rural America wait months to see a specialist, while others never do. That moment helped spark ANDI, a free, web-based tool now guiding eye doctors across the U.S. in diagnosing and treating amblyopia, the leading cause of preventable single-eye vision loss in children. Affecting 3 in every 100 kids, amblyopia often goes undetected or undertreated, especially in areas with few pediatric eye specialists. With ANDI, clinicians—even those without specialized training—can now access expert-level guidance in real time, helping close critical gaps in care.
Amblyopia develops when the brain fails to fully process input from one or both eyes during early childhood, often due to misaligned eyes, unequal refractive errors, or visual obstruction. If untreated, the condition can lead to permanent vision loss that no glasses or contacts can fix. The good news: most children respond well to treatment, especially when it starts early. Yet workforce studies show pediatric eye specialists are clustered in urban centers and certain states, leaving vast regions underserved. In some areas, children must travel hundreds of miles for care, delaying treatment and worsening outcomes.
ANDI, short for Amblyopia Navigator Decision-Support Instrument, changes that. Developed by researchers at Oregon Health & Science University and the Pediatric Eye Disease Investigator Group (PEDIG), the tool walks eye care providers through diagnosis, initial treatment, and long-term management. It calculates the optimal glasses prescription based on clinical findings and advises how long to monitor vision improvement with glasses alone—effective in up to a third of cases. When more intervention is needed, ANDI guides clinicians through evidence-based options: patching the stronger eye, using atropine drops, or trying digital therapies like therapeutic video games. If progress stalls, the tool recommends adjusting treatment intensity, switching methods, or referring to a specialist. It even outlines follow-up schedules and warns of potential relapse signs after treatment ends.
"This online tool quickly distills the relevant literature into individualized treatment advice for busy clinicians anywhere with internet access," said Dr. Summers, associate professor at OHSU and lead author of the JAMA Ophthalmology paper introducing ANDI. Co-chair of PEDIG, Dr. Stacy L. Pineles of UCLA’s Jules Stein Institute, added that the goal is to ensure every child, regardless of zip code, receives timely, high-quality care. The tool is already being used in clinics from Maine to Alaska, with printable versions available for areas with limited internet.
With amblyopia affecting millions of children and long-term impacts on learning, employment, and independence, ANDI represents a quiet revolution in equitable eye care. As digital support tools gain traction, the hope is that no child will lose sight to a treatable condition—just because they live too far from a specialist.