Amblyopia management can become more complicated as care progresses. A child’s visual acuity may stop improving, adherence may become difficult, or a clinician may need to decide whether the current approach should be continued or reconsidered.
The evidence to support those decisions exists, but finding the most relevant research during a busy clinic is not always practical. The Pediatric Eye Disease Investigator Group, or PEDIG, developed the Amblyopia Navigator Decision-Support Instrument (ANDI) to make that evidence easier to use during patient care.
Released in 2026, ANDI is a free, web-based decision-support tool for patients ages 3 through 17 with suspected or diagnosed amblyopia. It allows clinicians to enter patient-specific findings and receive guidance based on the evidence PEDIG used to build the tool.
What makes ANDI particularly interesting is not simply that it delivers recommendations. Its workflow reinforces something fundamental to pediatric eye care: decision support is only as useful as the clinical information entered into it.
Bringing Amblyopia Evidence Into the Exam Room
ANDI was developed by pediatric optometrists and ophthalmologists within PEDIG, a collaborative research network focused on amblyopia, strabismus and other childhood eye disorders.
The tool distills evidence from 147 publications, including randomized clinical trials, into a format that can be accessed from a phone, tablet or computer. Clinicians can use separate pathways for new and returning patients and enter findings such as age, best-corrected visual acuity, cycloplegic refraction and strabismus status.
From there, ANDI can provide evidence-based guidance related to eyeglass prescribing, treatment planning and follow-up. At later visits, updated findings can be entered to help clinicians assess treatment response or consider whether changes may be appropriate.
ANDI also provides access to the publications behind individual recommendations. That matters because the tool is not simply presenting a fixed protocol. Clinicians can review the evidence supporting a recommendation when they want to look more closely at the reasoning behind it.
Good Decisions Start With Reliable Visual Acuity Data
Before ANDI can help interpret a child’s clinical picture, the clinician needs a dependable measure of visual acuity.
That is especially important in amblyopia because the way visual acuity is measured can affect the result. The Review of Optometry article describing ANDI emphasizes testing with a single optotype surrounded by crowding bars. Children with amblyopia may identify an isolated optotype more easily than one presented with surrounding visual information, so testing without appropriate crowding can overestimate visual acuity.
ANDI’s own data-entry guidance reflects this. For children ages 3 through 6, the interface specifies single-surround HOTV or LEA Symbols. For children age 7 and older, it calls for single-surround ETDRS or single-line Snellen testing.
For younger children, the choice of optotype also matters. LEA Symbols and HOTV can allow children to identify or match familiar optotypes without needing to know the full alphabet. Matching cards can offer another response method for children who are more comfortable pointing than naming what they see.
This is where standardized pediatric testing and digital decision support meet. ANDI may help interpret findings, but the quality of its guidance still begins with selecting an appropriate test and obtaining the most reliable measurement possible.
Building a Clinical Picture Before Making a Decision
Amblyopia is not defined by reduced visual acuity alone. The source describes it as subnormal best-corrected visual acuity in one or both eyes, not caused by another ocular disease, together with an amblyogenic risk factor that created abnormal visual experience early in life.
ANDI focuses on risk factors including anisometropia, unilateral constant strabismus and bilateral high refractive error. Deprivation amblyopia associated with conditions such as cataract, ptosis or corneal scarring falls outside the tool’s scope because management is more complex and tied to the underlying condition.
The clinician therefore enters more than an acuity value. Cycloplegic refraction and strabismus status are also incorporated into the decision pathway.
That distinction helps explain why ANDI is better understood as a decision-support system rather than a simple treatment calculator. It uses several parts of the examination to help frame the recommendation.
Decision Support Continues at Follow-Up
Amblyopia management frequently unfolds over multiple visits. Visual acuity may improve, plateau or change more slowly than expected, while families may also encounter challenges with adherence.
ANDI can be used again at follow-up visits, allowing updated findings to inform the next recommendation. Depending on the clinical scenario, the tool may provide guidance related to continued optical correction, patching, atropine penalization or alternative treatment approaches.
The source notes that many children with amblyopia are followed every two to four months to monitor response, although the appropriate interval can vary according to clinical circumstances.
The important point is not that ANDI removes the need for clinical judgment. It organizes relevant evidence around the findings entered by the clinician, giving the practitioner another resource when deciding what should happen next.
Designed for Everyday Clinical Workflow
Decision-support tools are most useful when they fit into clinical practice without creating additional friction.
ANDI is web-based and can be accessed across common devices. It also includes a “Copy Plan” function that allows examination information and recommendations to be copied for use in an electronic health record or another program.
According to the source, ANDI does not store protected health information. Because the application is web-based, clinicians can access the current version without maintaining a locally installed copy that may become outdated.
PEDIG also provides supporting reference materials for clinicians who prefer not to use the application itself, including a clinical flow chart, age-based visual acuity norms and guidance related to acuity measurement and eyeglass prescribing.
These features address a practical problem in evidence-based care. Research has limited value if clinicians cannot find or apply it when a decision needs to be made.
Technology Does Not Replace the Fundamentals
ANDI shows how clinical decision-support technology can bring a substantial body of pediatric eye care research closer to the exam room. Its usefulness, however, still depends on the fundamentals that come before the algorithm.
Age-appropriate optotypes, appropriate crowding, reliable visual acuity measurement, cycloplegic refraction and assessment of ocular alignment all contribute information that shapes the recommendation. If those inputs do not accurately represent the child’s visual function, the decision-support tool has less useful information to work with.
For pediatric eye care, that may be one of the most important lessons from ANDI. Digital tools can help clinicians navigate complex evidence and treatment pathways, but they work alongside careful examination and standardized testing rather than replacing them.
ANDI brings the evidence closer to the point of care. The clinician still provides the measurements, context and judgment that make that evidence meaningful for the child in front of them.
Sources
Hatch S, Summers A, Wiese K. “How ANDI Can Help Take the Guesswork out of Amblyopia.” Review of Optometry, September 2026.
Pediatric Eye Disease Investigator Group (PEDIG), Amblyopia Navigator Decision-Support Instrument (ANDI).
