NEI-backed ANDI tool guides ODs in amblyopia management

Researchers from the National Eye Institute (NEI)-supported Pediatric Eye Disease Investigator Group (PEDIG) have launched the Amblyopia Navigator Decision-Support Instrument (ANDI), a free web-based clinical decision tool designed to guide any eye doctor through amblyopia diagnosis and management.^1,2 Built on evidence from 147 published studies, ANDI is aimed directly at optometrists and other eye care providers who encounter pediatric patients without access to a pediatric subspecialist, according to an NEI news release.

Study authors, led by Allison I. Summers, OD, MCR, associate professor at Oregon Health & Science University in Portland, Oregon, presented “the process used, supporting evidence, and recommendations for testing methods, refractive correction, amblyopia treatment options, treatment adjustments, and monitoring schedules” in an article published May 7, 2026, in JAMA Ophthalmology.^1,2

Workforce research has documented substantial geographic clustering of pediatric optometrists and pediatric ophthalmologists throughout the US, with some states holding no subspecialists at all.^3,4 With amblyopia affecting approximately three in every 100 children and representing the leading cause of preventable monocular vision loss in this population, the gap in access to evidence-based pediatric eye care is a pressing practice-level concern for ODs.^1,2

How ANDI supports eye care providers

ANDI guides the clinician through amblyopia diagnosis first, then through individualized treatment planning based on a small number of clinical findings entered at the point of care. The tool helps ODs determine the optimal spectacle correction for the patient, a step shown to resolve amblyopia in up to one-third of children without any additional intervention.¹ For patients who do not respond to optical correction alone, ANDI walks the clinician through evidence-based next steps: patching the fellow eye, prescribing atropine drops to temporarily blur fellow-eye acuity, or considering newer digital treatment modalities delivered through specially designed games or videos.

If a child plateaus during treatment, ANDI advises whether to increase treatment intensity, switch modalities, reassess the spectacle prescription, or refer to a subspecialist. The tool provides structured guidance for follow-up visit intervals and recurrence surveillance after treatment ends. ANDI can be applied at an initial visit or any point in the patient's amblyopia care journey, making it practical for ODs managing these cases longitudinally across a primary eye care practice. Access is available at public.jaeb.org/pedig/, and the published article figures are formatted for offline use as clinical reference sheets.

"This online tool quickly distills the relevant literature into individualized treatment advice for busy clinicians anywhere with internet access," Summers stated in the release. "Those without internet access can utilize the article figures as clinical reference sheets."

Practice implications

ANDI was developed by PEDIG, an NIH-funded research network of more than 400 investigators, and draws on 147 published clinical studies to generate individualized recommendations.¹ The tool is not designed to replace subspecialty care, but to support ODs managing patients in communities where no pediatric subspecialist is available, or where referral timelines are long. Stacy L. Pineles, MD, co-chair of PEDIG and faculty at the Jules Stein Institute at the University of California, noted: "We hope this tool can be leveraged to minimize gaps in access to pediatric ophthalmic care."

For optometrists, ANDI represents a structured, literature-grounded framework for clinical decisions ODs are often asked to make without formal subspecialty training in pediatric eye disease, according to the NEI. The tool's accessibility, open-access design, and compatibility with a range of clinical settings make it directly applicable to OD practice, particularly in underserved or rural communities. The NEI suggests that ODs who currently screen, diagnose, or initiate amblyopia treatment should consider integrating ANDI into their clinical workflow.¹

References:

1. NEI-supported project expands access to care for children with amblyopia. News release. National Eye Institute. May 18, 2026. Accessed June 9, 2026. https://www.nei.nih.gov/research-and-training/research-news/nei-supported-project-expands-access-care-children-amblyopia

2. Summers AI, Hatch WS, Hatt SR, et al; for PEDIG. Web-based amblyopia decision support tool. JAMA Ophthalmol. Published online May 7, 2026. doi:10.1001/jamaophthalmol.2026.1095

3. Walsh HL, Parrish A, Hucko L, Sridhar J, Cavuoto KM. Access to pediatric ophthalmological care by geographic distribution and US population demographic characteristics in 2022. JAMA Ophthalmol. 2023;141(3):242-249. doi:10.1001/jamaophthalmol.2022.6010

4. Siegler NE, Walsh HL, Cavuoto KM. Access to pediatric eye care by practitioner type, geographic distribution, and US population demographics. JAMA Ophthalmol. 2024;142(5):454-461. doi:10.1001/jamaophthalmol.2024.0612