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To improve the educational system, an outcomes measurment called "High School Exit Exam" has been implemented to 1) determine who has learned enough, 2) determine which student needs additional help, 3) determine which regions and schools have deficiencies so 4) efforts can be directed at improving overall education. So far, worldwide, there is no "exit exam" for amblyopia.

"Cured by Third" is a proposed "Exit Exam" for amblyopia. It would be administered through schools (public, private and home) at the third grade level when students are about 8-years-old. According to the kineteics of amblyopia, 8 might be a "magic" age for amblyopia. In other words, a patient who has been screened, detected early and thoroughly treated by age 8 may be "cured" so that cessation of treatment might not result in irreversible vision impairment from amblyopia. On the other hand, ATS3 and other studies have demonstrated that substantial improvments can be attained in a newly-detected amblyopic patient after age 8 years. From a refractive development standpoint, the average child is still slightly hyperopic at age 8; many older children have onset of myopia which would decrease uncorrected distance acuity.

Components of "Cured by Third:" Third graders will perform a patched, surround acuity test with a critical line equivalent to 20/32. A student struggling to pass the 20/32 line will be retested with pinhole over the unpatched eye. Best optical correction will be used. any student unable to pass the 20/32 critical line either right or left eye will then be referred for a confirmatory eye exam unless prior medical evidence is available by school record, home record, or phone / fax / internet contact with eye doctor. the outcome of the confirmatory eye exam, or other medical reason for sub-critical acuity will be recorded.

Alaska desires to eliminate amblyopia for rural children as well as urban children. Therefore, data on regional "Cured by Third" findings will be reviewed as to how resources can best be directed to maximize pediatric vision in Alaska over time.

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