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Frea Sloot, Aya Sami, Hatice Karaman, Sjoukje E Loudon, Janine Benjamins, Hein Raat, Huibert Jan Simonsz; Disinvestment of population-wide eye screening at age 14-24 months in the Netherlands. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5209.
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© ARVO (1962-2015); The Authors (2016-present)
Dutch children are eye-screened 7 times at Child Health Care Centers that screen 97% of all children for general health disorders. Omission of eye screening at age 6-9 months (ARVO 2014) did not seem to reduce referrals and detection of amblyopia; referral was based mostly on conspicuous strabismus noted by parents or screening physicians. We now assessed the screening examinations at age 14 and 24 months.
Preverbal screening (cover test, Hirschberg test, eye movements, cornea and pupillary reflexes) was omitted in the second of two sequential birth cohorts. All children were screened at 1-2 and 3-4 months, but at 14 and 24 months only children in the control group (born July-December 2011) were eye screened. Children in the intervention group (born January-June 2012) did attend consultations for all other basic screening and vaccinations, but eye screening, was performed only in case of positive family history, something noted by the parents or a visually apparent eye disorder. Data was collected from screening records, anonymous questionnaires and on-site observations.
112 out of 6188 children (1.8%) in the control group and 76 out of 5623 children (1.4%) in the intervention group were referred to an orthoptist or ophthalmologist. Visually apparent eye disorders or conspicuous strabismus noted by the parents or screening physician led to referral in 79 children (1.3%) versus 66 children (1.2%). Twenty-seven children in the control and six in the intervention group were referred because of specific eye screening. The latter six children were examined because of a positive family history (1), smaller eye (1) or for unknown reasons (4). In the questionnaires screening physicians had indicated that they found examination of children at age 14-24 months difficult, especially the cover test. During the observations, cover test, motility and pupillary reflexes were not always performed correctly. Hirschberg test was almost always performed correctly.
At the age of 14-24 months most children are referred because of a visually apparent eye disorder or conspicuous strabismus. Although still a minority, specific eye screening led to more referrals at the age of 14-24 months than at 6-9 months.
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