Abstract
Purpose: :
Children at 3.5 years in Japan undergo physical, mental and developmental checkup, based on Maternal and Childhood Health Law since 1961. Vision and hearing examinations were included since 1991. The vision-screening program consists of 3 steps: questionnaires and home visual acuity testing as 1st step, visual acuity testing by nurses and inspection by medical officers at regional Health Care Centers as 2nd step, and detailed examinations by ophthalmologists as 3rd step. In this study, we conducted hand-held autorefraction in addition to visual acuity testing and inspection at regional Heath Care Center to reveal whether autorefraction leads to better detection of eye problems.
Methods: :
Hand-held autorefraction was done by a single well-trained examiner (C.M.) in 265 children at 3.5 years who visited at Okayama East Health Care Center in 6 consecutive sessions from Nov 2007 to Feb 2008. As the current standard, eyes were inspected by medical officers, and visual acuity tests using 0.1 and 0.5 Landolt-C cards at 5 m for each eye were done by nurses in children who failed or did not undergo visual acuity testing at home. Children were sent to 3rd step examinations by ophthalmologists, based on refractive error criteria: >3 diopters myopia, >2 diopters astigmatism, or >1 diopter hyperopia in either eye, in addition to the current criteria: 1) failure in either eye for 0.5 visual acuity, 2) eye-related symptoms raised by questionnaires, or 3) eye problems detected by medical officers.
Results: :
Notice to visit ophthalmologists was issued for 64 children (24%), and 37 of those (58%) did so to make documents wiith final diagnoses sent back to Health Care Office. Of the 64 children, 12 was sent to ophthalmologists based on the current criteria only, 9 based on both the current criteria and the refractive error criteria, and 43 based on the refractive error criteria only. Eleven of 12 children visiting ophthalmologists by the current criteria had diagnoses such as amblyopia and strabismus. In contrast, 16 of 25 children visiting ophthalmologists by the refractive error criteria only had mainly diagnoses of refractive errors with no serious problems.
Conclusions: :
Autorefraction in addition to visual acuity testing and inspection led to additional eye disease detection at 3.5 years. Autorefraction is not recommended as an additional test from the viewpoint of cost-effectiveness as far as the current system was conducted appropriately.
Keywords: strabismus: diagnosis and detection • refraction • visual acuity