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M. de Graaf, A.M. Tjiam, H.J. Groenewoud, H.J. de Koning, H.J. Simonsz; Effectiveness of Screening for Amblyopia: Non–Compliance With Referral . Invest. Ophthalmol. Vis. Sci. 2006;47(13):704.
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To specify causes for unsuccessful referral by the Child Health Care Center (CHC) in case of suspected amblyopia.
The Rotterdam AMblyopia Screening Effectiveness Study (RAMSES) is a 7–year, prospective birth cohort study comprising 4624 children. Children underwent preverbal eye screening at ages 9, 14 and 24 months and screening with measurement of visual acuity at ages 36, 45 and 54 months. Children referred after a positive screening test as well as children from the birth cohort under treatment for amblyopia or other eye–disorders were registered. The parents whose children had been referred but were not registered as being treated, were contacted to find causes for unsuccessful referral. We made a distinction between misclassified referral recommendation, misclassified parental non–compliance and true non–compliance. The last group was presented a semi–structured qualitative interview.
One out of five children had at least one positive test result. 40% of these were not being reported as being treated. About one sixth were misclassified as non–compliant. In the majority of cases the parents reported that they had not been instructed to consult their GP (misclassified referral recommendation). Indicated reasons for true non–compliance were parental disagreement with the test result, family circumstances, lack of insight in referral, language barrier and consultation with an optologist or optician. In most cases visual acuity at age 7 was sufficient, however.
The complexity of the inadequate referral pattern warrants further analysis.
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