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Frea Sloot, Hatice Karaman, Aya Sami, Sjoukje E Loudon, Janine Benjamins, Huibert Jan Simonsz; Disinvestment of population-wide eye screening at age 6-24 months in the Netherlands. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© 2017 Association for Research in Vision and Ophthalmology.
Dutch children are eye-screened seven times at Child Health Care Centers that screen 97% of all children for general health disorders. We assessed the preverbal, mainly orthoptic eye screening examinations at age 6-9, 14 and 24 months and the follow-up examinations with visual acuity (VA) measurements at 36 and 45 months.
Preverbal screening (cover test, Hirschberg test, eye motility, quality of pursuit, 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 for congenital disorders and VA was measured at 36 and 45 months, but at 6-9, 14 and 24 months only children in the control group (born July-December 2011) were eye screened. Children in the reduced screening 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 noticed by the parents or by the screening physician. Data was collected from screening records, anonymous questionnaires and on-site observations.
177 out of 6064 children (2.9%) in the screened group and 129 out of 5492 children (2.3%) in the unscreened group were referred. Referral based specifically on the screening test was reason for referral in 47 versus 15 children. All other children were referred because of visually apparent eye disorders or conspicuous strabismus. Amblyopia was found in 42 (0.7%) versus 22 (0.4%) cases. VA measurements were performed at 36 months with the Amsterdam Picture Chart or Tumbling-E and at 45 months with the Landolt-C. Of the 80 distributed questionnaires, 56 were filled out. The cover test was found difficult in 75% and the decision to refer a child based on the test was found difficult in 87%. During the observations, cover test, motility and pupillary reflexes were performed correctly in 37%, 7% and 14%. Hirschberg test was performed correctly in 87%. VA measurements were performed correctly in 91%.
Referral was based mostly on conspicuous strabismus or other visually apparent disorders noted by parents or screening physicians. Although still a minority, specific eye screening led to more referrals at the age of 14-24 months than at 6-9 months. It seems that omission of specific eye screening tests at age 6-24 months does not reduce detection of amblyopia cases significantly.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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