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Frea Sloot, Esmay Bresser, Sjoukje Loudon, Trijntje Sjoerdsma, Janine Benjamins, Hein Raat, Huibert Simonsz; Disinvestment of population-based preverbal vision screening in the Netherlands. Invest. Ophthalmol. Vis. Sci. 2013;54(15):3987.
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© ARVO (1962-2015); The Authors (2016-present)
Since the 1980’s preverbal screening has been added to preschool screening at the Child Health Centers (CHC’s) that screen >99% of all Dutch children. Preverbal examination includes cover test, Krimsky test, eye movements, cornea and pupillary reflexes. The RAMSES birth-cohort study showed that preverbal screening contributed little to the detection of refractive amblyopia.
Preverbal screening is abolished in half of approximately 10,000 children in a large rural area of the Netherlands. As the rural area has a low proportion of immigrants, the northern district of Amsterdam has been added with 3 CHC’s, because their priority in screening is different. Children born between January and June 2012 will be screened at 1-2, 3-4, 36, 45 and 54-60 months (intervention). Children born between July and December 2011 will be screened according to current protocol, i.e. also at 6-9 and 14-24 months (controls). Primary endpoint is the number of detected and missed cases of amblyopia at 45 months. Secondary endpoint is the added cost-effectiveness of the preverbal screening. Evaluation of the screening and referral process is assessed trough anonymous questionnaires. Data is collected from screening records, the anonymous questionnaires and on-site observations with time-recording. In a smaller parallel study the effectiveness of preverbal photo screening in avoiding amblyopia by early prescription of glasses will be examined.
5205 children were included in the intervention group, against 5649 in the control group (6% of the birth rate). Extensive instruction was given to all participating CHC’s. So far 27 questionnaires have been evaluated. Vision screening is considered difficult by 62.5% (age 0-4 months), by 82% (age 6-24 months), by 77% (age 36 months) and by 50% (age 45 months) of respondents. The decision of referral is considered difficult by 36% (age 0-4 months) by 83% (age 6-24 months) by 50% (36 months) and by 14% (age 45 months) of respondents mostly due to lack of cooperation or doubtful test results. 75% of respondents admit that vision screening is sometimes omitted, mostly due to lack of cooperation.
In 2016 it will be clear if continuing this form of preverbal screening is worthwhile.
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