June 2013
Volume 54, Issue 15
ARVO Annual Meeting Abstract  |   June 2013
Disinvestment of population-based preverbal vision screening in the Netherlands
Author Affiliations & Notes
  • Frea Sloot
    Ophthalmology, Erasmus MC, Rotterdam, Netherlands
  • Esmay Bresser
    Ophthalmology, Erasmus MC, Rotterdam, Netherlands
  • Sjoukje Loudon
    Ophthalmology, Erasmus MC, Rotterdam, Netherlands
  • Trijntje Sjoerdsma
    Public Health Service Amsterdam, Amsterdam, Netherlands
  • Janine Benjamins
    Icare, Meppel, Netherlands
  • Hein Raat
    Public Health, Erasmus MC, Rotterdam, Netherlands
  • Huibert Simonsz
    Ophthalmology, Erasmus MC, Rotterdam, Netherlands
  • Footnotes
    Commercial Relationships Frea Sloot, None; Esmay Bresser, None; Sjoukje Loudon, None; Trijntje Sjoerdsma, None; Janine Benjamins, None; Hein Raat, None; Huibert Simonsz, None
  • Footnotes
    Support None
Investigative Ophthalmology & Visual Science June 2013, Vol.54, 3987. doi:https://doi.org/
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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. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: In 2016 it will be clear if continuing this form of preverbal screening is worthwhile.

Keywords: 709 screening for ambylopia and strabismus • 417 amblyopia  

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