Abstract
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