Abstract
Purpose: :
In the Netherlands, population-based preverbal screening is performed at 9, 14 and 24 months and preschool screening at 36, 45 or 54, and 60 months. The Rotterdam AMblyopia Effectiveness Study (RAMSES) was a 7-year, prospective, birth-cohort study of the effectiveness of screening for amblyopia.
Methods: :
The RAMSES comprised 4626 children born in Rotterdam between 15 September 1996 and 15 May 1997. We collected all vision screening results of the children, data on screen-positive tests and referrals, as well as clinical orthoptic and ophthalmologic data provided by eight eye departments in the area of Rotterdam. A final vision examination was performed at age 7. If follow-up of referral after a positive screening test was unclear, parents were contacted and completed a questionnaire. Fluency in Dutch was also determined. If parents were unaware of referral, the screening records of the child were checked.
Results: :
In 2003, 3897 children were still living in Rotterdam. 2964 children of these underwent the final vision examination at age 7. 98 of the 3897 had confirmed amblyopia. However, insufficient follow-up data were available in 96 of the 750 cases with a positive screening test and in 1264 of the 3147 cases with no positive screening test. Overall, at age 7, 37 out of 2964 had acuity >0.2LogMAR: 14 had an untreatable eye-disorder or a refractive problem, and 23 had insufficiently treated amblyopia. Of these, 6 were false negative by screening, 14 had failed amblyopia therapy, and 3 had been referred unsuccessfully. One of the 6 children who had been missed at screening never attended VA screening after age 3. Nine of 14 children who had unsuccessful amblyopia treatment, lived in low-socio-economic status (SES), non-native, suburban areas. The parents of the 3 unsuccessfully referred children said to be unaware of the referral, but in one case a referral letter was present in the child’s screening record. 2 of these 3 parents had a low working knowledge of the Dutch language and 2 lived in low-SES, non-native, suburban areas.
Keywords: screening for ambylopia and strabismus • amblyopia • strabismus