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A. M. Tjiam, J. H. Groenewoud, E. Vukovic, S. E. Loudon, H. J. de Koning, V. K. Lantau, H. J. Simonsz; Unsuccessful Referral in a 7-Year, Prospective, Birth-Cohort Study of Population-Based Screening for Amblyopia. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2581. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
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.
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.
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.
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