Determinants and outcome of unsuccessful referral after positive screening in a large birth-cohort study of population-based vision screening

Self Cite

Purpose In the Netherlands, youth health care physicians and nurses screen all children for general health disorders at Child Health Care Centers. As part of this, the eyes are screened seven times, with the first visual acuity (VA) measurement at 36 months with the Amsterdam Picture Chart (APK). The suitability of the APK has been questioned. Methods Children born between July 2011 and June 2012 born in the provinces Drenthe, Gelderland and Flevoland and invited for screening at 36 months were eligible. Parents were sent the APK picture optotypes to practise with their children in advance. Data were collected from electronic screening records. The Dutch vision screening guideline prescribes that children with VA <5/6, or one line interocular difference (not logMAR, however) should be retested or referred. Results Of 10 809 eligible children, 1546 did not attend and 602 attended but had no VA measurement at age 36 months, 247 of these were under orthoptic treatment. Of the 8448 children examined, VA was sufficient in 5663 (67.0%) and insufficient in 1312 (15.5%). In 1400 (16.6%), the measurement of VA itself failed. In 73 (0.9%), data were missing. Of the 216 children with 2 failed VA measurements, 150 (69%) were not referred, and measurement of VA was deferred to the next general screening examination at 45 months. Conclusion Although most parents had practised the APK picture optotypes at home with their children, the rate of failed APK measurements plus the measurements with insufficient VA was 32.1% at 36 months. Similar rates have previously been reported for Lea Symbols and HOTV, permitting the conclusion that measurement of VA at the age of 36 months cannot be recommended as a screening test in the general population.

Section: Discussionmentioning

confidence: 93%

High rate of failed visual‐acuity measurements with the Amsterdam Picture Chart in screening at the age of 36 months

Telleman

Sloot

Benjamins

et al. 2018

Self Cite

“…A large Dutch birth cohort study (Tjiam et al. ) has shown that 25% of positively screened children are not referred successfully. In Sweden, all citizens have a National ID number.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of vision screening in five‐ to eight‐year‐old children living in Region Västra Götaland, Sweden – a prospective multicentre study

Gyllencreutz

Chouliara²,

Alibakhshi

et al. 2018

Purpose: To evaluate the current vision screening criteria regarding amblyopia and refractive errors, with emphasis on screening limits and retesting, in Region V€ astra G€ otaland (VGR), Sweden. Visual acuity (VA) screening is performed by nurses at primary healthcare centres (PHCs) in 4-year-old children and at school in 6-or 7-year-old children. Children with VA <0.65 (>0.19 logMAR) at either eye are referred. If VA is 0.65 in one or both eyes, a retest is performed by nurses at PHCs and schools, the children are then referred if VA is <0.8 (>0.10 logMAR). Methods: We included all children aged ≥5 and <8 years referred between October 2014 and June 2015 from PHCs and schools to the four eye clinics in VGR, with VA ≥0.65 in one or both eyes. At the eye clinic, children underwent assessment of VA, refraction in cycloplegia, eye motility, cover test, stereo test and a slit lamp examination. Results: Among the 259/295 children (139 female) participating, median age was 5.7 years (5.0-7.8 years) at referral. Glasses were prescribed due to subnormal VA with refractive errors in 20% of the children, 22% displayed heterophoria, none had heterotropia and one younger child had amblyopia. Accurate retesting gave fewer false-positive referrals. Conclusion: Our results showed that a vision screening referral cut-off limit of VA <0.65 would leave undetected refractive errors. Residual amblyopia was uncommon. Accurate referral criteria, retesting and training of those performing the screening as well as re-evaluation of the screening programme are all important.

“…Among those not detected, about half had amblyopia which was not detected (false negatives) and the other half were either not successfully treated or not referred (Groenewoud et al 2010). A Dutch study (Tjiam et al 2011) found a 25% amblyopia rate among positively screened children who did not receive follow-up, owing to parental non-compliance with the referral, miscommunication (often due to language barrier), non-documentation or physician noncompliance. We had two cases of amblyopia in the 'preschool-screened' group: one which did not attend preschool vision screening and one which did not follow up with the recommended treatment.…”

Section: Discussionmentioning

confidence: 99%

Danish Rural Eye Study: the association of preschool vision screening with the prevalence of amblyopia

Høeg

Moldow

Ellervik

et al. 2014

ABSTRACT.Purpose: To determine the prevalence of amblyopia in Denmark before and after the initiation of the Danish national preschool vision screening programme. Methods: In a population-based cross-sectional study, 3826 participants of the Danish General Suburban Population Study (GESUS) aged 20 years and older from a Danish rural municipality received a complete general health examination and an ophthalmological interview and examination. This study included a comprehensive ophthalmologic interview, measurement of best corrected visual acuity (BCVA) in each eye, Hirschberg's test for strabismus and two 45-degree retinal fundus photographs of each eye. A complete ophthalmologic examination was performed when indicated. Results: The prevalence of monocular visual impairment (MVI) was 4.26% (95% CI, 3.66-4.95, n = 163). Amblyopia was the most common cause, accounting for 33%. The prevalence of amblyopia was 1.44% (95% CI, 1.01-1.81, n = 55), being higher among non-preschool vision screened persons compared to those who were offered (estimated 95% attendance) preschool vision screening (1.78%, n = 41, 95% CI 1.24-2.33 versus 0.44%, n = 2, 95% CI, 0.12-1.60, p = 0.024). The leading cause of amblyopia was anisometropia (45.5%, 25/55). Conclusions: Amblyopia was the most common cause of MVI. Following the initiation of the Danish national preschool vision screening programme, which has an approximate attendance rate of 95%, the prevalence of amblyopia decreased by fourfold.