Page 150 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 8
INTRODUCTION
Paediatric vision screening is generally considered an effective intervention to reduce the prevalence of persistent amblyopia among adults1 and is common is most European countries. Amblyopia is a condition of decreased visual acuity (VA) that is usually unilateral.2 The average period of bilateral visual impairment is much longer in children with persistent amblyopia3 and unilateral amblyopia also negatively affects the quality of life.4 Its prevalence is approximately 3.4%.5 It can best be treated before the age of seven, with glasses, occlusion of the better eye or both.6 The European Union gives priority to “early detection by screening and follow-up for hearing, vision and speech disorders in children in order to contribute to create equal educational, social and economic opportunities for children”.7 The EUSCREEN study8 compares paediatric vision and hearing screening programmes in Europe and aims to develop a cost-effectiveness model to assist with introduction or modification of screening programmes, taking local circumstances into account (Additional file 1). Alongside the development of the model and informed by its preliminary predictions, a vision screening programme was implemented in the county of Cluj in Romania (Additional file 2). Romania is one of a few European countries without a national vision screening programme. Vision screening has been provided by the Lion’s Club project ‘Clear view, healthy eyes’9 but not on a structural basis and geographically limited. Therefore, Romania was chosen for implementation of a vision screening programme. The implementation study would provide an opportunity to identify barriers, requisites and facilitators encountered when implementing a new vision screening programme. The implementation commenced on January 1st, 2018 and concluded on December 31st, 2019. We report on the first year of implementation.
METHODS
Screening population
A protocol was developed based on literature and expert opinion (Additional file 3). Children aged four and five are old enough for VA measurement10 and young enough to be successfully treated for amblyopia if needed.3 In 2018, all children born in Cluj County in 2013 and 2014 would be eligible. Altogether these were 12,795 children: 6,083 in the county seat Cluj-Napoca, 2,260 in five small cities and 4,452 in rural areas, where 34% of the county’s population resides.11 The majority of the population of Cluj County consists of Romanians (75%) but there are two substantial ethnic minority
148