Page 16 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS
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CHAPTER 1
History of eye screening
The first Child Health Care (CHC) Centre was founded in Paris, France, in 1892 by Pierre Budin. According to Budin’s vision attention should be given to stimulate lactation and to check children’s growth. Infants were examined and weighed every week and instruction was given to their mothers about hygiene and care. Free sterile milk was provided when breastfeeding was not possible. The rest of France, as well as other countries like Belgium, Italy, Hungary, Canada and Spain followed.24
Ten years later, in 1901 a Dutch paediatrician, Plantenga, inspired by the French initiative opened the first CHCC in the Netherlands, which also gave out free milk. This first private initiative was followed by other organizations and eventually became nationwide implemented in the Netherlands.25 Vision screening was implemented in this already existing health screening programme for mother and child in 1960. Around that time population-wide vision screening was also implemented in Denmark, Finland and Sweden. Norway followed in 1970 and Austria, Belgium, France and the UK around 1980. The vision screening programme in the Netherlands was extended with preverbal vision screening tests in the 1980’s.25,26
Aims of vision screening
The purpose of vision screening is to prevent bilateral visual impairment later in life, by reducing amblyopia. Even though the primary aim for preschool vision screening is to reduce amblyopia, it is important to recognize other beneficial effects. These include detection of visual disorders other than amblyopia, such as organic disorders, and conditions that may impede schoolwork, such as high hyperopia.
Screening tests
Red reflex examination
The red reflex test is a rapid, non-invasive, simple test usually performed at the age of 0-6 months to detect congenital disorders. A direct ophthalmoscope is used in a darkened room and the eyes are assessed individually at 30 to 45 cm. A normal red reflex requires clarity of the cornea, aqueous humour, lens and vitreous body. Leukocoria (white pupillary reflex) can, among others, indicate retinoblastoma or congenital cataract. Any asymmetry is a reason for referral for full eye examination.
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