Page 166 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 8
Outcome of screening
The outcome registered by the screener (pass, repeat or refer) was checked against the measured VA. Out of 7,876 screenings, in 61 cases (0.8%) VA was recorded as below the threshold, and the screener nevertheless recorded a pass (see Supplementary table 1, Additional file 9). Conversely, in 12 cases (0.2%) where the recorded VA did not warrant referral, the result was recorded as a referral nevertheless. It should be noted that we do not known whether these children were indeed erroneously (not) referred or whether the outcome was entered in the database incorrectly.
Repeat screens were performed in the city of Cluj-Napoca about a month later in most cases. Scheduling these was not a problem because the nurses saw the children every day. In the small cities and the rural areas, the repeat screen was generally performed on the same day as the first screen (80% and 76%) even though, according to protocol, the repeat test should have taken place after one month.
Out of 187 (2%) repeat screens, 46% of children passed the repeat screen while 33% were referred to an ophthalmologist. In 21% of cases a repeat screen was not performed or the result was not entered in the database. Out of 1,071 children referred altogether, in 200 (19%) cases a report from the ophthalmologist was entered in the database (see Supplementary table 2, Additional file 9). On average, these 200 children were examined 32 days after they were screened. The flow chart of referrals is presented in figure 4. An analysis of the ophthalmologists’ reports can be found in Additional file 10.
There may be several reasons why in relatively few cases a diagnostic report was entered in the database. A substantial number of parents may not have taken their child to an ophthalmologist in spite of the child being referred. In the rural areas there are no ophthalmologists, meaning parents from rural areas had to take their child to a city for an ophthalmological assessment and repeat visits for treatment of amblyopia. Almost twice as many ophthalmological reports from Cluj-Napoca as
from the rural areas were entered in the database: 21% as compared to 11%. From the small cities this was 16%.
A substantial number of children may have seen an ophthalmologist without the results of their examinations having been reported back. Unfortunately we do not have data on whether forms were given to parents of all referred children, whether the parents understood the instruction to give the form to the ophthalmologist, whether the ophthalmologists filled out the forms and gave the forms back to the parents, whether the parents returned the forms to the screening nurse and whether the form was sent to the study centre and entered in the database. This will be followed up on in the future.
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