Page 176 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 9
In the Netherlands, Child Health Care (CHC) centres exist since 1901. The first CHC centre was an initiative of the Dutch paediatrician Dr. Plantenga, who was inspired by Pierre Budin, an French obstetrician, who had opened the first baby clinic in 1892 in Paris. Babies were examined, weighed and instructions and advices were given to mothers about hygiene and breastfeeding.1,2,3 This first private initiative was followed by other organizations and eventually became nationwide implemented in the Netherlands. Vision screening, primarily for the detection of amblyopia, was added to general health screening at the CHC centres after 1960 and included inspection, testing of ocular alignment, monocular visual acuity (VA) and stereo acuity testing in children aged three years and older. 4,5 At that time children were diagnosed with amblyopia at approximately age six or seven and treatment started at that age is much less effective and successful than when started at age four or five.
Vision screening was extended with the preverbal orthoptic vision screening Early Detection of Visual Disorders (Vroegtijdige Onderkenning Visuele stoornissen: VOV) test after 1980, because it was assumed that amblyopia should be diagnosed and treated as early as possible. At 0-6 months of age this screening comprised inspection of the eyes, pupillary reflexes, red fundus reflex and eye motility to detect congenital eye disorders like cataract, retinoblastoma and congenital glaucoma. At 6-24 months, this preverbal screening comprised also Hirschberg test (corneal light reflex), cover test for detection of strabismus, and pursuit movements.6,7 Initially, these tests were intended to be performed by orthoptists at the CHC centres, but in the end these tests were performed by CHC physicians, after instructions given, in courses, by orthoptists.
To evaluate the effectiveness of the amblyopia screening in the Netherlands, the Rotterdam Amblyopia Effectiveness Study (RAMSES), an observational birth-cohort study (N=4624) was started in 1996. Three thousand children were followed form birth up to the age of seven. Children were examined at age seven and this study showed that preverbal screening contributed little to the detection of refractive amblyopia, while strabismus amblyopia was detected by the parents in approximately half of cases.8 If strabismus is first detected by the parents because it is visually apparent, screening is, in that case, not necessary. As stated above, preverbal vision screening with orthoptic tests at age 6-24 months was added to detect and treat amblyopia at an even younger age, assuming that amblyopia should be detected and treated as early as possible. The RAMSES study showed, however, that these tests mostly detected strabismus amblyopia, which is visually apparent.
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