Page 26 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 2
ABSTRACT
OBJECTIVE To examine the diversity in paediatric vision and hearing screening programmes in Europe.
METHODS Themes for comparison of screening programmes derived from literature were used to compile three questionnaires on vision, hearing and public health screening. Tests used, professions involved, age, and frequency of testing seem to influence sensitivity, specificity, and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU full-member, candidate, and associate states. Answers were cross-checked.
RESULTS Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity is measured in 35 countries, in 71% of these more than once. First measurement of visual acuity varies from three to seven years of age, but is usually before the age of five. At age three and four, picture charts, including Lea Hyvarinen, are used most; in children over four, Tumbling-E and Snellen. As first hearing screening test, otoacoustic emission is used most in healthy neonates, and auditory brainstem response in premature newborns. The majority of hearing testing programmes are staged; children are referred after 1-4 abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand.
CONCLUSIONS Largest differences were found in visual acuity charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4), and funding sources (8).
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