Page 77 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Semistructured observation of population-based eye screening in The Netherlands
and other relevant diagnoses, visual history of the child and his or her family, the child’s parents’ language skill, and the working experience of the CHC physician. In addition, all the examinations of the eye were listed on scoring checklists on the observation form to rate the performance quality of the tests, including the inspection of the external structures of the eye, fundus red reflex, and pupillary reflexes, and whether these tests were performed in light or dark conditions.
The cover-uncover and alternating-cover test were scored as “not possible to perform”, “not performed according to the guidelines”: incomplete covering of the eye and/ or too quick switching from the covered to the uncovered eye; or “well performed”: complete covering of the eye and/or switching adequately from the covered to the uncovered eye. Eye motility was scored as “not performed”, “partially performed”: not all the eight gaze directions; or “well performed”: maximum in all directions of gaze. The test of monocular pursuit movement, used as indirect measurement of VA, was scored as “not performed”, “not performed according to the guideline: performed using a fixation object without a pen light; or “well performed”: with pen light and fixation object. VA measurement was scored in detail, with scores for the type of optotype chart used, distance between chart and the child, and whether the exam was started with the right or left eye. Finally, to contact the parents after referral, permission was asked for follow-up of the child in case the child was referred to an orthoptist or ophthalmologist (Appendix 2).
In the first week, the observations were done simultaneously by the two orthoptic students, and after a week results of the observations were compared and checked for concordance. After the observation period, all observation forms were collected and analysed. Afterwards all CHC physicians were asked to participate in feedback sessions, where the general outcomes and findings of the observations were presented and discussed.
Excluded were children who took part in the study cohort of the OVAS study (children born between January 1st and June 30th 2012), because no eye screenings tests were performed in this cohort between 6 and 24 months of age. Children were also excluded when parental consent to attend the consultation and do the observation was not obtained. Children with missing observation forms were also excluded.
SPSS version 20 (for Windows IBM Corp., Armonk, NY, USA) was used to analyse the collected data.
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