Page 79 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Semistructured observation of population-based eye screening in The Netherlands
Age category between 1 and 24 months of age
Fundus red reflex testing was performed in 73 out of 82 children (89%). CHC physicians performed the Hirschberg test in 210 out of 239 children (88%), two of the 210 (1%) performed Hirschberg tests could not be assessed due to lack of cooperation of the child. In the remaining 29 out of 239 children (12%), Hirschberg test was not performed for unknown reasons. Pupillary reflexes were tested in 33 out of 239 children (14%), 19 (58%) of these tests were performed in a lit room; in most cases the light could not be switched off. Twenty-four out of 33 (73%) pupillary reflexes were performed on children younger than four months. Of the 239 children, 157 were between 6 and 24 months of age. Cover-uncover test was not performed in 55 out of 157 children (35%) and alternating-cover test was not performed in 59 children (38%). Fifteen of the 102 (15%) performed cover-uncover tests and 14 of the 98 (14%) performed alternating- cover tests could not be assessed due to lack of cooperation of the child. Incomplete covering of the eye and/or too quick switching from the covered to the uncovered eye was noted in 38 of performed cover-uncover tests (37%) and 49 of performed alternating-cover tests (50%) (Table 1).
Eye motility was tested in 106 out of 157 children (68%). Not all the eight gaze directions (horizontal, vertical and diagonal) were tested in 99 of the 106 performed eye motility tests (93%) (Table 1). Monocular pursuit was tested in 57 out of 157 children (36%); 52 of the 57 (91%) were well performed, but in five children (9%) a fixation object was used without a pen light.
Age category between 36 and 45 months of age
Ninety children were included in this group. Of these, 28 children (31%) were 36 months old and 62 children (69%) were 45 months old. VA measurement was performed in 85 out of 90 children (94%). From the remaining five children, four children (5%) were under treatment of an orthoptist and therefore not screened and in one child (1%) it was unknown why VA measurements had not been performed. Three out of the 85 (3%) performed VA measurements failed due to developmental problems.
VA charts were used at 5-meter distance in 80 children (94%). In two cases, APK chart distance was three meters due to a small room size. According to the guidelines, CHC physicians have to start with measurements of the right eye to avoid wrong notations. In 14 children (16%) VA measurements were started with the left eye. In 4 of these 14 children (29%), this was done due to an uncertain examination result of the left eye at the last screening examination or because the parents had noticed something conspicuous with the left eye. In some children, the CHC physician did not measure
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