Page 80 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 4
beyond 0.5 decimal VA line. VA was measured up to the highest level on the optotype chart in 75 children (89%). Here the problem is that, according to the Guideline, the child passes when both eyes reach 0.5 VA with the Landolt-C but when a difference of 2 lines is found, for instance 0.5 and 0.8, the child should be referred. The Landolt-C chart was not used in 15 of the 62 children of 45 months of age and the APK was used alternatively.
In total 13 out of 329 children (4%) were referred. Ten children (77%) were referred due to insufficient VA at age of 36 or 45 months. These referrals were based on correctly performed VA measurement by the CHC physicians with an insufficient result. The other three children (23%) were referred between the ages of 0-24 months. One child was referred because of abnormal, but correctly performed fundus red reflex. One child was referred because the parents had noticed strabismus, positive family history of strabismus, and a correctly performed cover-uncover test and eye motility test. The final child was referred because the parents had noticed strabismus, positive family history of strabismus, but not correctly performed cover-uncover test.
After referral, children were followed up by calling the parents to enquire the results of the referral. In five children, no results could be obtained because parental permission was not given or the parents could not be reached. Data were obtained for eight children, all between 36 and 45 months of age and referred due to low VA. Two of them were diagnosed with amblyopia, one child had an exotropia with good vision, one child had a moderate bilateral hypermetropia, two children had normal findings (false positives), and the parents of one child did not comply with the referral.
General results of this study were presented to all participating CHC physicians during three meetings. During these meetings the majority of the CHC physicians stated that they indeed had difficulty with the performance and interpretation of the cover-uncover test, alternate-cover test, and monocular pursuit. In addition, some of them would like to have an additional training to improve their execution of eye screening tests. They also reported that they often skipped pupillary reflexes because the room lights cannot be switched off. Further, it appeared that about half of the CHC physicians thought that testing monocular pursuit gave an indication of eye motility and had not understood that monocular pursuit movement is an indirect measurement of VA.
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