Page 86 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

CHAPTER 4
Appendix 1: Overview of the Dutch eye screening program (Nederlands Centrum Jeugdgezondheidszorg 2010)
Examinations
Age in months
1-2 3-4
x x x x
x x
6-9 14-24
x x x x
x x
x x x x x x x x
36 45
xx
Inspection of the anterior segment of the eye
Pupillary reflex: In the dark, the pupils are inspected for size
and equal reaction to light.
Fundus red reflex: the optic media are assessed with a co- axial light by viewing the eye at 15cm distance, through an ophthalmoscope for a white pupil caused by retinoblastoma, congenital cataract or other opacities.
Hirschberg test: The observer shines a white penlight into the eyes of the child and observes whether the corneal light reflections in both eyes are approximately at the same distance of the edge of the pupil.
Cover test: The child looks at a penlight and one eye is covered. If the other eye moves to fixate the penlight that eye was squinting.
Alternating cover test: The child looks at a penlight and the eyes are covered alternatingly. If the eye moves to fixate when the cover is removed, that eye was squinting.
Eye motility: The child follows a penlight to test free movement in up, down, right, left, bottom left, bottom right, top left and top right gaze.
Pursuit movements: While one eye is covered, the child follows an object that moves from left to right or right to left. A steady, smooth pursuit movement is only possible when vision of the eye is good. This test is a strong indicator of amblyopia in young children.
Visual acuity with Amsterdam Picture Chart: a non-logarithmic Dutch picture optotype chart. A VA of 5/6 or more in both eyes, with no more than one line difference between the
eyes at 36months is considered sufficient. Tests should be repeated within three months in case of uncertain outcome, for instance lack of cooperation or a near-threshold VA. If
a child fails the screening or has two uncertain outcomes a referral is made to a general practitioner, orthoptist or ophthalmologist.
Visual acuity with Landolt-C Chart: A non-crowded logarithmic chart. A VA of 0.5 or more in both eyes, with no more than one line difference between the eyes at 45 months is considered as sufficient. Tests should be repeated within three months in case of uncertain outcome, for instance lack of cooperation of the child or a near-threshold VA. If a child fails the screening or has two uncertain outcomes a referral is made to a general practitioner, orthoptist or ophthalmologist.
x
x
84