Page 93 - DISINVESTMENT AND IMPLEMENTATION OF VISION SCREENING TESTS BASED ON THEIR EFFECTIVENESS

Effect of omission of population-based eye screening at age 6-9 months in the Netherlands
INTRODUCTION
Pierre Budin, an obstetrician, opened the first baby clinic in 1892 in Paris, where babies were examined, weighed and instructions and advices were given to mothers about hygiene and breastfeeding.1,2 In 1901 a Dutch paediatrician Dr. Plantenga inspired by the French initiative opened the first Child Healthcare Centre (CHC) in the Netherlands, an office where mothers came with their newborns. This first private initiative was followed by other organizations and eventually became nationwide implemented. Aim of these organizations was to improve the overall health of infants and lower the infant mortality.3 Since approximately 1960, eye screening became implemented in this health screening programme. Examination included inspection, ocular alignment, monocular visual acuity and stereo acuity testing in children from the age of three. It was suggested that the CHC’s could play an important role in the detection of amblyopia.4,5 As the general belief was that the earlier amblyopia was discovered and treated the better, eye screening was extended in the 1980’s with the preverbal VOV (“Vroegtijdige Onderkenning Visuele stoornissen”: early detection of visual disorders) test. At 0-6 months this test comprises inspection of the eyes, pupillary reflexes, red fundus reflex and eye motility. At 6-24 months, this test comprises also Hirschberg test, cover test and pursuit movements, but no red fundus reflex testing.6,7
Nowadays, with four preverbal eye exams (at 1-2, 3-4, 6-9, 14-24 months) and three visual acuity tests (at 36, 45 and 54-60 months) the Netherlands have one of the most extensive eye screening programmes worldwide. A high participation rate is reached, 97% coverage, because the eye screening is imbedded in a population-based, no-cost, voluntary, comprehensive health promotion, screening and vaccination programme.8 Eye screening at the CHC’s is performed by preventive child healthcare (CHC) physicians and nurses. These physicians follow a one-day eye screening course, given by an orthoptist that should be repeated once every 5 years.
To evaluate the effectiveness of the amblyopia screening in the Netherlands, the RAMSES birth-cohort study (N=4624) was performed. This study showed that preverbal screening contributed little to the detection of refractive amblyopia, while strabismic amblyopia was self-referred in approximately half of cases.9
Therefore, the Optimization of Amblyopia Screening (OVAS) study assesses whether the omission of preverbal eye screening leads to a decrease in the number of detected amblyopia cases at the age of 45 months.
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