Page 95 - 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
proposal as it concerned population-based prevention and that the “Besluit Publieke Gezondheid” (Public Health Decision, Ministry of Health 2008) applied, where only permission to deviate from the national screening guidelines is required (reference number MEC-2012-003). Permission was granted from the Dutch Health Care Inspectorate to deviate from the national screening guidelines. The research adhered to the tenets of the Declaration of Helsinki.
Data Collection
Screening
Vision screening data were collected from the electronic screening records from the CHC’s. The CHC organizations provided an Excel dataset to the researchers. Treating orthoptists working in the study area provided clinical orthoptic data. Orthoptists filled out a standardized form for each first hospital visit of a child in the two birth cohorts about diagnose and treatment. The treating orthoptists were asked to indicate whether the child (possibly) had amblyopia and, if amblyopia was suspected, whether it was strabismic, refractive, combined-mechanism or deprivation amblyopia.
Anonymous questionnaires
Anonymous questionnaires were designed to evaluate preventive CHC physicians’ opinion about preverbal screening and referral. Questionnaires were made by the research team in a focus group and were distributed to all participating preventive CHC physicians twice. The questionnaire included detailed questioning about preverbal and preschool eye screening, that is, questions about demographics, different tests used, execution of the different tests, difficulty of the different tests and referral procedures. Questions about the adherence to the study protocol were also incorporated.
On-site observations
On-site observations were performed by two orthoptic students (A.S. & H.K.) in a separate study population, that is, at the participating CHC’s, but not necessarily children from one of the two birth cohorts. Fifteen CHC’s with 25 employed preventive CHC physicians were participating. Of the entire physical examination, only eye screening was observed in a semi-structured fashion. The observation comprised demographics, parents’ language skill and detailed assessment of physicians’ performance of fundus reflex, pupillary reflex, Hirschberg test, cover and alternating cover test, eye motility, visual-acuity measurement, room and chart illumination, type of chart and testing distance.
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