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Chapter 5156Refractive errors were frequently reported in all included studies (Table 1). Hyperopia was the most common refractive error, with a prevalence ranging from 6% to 48% for moderate to severe hyperopia. Moderate to severe myopia (3-10%) and high astigmatism (3-12%) were less frequent. One study showed an increase in high astigmatism with age.8Ocular findings that were most frequently reported were retinal vascular tortuosity (4-78%), posterior embryotoxon (41-50%), strabismus (12-36%), amblyopia (2-6%) and optic disc abnormalities (0-6%) (Table 1). Optic disk abnormalities consisted of hypoplastic or small optic discs (6%), and tilted optic discs (1%). Other ophthalmic findings that were reported were ptosis (4-6%), distichiasis (2-6%),8, 9 lens opacities (3-6%),7, 9 glaucoma (6%),9cataract (3%),7 iriscoloboma (3%),7 Peters’ anomaly (3%)7 and keratoconus (1%).17Dutch multicenter studyResultsIn our cross-sectional study, 132 patients (60 males, [45%]) were included. Median age at last ophthalmic screening was 8.9 (range 0-56) years, with 23% aged 18 years or older. Twenty-two patients (17%) were referred to the ophthalmologist for: suspected visual impairment (n=9), suspected reduced color vision (n=1), persistent conjunctivitis (n=1), recurrent eye lid infection (n=2), entropion (n=1), vitreous floaters (n=1), suspected papilledema (n=1), suspected eye movement disorder (n=1), suspected amblyopia (n=1), strabismus (n=2) and two patients for a second opinion because of esotropia (n=1) and amblyopia (n=1). Five patients received ophthalmic screening because of another underlying condition (juvenile idiopathic arthritis (n=4), diabetes mellitus (n=1)). VA was available for 109 patients (83%) and was normal in the majority (N=101, [93%]). Of the 23 patients who had no quantitative VA measurement, nine patients (39%) showed good fixation during ophthalmic screening. Reasons for a mild visual impairment (N=5, [5%]) were bilateral or unilateral amblyopia, mild cataract and high myopia. Three of these five patients (60%) were adults. Moderate visual impairment was found in two children (2%) with only dacryostenosis in one and mild hypoplastic optic disks in the other patient. Both patients were reported to have difficulties with performing the test.