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Rotterdam AMblyopia screening effectiveness study: detection and causes of amblyopia in a large birth cohort
Johanna H Groenewoud1, Angela M Tjiam, V Kathleen Lantau
1Departments of Public Health, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
This study shows that organized vision screening effectively detects amblyopia (lazy eye) in children. However, preverbal screening was less effective for detecting amblyopia caused by refractive errors.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- The Dutch child health monitoring program includes vision screening for children aged 1-24 months and 36-72 months.
- Early detection of amblyopia is crucial for effective treatment and preventing long-term vision impairment.
Purpose of the Study:
- To evaluate the contribution of an organized, population-based vision screening program to the detection of amblyopia in children.
- To assess the effectiveness of preverbal and preschool vision screening in identifying different types of amblyopia.
Main Methods:
- A 7-year birth cohort study involving 4624 children in Rotterdam, initiated in 1996/1997.
- Data collection included vision screening results, diagnostic information from orthoptists, and parental questionnaires/interviews.
- A final examination at age 7 years was conducted by study orthoptists for a subset of participants.
Main Results:
- Amblyopia was diagnosed in 3.4% of the 2964 children who completed the final examination.
- Refractive error was the most common cause of amblyopia (42 cases), followed by combined-mechanism (30) and strabismus (19).
- Vision screening detected 56 amblyopia cases, while 26 were self-referred; preverbal screening identified only 15 cases of amblyopia, primarily not refractive.
Conclusions:
- Organized vision screening, particularly preschool screening, is effective in detecting most cases of childhood amblyopia.
- Preverbal vision screening demonstrated limited contribution to detecting amblyopia caused by refractive errors.
- Further improvements in screening protocols may be needed to enhance early detection rates for all types of amblyopia.
Abstract:
PURPOSE. The Dutch population-based child health monitoring program includes regular preverbal (age range, 1-24 months) and preschool (age range, 36-72 months) vision screening. This study is on the contribution of an organized vision screening program to the detection of amblyopia. METHODS. A 7-year birth cohort study of 4624 children was started in 1996/1997 in Rotterdam. Vision screening data were obtained from the child screening centers. Treating orthoptists working at the regional ophthalmology departments provided information about diagnosis and treatment. The diagnosis was reviewed by two experts. The parents provided additional information on their child's eye history through written questionnaires and telephone interviews. At age 7 years, the children underwent a final examination by the study orthoptists. RESULTS. Of the 3897 children still living in Rotterdam by 2004, 2964 (76.1%) underwent the final examination. Amblyopia was diagnosed in 100 (3.4%) of these (95% CI, 2.7-4.0). At age 7, 23% had visual acuity >0.3 logMAR. Amblyopia was caused by refractive error (n = 42), strabismus (n = 19), combined-mechanism (n = 30), deprivation (n = 7), or unknown (n = 2). Eighty-three amblyopia cases had been detected before age 7. Amblyopia detection followed positive results in vision screening in 56 children, either preverbal (n = 15) or preschool (n = 41). Twenty-six other amblyopes were self-referred (n = 12, before a first positive screening test), especially strabismic or combined-mechanism amblyopia; data were uncertain for one other positively screened amblyopic child. Amblyopia remained undetected until age 7 due to unsuccessful referral (n = 4, three with visual acuity >0.3 logMAR at age 7) or false-negative screening (n = 13). CONCLUSIONS. Most cases of amblyopia were detected by vision screening with visual acuity measurement. Preverbal screening contributed little to the detection of refractive amblyopia.
