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Effectiveness of screening for amblyopia and other eye disorders in a prospective birth cohort study
Harry J de Koning1, Johanna H Groenewoud, V Kathleen Lantau
1Dept. of Public Health, Erasmus MC Dr. Molewaterplein 50 3015 GE Rotterdam, the Netherlands.
Insights
The Dutch vision screening program for children effectively reduces the risk of permanent vision loss. This study found the program significantly lowers the prevalence of amblyopia by over 50% in children by age seven.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- The Netherlands implements routine preverbal and preschool vision screening for all children.
- The effectiveness of this national vision screening program in preventing amblyopia and permanent visual loss has not been previously established.
- High screening attendance rates necessitate an evaluation of program efficacy.
Purpose of the Study:
- To determine the effectiveness of the current Dutch vision screening program in preventing permanent visual loss.
- To estimate the sensitivity and specificity of the vision screening program.
- To assess the impact of screening on amblyopia prevalence.
Main Methods:
- A 7-year cohort study followed 4624 children born in Rotterdam.
- Children underwent routine vision screening examinations from infancy through preschool age.
- Visual acuity was assessed at age seven, with further examination for children meeting specific criteria.
Main Results:
- Amblyopia prevalence was 3.4%, with a program sensitivity of 73% and specificity of 83%.
- At age seven, 0.7-1.2% of children had poor visual acuity (VA > 0.3 logMAR) in the worse eye, lower than reported rates in non-screening populations.
- Lower screening attendance correlated with a higher chance of poor vision at age seven.
Conclusions:
- The Dutch child vision screening program appears effective in reducing the risk of persistent amblyopia.
- The program may decrease the risk of significant visual impairment (VA > 0.3 logMAR) by over 50% by age seven.
- Consistent participation in vision screening is crucial for preventing long-term visual deficits.
Objective:
To establish whether the current vision screening practice in the Netherlands is effective in preventing permanent visual loss and to estimate the sensitivity of the programme.
Settings:
In the Netherlands, all children are invited for preverbal (1, 3, 6-9 and 14-24 months) and preschool (36, 45, and 60-72 months) vision screening. Screening attendance is high, but the effectiveness in reducing amblyopia is unknown.
Methods:
In a 7-year cohort study, 4624 children born in the city of Rotterdam between 16 September 1996 and 15 May 1997 were followed through all routine vision screening examinations. At age seven, visual acuity (VA) of children still living in Rotterdam was assessed by study orthoptists. In case of VA > 0.1 logMAR in one or both eyes, two or more logMAR lines of interocular difference or eye disorders like strabismus, children underwent a more intensive eye examination.
Results:
Attendance at the 9-month screening was 89%, decreasing to about 75% at later examinations. Of preverbal tests, 2.5% were positive, and of preschool tests, 10%. In total, 19% of children had a positive vision screening test at least once. Amblyopia prevalence was 3.4%. Sensitivity of the vision screening programme was 73% and specificity 83%. At age seven, 0.7-1.2% (confirmed vs final exam) of the children had a VA > 0.3 logMAR in the worse eye compared with 2-3.9% (in literature) reported prevalence in non-screening situations. Children who were less frequently screened had a higher chance of poor vision (>0.3 logMAR) at age seven.
Conclusion:
The Dutch child vision screening programme may reduce the risk of persistent amblyopia (VA > 0.3 logMAR) at age seven by more than half.
