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Effectiveness of routine population-wide orthoptic preschool vision screening tests at age 6-24 months in the
Frea Sloot1, Marieke Alberdina Johanna Telleman1, Janine Benjamins2
1Department of Ophthalmology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Insights
Vision screening effectiveness for amblyopia was not affected by omitting preverbal orthoptic tests. Visual acuity measurements were key for detecting refractive and bilateral amblyopia in young children.
Area of Science:
- Ophthalmology
- Pediatric vision screening
Background:
- Early detection of amblyopia is crucial for effective treatment.
- Population-wide screening aims to identify visual impairments in infants and young children.
- Orthoptic tests are traditionally used in preverbal children to assess eye alignment and motility.
Purpose of the Study:
- To assess the effectiveness of population-wide vision screening using preverbal orthoptic tests at 6, 9, 14, and 24 months of age.
- To compare the outcomes of routine vision screening with a modified approach omitting specific orthoptic tests.
Main Methods:
- Two birth cohorts were compared across 134 centers.
- The intervention group received vision screening four times between 6 and 24 months, including inspection, pupillary reflexes, eye motility, Hirschberg, cover test, and monocular pursuit.
- The control group received screening only for visually apparent abnormalities or positive family history, with visual acuity measured at 36 and 45 months.
Main Results:
- Amblyopia prevalence was similar between the groups (3.3% vs. 3.1%).
- Referral rates and the proportion of children diagnosed with amblyopia after visual acuity (VA) measurement were comparable.
- Refractive and bilateral amblyopia were predominantly detected through VA measurements in both groups.
Conclusions:
- Omitting preverbal orthoptic tests in routine vision screening did not impact overall effectiveness.
- Visual acuity measurements are highly effective for detecting refractive and bilateral amblyopia in young children.
- Screening strategies can be optimized by focusing on visual acuity assessment.
Purpose:
The effectiveness of preverbal orthoptic tests at age 6, 9, 14 and 24 months in population-wide screening was assessed.
Methods:
Two consecutive birth cohorts at 134 centres were compared. At general health screening visits, children born July-December 2011 were vision screened four times between 6 and 24 months with inspection, pupillary reflexes, eye motility, Hirschberg, cover test and monocular pursuit. Children born January-June 2012 were vision screened at general screening visits only in case of visually apparent abnormalities or positive family history. After referral, cause and severity of amblyopia were determined. Visual acuity was measured in all children at 36 and 45 months.
Results:
The control and intervention group comprised 5649 versus 5162 children. Amblyopia was diagnosed in 185 (3.3%) versus 159 children (3.1%), outside of screening in 21 (11.4%) versus 25 (15.7%). Between 6 and 24 months, 44 (23.8%) versus 27 (17%) (RR = 0.67 [95% CI 0.42, 1.09]) were referred and after visual acuity (VA) measurement 120 (64.9%) versus 107 (67.3%). Of 109 versus 108 children with refractive or bilateral amblyopia, 94 (86.2%) versus 92 (85.2%) were detected with VA measurements. Visual acuity of the amblyopic eye, after referral, was not significantly different between groups (p 0.896), nor was the time to amblyopia diagnosis (intention to screen [p 0.55]; per protocol [p 0.11]).
Conclusion:
The effectiveness of vision screening was not influenced by omission of orthoptic tests at general health screening at 6-24 months. Refractive and bilateral amblyopia were almost exclusively found by VA measurements.
