Departments of Public Health, Erasmus Medical Center (MC), University Medical Center Rotterdam, Rotterdam, The Netherlands.
Invest Ophthalmol Vis Sci. 2010 Jul;51(7):3476-84. doi: 10.1167/iovs.08-3352. Epub 2010 Jan 20.
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.
目的。荷兰基于人群的儿童健康监测计划包括定期的言语前期（1-24 个月）和学前（36-72 个月）视力筛查。本研究旨在探讨有组织的视力筛查计划对弱视检测的贡献。
方法。1996/1997 年，在鹿特丹启动了一项针对 4624 名儿童的 7 年出生队列研究。视力筛查数据来自儿童筛查中心。在区域眼科部门工作的治疗性视轴矫正专家提供了诊断和治疗信息。两位专家对诊断进行了复查。父母通过书面问卷和电话访谈提供了有关孩子眼部病史的额外信息。在 7 岁时，研究视轴矫正专家对孩子进行了最终检查。
结果。2004 年，仍居住在鹿特丹的 3897 名儿童中，有 2964 名（76.1%）接受了最终检查。这些儿童中诊断出弱视 100 例（95%CI，2.7-4.0）。7 岁时，23%的儿童视力大于 0.3 logMAR。弱视的病因包括屈光不正（n=42）、斜视（n=19）、联合机制（n=30）、剥夺（n=7）或未知原因（n=2）。83 例弱视病例在 7 岁前已被发现。56 例儿童视力筛查阳性（其中言语前期 15 例，学前 41 例）后，弱视的检出率为 56 例。26 例其他弱视患儿为自我转诊（首次筛查阳性前，n=12），特别是斜视或联合机制弱视；另一名阳性筛查弱视患儿的情况不确定。由于转诊失败（n=4，其中 3 名在 7 岁时视力大于 0.3 logMAR）或筛查假阴性（n=13），有 4 例弱视患儿直到 7 岁才被发现。
结论。大多数弱视病例通过视力筛查结合视力测量发现。言语前期筛查对屈光不正性弱视的检出率贡献不大。
