Sloot Frea, Sami Aya, Karaman Hatice, Benjamins Janine, Loudon Sjoukje E, Raat Hein, Sjoerdsma Trijntje, Simonsz Huibert Jan
Department of Ophthalmology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
Orthoptics, University of Applied Sciences, Utrecht, the Netherlands.
Acta Ophthalmol. 2015 Jun;93(4):318-21. doi: 10.1111/aos.12556. Epub 2014 Oct 1.
To investigate omission of population-based eye screening at age 6-9 months in the Netherlands.
Prospective population-based consecutive birth cohort study was used. In two consecutive birth cohorts, children were eye screened at 1-2 and 3-4 months, but at general-health screening at 6-9 months, the second cohort was not eye screened, unless anything conspicuous was noted or in case of positive family history. Data were collected from screening records and anonymous questionnaires. Semi-structured daylong observations were made of physicians examining children aged 0-4 years, including children from the cohorts, by two orthoptic students.
58 of 6059 children (0.96%), in the screened, and 48 of 5482 children (0.88%) in the unscreened group were referred to orthoptist or ophthalmologist, mostly for observed strabismus. Amblyopia, all combined with strabismus, was diagnosed in ten screened (0.17%) versus six unscreened children (0.11%). Most physicians found preverbal examinations and decisions to refer difficult. The observations by orthoptic students revealed that cover test, pupillary reflexes, pursuit movements and eye motility were frequently performed inadequately, contrary to the Hirschberg test, at this age.
The screened and unscreened group differed little regarding the number of children referred and found to have amblyopia. Referral was mostly based on observed strabismus.
调查荷兰6至9个月龄儿童基于人群的眼部筛查遗漏情况。
采用前瞻性基于人群的连续出生队列研究。在两个连续的出生队列中，儿童在1至2个月和3至4个月时接受眼部筛查，但在6至9个月的一般健康筛查中，第二个队列未进行眼部筛查，除非发现明显异常或有阳性家族史。数据从筛查记录和匿名问卷中收集。两名斜视矫正专业学生对包括队列中的儿童在内的0至4岁儿童进行了为期一天的半结构化观察，观察医生对这些儿童的检查情况。
在接受筛查的6059名儿童中有58名（0.96%），在未接受筛查的5482名儿童中有48名（0.88%）被转诊至斜视矫正师或眼科医生处，主要原因是观察到斜视。筛查组中有10名（0.17%）、未筛查组中有6名（0.11%）被诊断为弱视，所有弱视均伴有斜视。大多数医生认为对学语前儿童的检查和转诊决定很困难。斜视矫正专业学生的观察结果显示，在这个年龄段，与 Hirschberg 试验相反，遮盖试验、瞳孔反射、追踪运动和眼球运动的检查经常做得不充分。
在转诊儿童数量和弱视发现数量方面，筛查组和未筛查组差异不大。转诊主要基于观察到的斜视。
