Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
Department of Ophthalmology, Skaraborg Hospital, Skövde, Sweden.
Acta Ophthalmol. 2019 Mar;97(2):158-164. doi: 10.1111/aos.13900. Epub 2018 Oct 2.
To evaluate the current vision screening criteria regarding amblyopia and refractive errors, with emphasis on screening limits and retesting, in Region Västra Götaland (VGR), Sweden. Visual acuity (VA) screening is performed by nurses at primary healthcare centres (PHCs) in 4-year-old children and at school in 6- or 7-year-old children. Children with VA <0.65 (>0.19 logMAR) at either eye are referred. If VA is 0.65 in one or both eyes, a retest is performed by nurses at PHCs and schools, the children are then referred if VA is <0.8 (>0.10 logMAR).
We included all children aged ≥5 and <8 years referred between October 2014 and June 2015 from PHCs and schools to the four eye clinics in VGR, with VA ≥0.65 in one or both eyes. At the eye clinic, children underwent assessment of VA, refraction in cycloplegia, eye motility, cover test, stereo test and a slit lamp examination.
Among the 259/295 children (139 female) participating, median age was 5.7 years (5.0-7.8 years) at referral. Glasses were prescribed due to subnormal VA with refractive errors in 20% of the children, 22% displayed heterophoria, none had heterotropia and one younger child had amblyopia. Accurate retesting gave fewer false-positive referrals.
Our results showed that a vision screening referral cut-off limit of VA <0.65 would leave undetected refractive errors. Residual amblyopia was uncommon. Accurate referral criteria, retesting and training of those performing the screening as well as re-evaluation of the screening programme are all important.
评估瑞典西约塔兰地区（VGR）目前关于弱视和屈光不正的视力筛查标准，重点关注筛查的界限和复查，在 VGR，5 岁和 7 岁之间的儿童在基础保健中心（PHC）和学校进行视力筛查，4 岁儿童进行视力筛查。在任何一只或两只眼睛的视力（VA）<0.65（>0.19 logMAR）的儿童将被转诊。如果一只或两只眼睛的 VA 为 0.65，则在 PHC 和学校由护士进行复查，如果 VA<0.8（>0.10 logMAR），则将儿童转诊。
我们纳入了 2014 年 10 月至 2015 年 6 月期间从 PHC 和学校转诊到 VGR 四家眼科诊所的所有≥5 岁且<8 岁的儿童，这些儿童双眼中有一只或两只眼睛的 VA≥0.65。在眼科诊所，儿童接受 VA 评估、睫状肌麻痹下的屈光检查、眼球运动检查、遮盖试验、立体视检查和裂隙灯检查。
在参与的 259/295 名儿童（139 名女性）中，转诊时的中位年龄为 5.7 岁（5.0-7.8 岁）。由于屈光不正导致 VA 低于正常值，20%的儿童需要配镜，22%的儿童有隐斜视，没有显斜视，有一名年龄较小的儿童有弱视。准确的复查可减少假阳性转诊。
我们的结果表明，VA<0.65 的视力筛查转诊截止值会漏诊屈光不正。残余弱视并不常见。准确的转诊标准、对实施筛查的人员进行复查和培训，以及重新评估筛查方案都非常重要。
