Department of Ophthalmology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.
Child Healthcare, Icare, Meppel, The Netherlands.
Acta Ophthalmol. 2022 Feb;100(1):e100-e114. doi: 10.1111/aos.14859. Epub 2021 Apr 4.
The effectiveness of preverbal orthoptic tests at age 6, 9, 14 and 24 months in population-wide screening was assessed.
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.
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]).
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.
评估在 6、9、14 和 24 个月龄时进行预语言性视轴矫正测试在人群广泛筛查中的效果。
比较了在 134 个中心连续进行的两个出生队列。在一般健康筛查访视中，2011 年 7 月至 12 月出生的儿童在 6 至 24 个月期间接受了 4 次视力筛查，检查内容包括视力、瞳孔反射、眼球运动、Hirschberg 测试、遮盖试验和单眼追踪。2012 年 1 月至 6 月出生的儿童仅在出现明显的视觉异常或阳性家族史时，才在一般筛查访视中接受视力筛查。转诊后，确定弱视的原因和严重程度。所有儿童在 36 和 45 个月时测量视力。
对照组和干预组分别包括 5649 名和 5162 名儿童。在筛查之外诊断出弱视的儿童分别为 185 名（3.3%）和 159 名（3.1%），转诊的儿童分别为 44 名（23.8%）和 27 名（17%）（RR=0.67 [95% CI 0.42, 1.09]），在视力测量后分别为 120 名（64.9%）和 107 名（67.3%）。在 109 名和 108 名患有屈光不正性或双侧弱视的儿童中，分别有 94 名（86.2%）和 92 名（85.2%）通过视力测量发现。转诊后的弱视眼视力在两组间无显著差异（p=0.896），弱视诊断时间也无差异（意向筛查时 [p=0.55]；按方案筛查时 [p=0.11]）。
在 6-24 个月龄的一般健康筛查中省略视轴矫正测试并不影响视力筛查的效果。屈光不正性和双侧弱视几乎都是通过视力测量发现的。
