Käsmann-Kellner B, Heine M, Pfau B, Singer A, Ruprecht K W
Orthoptik und Kinderophthalmologie, Universität des Saarlandes, Homburg, Saar.
Klin Monbl Augenheilkd. 1998 Sep;213(3):166-73. doi: 10.1055/s-2008-1034968.
There are controversies concerning the necessity of pre-school vision screening.
evaluation of the prevalence of pathologic ophthalmologic findings in kindergarten children.
1030 families were offered a vision screening. Of these, a total of 948 children, aged 3 to 6 years, voluntarily underwent a screening for strabismus, amblyopia and refractive anomalies. The examination was performed in the kindergarten in the absence of the parents. METHODS OF EXAMINATION: A questionnaire concerning general and ophthalmologic history of the child and of the family was evaluated. Visual acuity, cover-uncover-test, Lang-stereotest, retinoscopy, ophthalmoscopy (undilated pupils) were performed and the glasses were evaluated.
The screening was highly accepted by the parents and 92% of the families (n = 948) took part. The compliance of the children was very good. A total of 38.7% (n = 381) of the children showed one or more abnormal parameters. 21.4% (n = 229) showed a reduced visual acuity. Strabismus was found in 3.7%. Half of the children with abnormal findings already had had a vision screening, but only 25% had received ophthalmologic treatment. Of those who possessed glasses, 25% came without them, and another 25% had a reduced visual acuity even with their glasses. The main problems were many false-positive results and high costs.
Ophthalmologic and orthoptic screening in kindergarten is technically easy and conclusive in experienced hands. Ideas to reduce costs and to avoid overreferrals are an age-related lowering of the visual acuity limit and a rescreening of suspected children in a screening-setting a second time before sending them to an ophthalmologist. Another possibility to reduce costs would be to perform examinations not by ophthalmologists but by "screening-orthoptists" who should be trained in retinoscopy and ophthalmoscopy.
关于学前视力筛查的必要性存在争议。
评估幼儿园儿童病理性眼科检查结果的患病率。
为1030个家庭提供视力筛查。其中，共有948名3至6岁的儿童自愿接受斜视、弱视和屈光不正的筛查。检查在幼儿园进行，家长不在场。检查方法：评估一份关于儿童及其家庭的一般和眼科病史的问卷。进行视力、遮盖-去遮盖试验、朗氏立体视检查、检影验光、眼底镜检查（瞳孔未散大）并评估眼镜情况。
家长对筛查的接受度很高，92%的家庭（n = 948）参与。儿童的依从性非常好。共有38.7%（n = 381）的儿童表现出一个或多个异常参数。21.4%（n = 229）的儿童视力下降。斜视的检出率为3.7%。一半有异常检查结果的儿童已经进行过视力筛查，但只有25%接受过眼科治疗。在佩戴眼镜的儿童中，25%未戴眼镜前来，另有25%即使戴了眼镜视力仍下降。主要问题是假阳性结果多和成本高。
在有经验的人员操作下，幼儿园的眼科和斜视检查在技术上容易且结论明确。降低成本和避免过度转诊的方法包括根据年龄降低视力下限，以及在将疑似儿童送往眼科医生处之前，在筛查环境中对其进行再次筛查。另一种降低成本的可能性是不由眼科医生进行检查，而是由经过检影验光和眼底镜检查培训的“筛查斜视矫正师”进行检查。
