High rate of failed visual-acuity measurements with the Amsterdam Picture Chart in screening at the age of 36 months

Purpose: In the Netherlands, youth health care physicians and nurses screen all children for general health disorders at Child Health Care Centers. As part of this, the eyes are screened seven times, with the first visual acuity (VA) measurement at 36 months with the Amsterdam Picture Chart (APK). The suitability of the APK has been questioned. Methods: Children born between July 2011 and June 2012 born in the provinces Drenthe, Gelderland and Flevoland and invited for screening at 36 months were eligible. Parents were sent the APK picture optotypes to practise with their children in advance. Data were collected from electronic screening records. The Dutch vision screening guideline prescribes that children with VA <5/6, or one line interocular difference (not logMAR, however) should be retested or referred. Results: Of 10 809 eligible children, 1546 did not attend and 602 attended but had no VA measurement at age 36 months, 247 of these were under orthoptic treatment. Of the 8448 children examined, VA was sufficient in 5663 (67.0%) and insufficient in 1312 (15.5%). In 1400 (16.6%), the measurement of VA itself failed. In 73 (0.9%), data were missing. Of the 216 children with 2 failed VA measurements, 150 (69%) were not referred, and measurement of VA was deferred to the next general screening examination at 45 months. Conclusion: Although most parents had practised the APK picture optotypes at home with their children, the rate of failed APK measurements plus the measurements with insufficient VA was 32.1% at 36 months. Similar rates have previously been reported for Lea Symbols and HOTV, permitting the conclusion that measurement of VA at the age of 36 months cannot be recommended as a screening test in the general population

Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania

BACKGROUND In 2018 and 2019, paediatric vision screening was implemented in Cluj County,Romania, where universal paediatric vision screening does not yet exist. We report on the preparation and the first year of implementation. METHODS Objectives, target population and screening protocol were defined. In cities, children were screened by kindergarten nurses. In rural areas, kindergartens have no nurses and children were screened by family doctors’ nurses, initially at the doctors’ offices,later also in rural kindergartens. CME-accredited training courses and treatment pathways were organised.Implementation was assessed through on-site observations, interviews, questionnaires and analysis of screening results of referred children. RESULTS Out of 12,795 eligible four- and five-year-old children, 7,876 were screened in 2018. In the cities, kindergarten nurses screened most children without difficulties. In Cluj-Napoca 1.62x the average annual birth rate was screened and in the small cities 1.64x. In the rural areas, however, nurses of family doctors screened only 0.49x the birth rate.In 51 out of 75 rural communes, no screening took place in the first year. Of 118 rural family doctors’ nurses, 51 had followed the course and 26 screened children. They screened only 41 children per nurse, on average, as compared to 80 in the small cities and 100 in Cluj-Napoca. Screening at rural kindergartens met with limited success. These are attended by few children because of low population density, parents working abroad or children being kept at home in case of bad weather and road conditions. CONCLUSIONS Three times fewer children were screened in rural areas as compared to urban areas. Kindergartens in rural areas are too small to employ nurses and family doctors’ nurses do not have easy access to many children and have competing healthcare priorities: there are 1.5x as many family doctors in urban areas as compared to rural areas. For nationwide scaling-up of vision screening, nurses should be enabled to screen a sufficient number of children in rural areas

Inventory of current EU paediatric vision and hearing screening programmes

OBJECTIVE: To examine the diversity in paediatric vision and hearing screening programmes in Europe. METHODS: Themes for comparison of screening programmes derived from literature were used to compile three questionnaires on vision, hearing, and public health screening. Tests used, professions involved, age, and frequency of testing seem to influence sensitivity, specificity, and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists, and audiologists involved in paediatric screening in all EU full-member, candidate, and associate states. Answers were cross-checked. RESULTS: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% of these more than once. First measurement of VA varies from three to seven years of age, but is usually before age five. At age three and four, picture charts, including Lea Hyvarinen, are used most; in children over four, Tumbling-E and Snellen. As first hearing screening test, otoacoustic emission is used most in healthy neonates, and auditory brainstem response in premature newborns. The majority of hearing testing programmes are staged; children are referred after 1-4 abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists, or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. CONCLUSION: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4), and funding sources (8)

Inventory of current EU paediatric vision and hearing screening programmes

Background: We examined the diversity in paediatric vision and hearing screening programmes in Europe. Methods: Themes relevant for comparison of screening programmes were derived from literature and used to compile three questionnaires on vision, hearing and public-health screening. Tests used, professions involved, age and frequency of testing seem to influence sensitivity, specificity and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists and audiologists involved in paediatric screening in all EU fullmember, candidate and associate states. Answers were cross-checked. Results: Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% more than once. First measurement of VA varies from three to seven years of age, but is usually before the age of five. At age three and four picture charts, including Lea Hyvarinen are used most, in children over four Tumbling-E and Snellen. As first hearing screening test otoacoustic emission (OAE) is used most in healthy neonates, and auditory brainstem response (ABR) in premature newborns. The majority of hearing testing programmes are staged; children are referred after one to four abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Conclusion: Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4) and funding sources (8)