title: Effect of omission of population-based eye screening at age 6-9 months in the Netherlands.
abstract: OBJECTIVE
  To investigate omission of population-based eye screening at age 6-9 months in the Netherlands.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Ophthalmology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Frea
authors.initials: F
authors.lastname: Sloot
authors.affiliation: Orthoptics, University of Applied Sciences, Utrecht, the Netherlands.
authors.forename: Aya
authors.initials: A
authors.lastname: Sami
authors.affiliation: Orthoptics, University of Applied Sciences, Utrecht, the Netherlands.
authors.forename: Hatice
authors.initials: H
authors.lastname: Karaman
authors.affiliation: Public Health Service Icare, Meppel, the Netherlands.
authors.forename: Janine
authors.initials: J
authors.lastname: Benjamins
authors.affiliation: Department of Ophthalmology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Sjoukje E
authors.initials: SE
authors.lastname: Loudon
authors.affiliation: Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
authors.affiliation: Municipal Health Service (GGD), Amsterdam, the Netherlands.
authors.forename: Trijntje
authors.initials: T
authors.lastname: Sjoerdsma
authors.affiliation: Department of Ophthalmology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Huibert Jan
authors.initials: HJ
authors.lastname: Simonsz
mesh_terms: D000550:Amblyopia / Q000175:diagnosis* / Q000453:epidemiology; D005133:Eye Movements / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015997:Neonatal Screening; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012025:Reflex, Pupillary / Q000502:physiology; D011795:Surveys and Questionnaires; D015351:Vision Screening; D014792:Visual Acuity / Q000502:physiology
keywords: amblyopia; eye screening; strabismus; vision screening