In this study the authors observed whether and how well orthoptic tests are performed by non-orthoptists in a screening setting. They assessed the quality of screening tests by semi-structured observations of youth health care (YHC) physicians who screened children aged 1-45 months. They observed 25 YHC physicians for a period of eight weeks while examining 503 children. After study exclusions, the study included 82 children aged 1-4 months, 157 aged 6-24 months and 90 aged 36-45 months. For ages of 1-24 months, fundus red reflex was tested in 73 children, Hirschberg’s tests in 210, pupil reflexes in 33, cover-uncover test in 102, alternate cover test in 98 and ocular movements in 106 children. For ages 36-45 months, visual acuity was tested in 85 children. In total 13/329 children were referred; 10 due to insufficient visual acuity, one with abnormal red reflex, and two with suspected strabismus. They found that the Hirschberg test, red reflex and visual acuity were measured according to guidelines in most cases. Cover test and ocular motility testing were often not performed correctly. Pupil reflexes were often skipped as room lights could not be dimmed. This study raises issues regarding appropriate eye screening by non-specialist clinicians.

Semi structured observation of population-based eye screening in the Netherlands.
Sloot F, Sami A, Karaman H, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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