SummaryIncluded in a general health control of an un‐selected population of 2 447 four‐year‐old children, a vision screening was performed, using a visual acuity test (Marquez‐Bostrom's hooks), cover test and Wirt Fly Stereo test. The screening could be carried out in 98% of the children. 364 children (15.2%) were referred because of newly detected visual defects, and 358 children (15.0%) were professionally examined. Of these, 40.8% had a visual acuity of ≤0.6 and 5.9% of ≤0.1. Functional amblyopia was found in 12.3% and manifest strabismus in 10.3%, The main error of refraction was hyperopia (≥ 2.5 D), diagnosed in 28.5%, while myopia was infrequent, 3.9%.The children examined by the ophthalmologist were also classified into four groups, according to their need of professional care, where group 0 means overreferral and groups 2–3 represent “significant eye disorders”, in need of ophthalmological treatment and/or observation. Overreferral was found in 16.5% and significant eye disorders in 43%. With the visual acuity test, 97% of the children with eye disorders were detected. Retesting children, who failed the tests, reduced the over‐referral from 39.5% to 12.5% (p<0.001). By lowering the passing standards of the visual acuity test, still fewer children would have been overreferred, but, at the same time, 1/5 of children needing treatment would then have remained undiscovered.Including children already under professional care, the prevalence of strabismus in this unselected material of 4‐year‐old children was just below 4%, and the need for corrective glasses around 8%.Children reported to have family eye disorders, partus complications or present eye complaints were in the risk zone for suffering significant eye disorders, but this information from the parents was not sufficiently selective to be of practical value as a screening method.A small control group of 73 children and a follow‐up of 479 children at school 3 years later, revealed that no children with functional amblyopia were missed at the screening test.

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Visual acuity in children with amblyopia might be overestimated if the HVOT test alone is used to assess vision. Use of the HVOT chart, therefore, should be restricted to the 3.5-4.5 years age group, for whom the KM chart is somewhat too difficult. In our opinion the KM chart should be preferred for use with older preschool children because it shows good consistency with the Monoyer chart.

An analysis of visual defects among 310 children referred from a vision screening of 2 178 7-year-old children revealed a 50% frequency of significant eye defects among the referrals (7% of screened children). Of the screened children, one group (1 530 children) had previous visual screening three years earlier. The other group (648 children) had no previous vision screening until the age of seven. A comparison between the two groups showed that the risk of finding a new significant eye disorder in a school entrant was more than 6 times greater for a child who was not examined in his preschool years, and the risk of finding an amblyopic child was more than 10 times greater. The results do indicate the need for continuation of the present vision screening program of pre-school children.

Quantitative analyses of plasma concentrations of retinol binding protein (RBP), prealbumin and total proteins were performed in normal subjects and in forty-two patients suffering from diseases of the intestine and liver. The visual dark adaptation ability (DAA) was also assessed. Reduction of DAA and of RBP and prealbumin levels was noted in patients with chronic liver disease and fat malabsorption. In sixty-eight patients with intestinal diseases the RBP concentration seemed to be reduced in relation to the degree and duration of steatorrhoea. Furthermore, inflammatory activity, as revealed by laborabory tests, markedly reduced the RBP level. Treatment with vitamin A increased the RBP and prealbumin concentrations and restored the DAA to normal in patients with malabsorption but normal liver function. In patients with liver disease reduced DAA and serum RBP values were not affected by vitamin A therapy. Only at RBP concentrations below half the normal was impairment of the dark adaptation observed, suggesting that serum RBP is a more sensitive indicator of vitamin A deficiency than measurement of dark adaptation.