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

Abstract

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.

As‐indicated versus routine vision screening of preterm children: a 17‐year retrospective regional study

“…The frequency of vision impairment in extremely preterm children has been reported as 2.0-3.1% (Leversen et al 2012;Holmstrom et al 2014, andFledelius et al 2015) compared to our finding of 3.0%. Holmstrom et al (Holmstrom et al 2014) found only 51% of extremely preterm children able to participate in optotype testing at 2.5 years and 32.1% failed optotype testing at 3 years in a recent Dutch study (Telleman et al 2019). In comparison with the cited studies, our subjects were less preterm on average in terms of gestational age and birthweight.…”

“…) found only 51% of extremely preterm children able to participate in optotype testing at 2.5 years and 32.1% failed optotype testing at 3 years in a recent Dutch study (Telleman et al. ). In comparison with the cited studies, our subjects were less preterm on average in terms of gestational age and birthweight.…”

Costs and effects of conventional vision screening and photoscreening in the Dutch preventive child health care system

“…Conventional vision screening included measurement of visual acuity with the Amsterdam Picture Chart (APK) in 3y and with the Landolt-C chart at the ages of 3y9m and 5/6y. 7 , 8 Measurements are usually performed at a distance of 5 m. The line number per eye of smallest symbols that the child could read should be registered, but often testing was stopped as soon as a pass was obtained. Cut-off criteria for visual acuity are age-dependent.…”

Plusoptix photoscreener use for paediatric vision screening in Flanders and Iran

“…Measurement of VA in children at the age of 36 months as part of population‐wide screening fails in 16.6% of children, in addition to 15.5% of children not reaching the threshold and, hence, cannot be done cost‐effectively (Telleman et al. ). The rates of failed measurement of VA are lower when performed by experienced orthoptists (Becker et al.…”