The Rotterdam AMblyopia Screening Effectiveness Study (RAMSES): compliance and predictive value in the first 2 years

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Abstract
BACKGROUND RAMSES is a 7 year follow up study, aiming at the evaluation of the effectiveness and the efficiency of screening for amblyopia. In this first report, concerning the first 2 years of life, the compliance with the prevention programme and the positive predictive value (PPV) of the screening tests used, are presented. METHODS All results of the standardised screening test for strabismus, applied by child healthcare physicians, within a birth cohort of 4072 Rotterdam children at the age of 9, 14, and 24 months, were registered. Children with a positive test result were referred to their general practitioner, who was asked to arrange a definitive referral to an ophthalmological centre. The results of the examinations at these centres were registered in standardised forms and served as reference for establishing the PPV. RESULTS The screening was (at least one time) attended by 3958 children (97%). 160 of these children (4%) were referred, of whom 101 (64%) visited an ophthalmological centre, so that a conclusive diagnostic evaluation was possible. For amblyopia, the predictive value of a positive test result followed by an effective referral was 0.42. CONCLUSION Referral procedures after a positive test result in the Dutch child healthcare screening programme for amblyopia need to be improved. The Dutch screening test used to detect amblyopia exhibits a relatively favourable PPV.