Implementation of an Educational Cartoon (“the Patchbook”) and Other Compliance-Enhancing Measures by Orthoptists in Occlusion Treatment of Amblyopia

Implementation of paediatric vision screening in urban and rural areas in Cluj County, Romania

BACKGROUND

In 2018 and 2019, paediatric vision screening was implemented in Cluj County, Romania, where universal paediatric vision screening does not yet exist. We report on the preparation and the first year of implementation.

METHODS

Objectives, target population and screening protocol were defined. In cities, children were screened by kindergarten nurses. In rural areas, kindergartens have no nurses and children were screened by family doctors' nurses, initially at the doctors' offices, later also in rural kindergartens. CME-accredited training courses and treatment pathways were organised. Implementation was assessed through on-site observations, interviews, questionnaires and analysis of screening results of referred children.

RESULTS

Out of 12,795 eligible four- and five-year-old children, 7,876 were screened in 2018. In the cities, kindergarten nurses screened most children without difficulties. In Cluj-Napoca 1.62x the average annual birth rate was screened and in the small cities 1.64x. In the rural areas, however, nurses of family doctors screened only 0.49x the birth rate. In 51 out of 75 rural communes, no screening took place in the first year. Of 118 rural family doctors' nurses, 51 had followed the course and 26 screened children. They screened only 41 children per nurse, on average, as compared to 80 in the small cities and 100 in Cluj-Napoca. Screening at rural kindergartens met with limited success. These are attended by few children because of low population density, parents working abroad or children being kept at home in case of bad weather and road conditions.

CONCLUSIONS

Three times fewer children were screened in rural areas as compared to urban areas. Kindergartens in rural areas are too small to employ nurses and family doctors' nurses do not have easy access to many children and have competing healthcare priorities: there are 1.5x as many family doctors in urban areas as compared to rural areas. For nationwide scaling-up of vision screening, nurses should be enabled to screen a sufficient number of children in rural areas.

The impact of an eye drop booklet on distress in children when receiving eye drops

PURPOSE

Child- and family-centered care is an increasingly important area in healthcare. Up to now, little attention has been paid to the experience of children and their parents in ophthalmological healthcare. During their conversations at Bartiméus, children indicated that the administration of eye drops constituted the most stressful element that needed to be improved. This study describes the amount of distress experienced by children when receiving eye drops. Furthermore, it investigates the value and impact of the developed eye drop booklet, for children and parents.

METHODS

In this multicenter study on distress related to the administration of eye drops, 370 children participated with ocular disorders or Cerebral Visual Impairment CVI (4-12 years), from four ophthalmology outpatient clinics. Half of the children, randomly chosen, were presented with a booklet before receiving eye drops. A faces scale together with a numeric scale (0-10) was used to determine the level of distress before and after the eye drops were administered. Parents were asked how satisfied they were about using the booklet.

RESULTS

The average distress score of the children who did receive a booklet was 3.40 at T1 and 2.70 at T2, and, of the children who did not receive a booklet, this was 3.69 at T1 and 2.97 at T2. The largest levels of distress were found in children between the ages of 7 and 9. The majority of parents indicated to appreciate the booklet, scoring it at 7.6 on a scale of 1 to 10. Furthermore, 91% of them considered the booklet a good idea or good preparation, 69% found it to have a positive effect on their child, and 83% would use it again.

CONCLUSIONS

At T1 and T2, the differences in the children's distress scores were not statistically significant between the booklet group and the group who did not use the booklet. Children, generally, anticipated greater discomfort than what they actually experienced during the administration of eye drops. For most children, the booklet had a positive effect on their distress levels, but not for all. A large majority of parents noticed the added value of the booklet for their child. They were very positive and wanted to continue using the booklet in the future, as it appeared to give their child a sense of control during the administration of eye drops.

[Amblyopia-Basic principles and current diagnostic and therapeutic standards]

Amblyopia is a visual deficit that occurs during childhood and results in an abnormal development of the normal cortical visual pathway. It is defined as the reduction of best corrected visual acuity of one or rarely both eyes, which is not explained by structural abnormalities of the eye alone. During the sensitive period amblyopia is completely or partially reversible. The main causes of amblyopia are strabismus and refractive errors. Congenital cataracts are less common but if present may cause pronounced amblyopia. In Germany the prevalence of Amblyopia is approximately 5%, which is relatively high in relation to other countries, even though data are not completely comparable. As amblyopia can only be successfully treated during the first years of life, early detection of amblyogenic factors is important. Screening tests help in identifying children at risk of amblyopia, while only a thorough ophthalmological examination including cycloplegic refraction reliably detects all risk factors of amblyopia. Treatment consists of removal of the amblyogenic factors and stimulation of the amblyopic eye.