Rikard E. Juttmann

Health-related quality of life in patients with adolescent idiopathic scoliosis after treatment: short-term effects after brace or surgical treatment

For treatment of teenagers with progressive adolescent idiopathic scoliosis in an early stage, two options are generally considered: treatment with a brace or observation followed by surgery if necessary. Many doctors and patients prefer conservative treatment (i.e. brace treatment) to surgical treatment, because surgery of the spine is generally considered a drastic intervention. Because potential differences in health-related quality of life (HRQoL) after treatment between braced and surgically treated patients are not well explored, this study aimed to determine whether short-term differences exist in HRQoL between adolescents treated with a brace or treated surgically. A cross-sectional analysis of HRQoL was made of 109 patients with adolescent idiopathic scoliosis who, after completing treatment, filled out the Dutch SRS-22 Patient Questionnaire. All patients had been treated either with a brace or surgery, or with a brace followed by surgery. Patients treated surgically had significantly higher mean scores in the satisfaction with management domain than those treated with a brace. No other consistent differences in HRQoL were found between patients treated with a brace and patients treated surgically. Gender, curve type and curve size had no relevant effect on HRQoL. We conclude that short-term differences in HRQoL after treatment in adolescent patients with idiopathic scoliosis are negligible and cannot support preference of one treatment above the other.

Rotterdam AMblyopia screening effectiveness study: detection and causes of amblyopia in a large birth cohort.

PURPOSE. The Dutch population-based child health monitoring program includes regular preverbal (age range, 1-24 months) and preschool (age range, 36-72 months) vision screening. This study is on the contribution of an organized vision screening program to the detection of amblyopia. METHODS. A 7-year birth cohort study of 4624 children was started in 1996/1997 in Rotterdam. Vision screening data were obtained from the child screening centers. Treating orthoptists working at the regional ophthalmology departments provided information about diagnosis and treatment. The diagnosis was reviewed by two experts. The parents provided additional information on their childs eye history through written questionnaires and telephone interviews. At age 7 years, the children underwent a final examination by the study orthoptists. RESULTS. Of the 3897 children still living in Rotterdam by 2004, 2964 (76.1%) underwent the final examination. Amblyopia was diagnosed in 100 (3.4%) of these (95% CI, 2.7-4.0). At age 7, 23% had visual acuity >0.3 logMAR. Amblyopia was caused by refractive error (n = 42), strabismus (n = 19), combined-mechanism (n = 30), deprivation (n = 7), or unknown (n = 2). Eighty-three amblyopia cases had been detected before age 7. Amblyopia detection followed positive results in vision screening in 56 children, either preverbal (n = 15) or preschool (n = 41). Twenty-six other amblyopes were self-referred (n = 12, before a first positive screening test), especially strabismic or combined-mechanism amblyopia; data were uncertain for one other positively screened amblyopic child. Amblyopia remained undetected until age 7 due to unsuccessful referral (n = 4, three with visual acuity >0.3 logMAR at age 7) or false-negative screening (n = 13). CONCLUSIONS. Most cases of amblyopia were detected by vision screening with visual acuity measurement. Preverbal screening contributed little to the detection of refractive amblyopia.

Estimating the Effectiveness of Screening for Scoliosis: A Case-Control Study

OBJECTIVE. The aim of this study was to test the hypothesis that screening for scoliosis is effective in reducing the need for surgical treatment. METHODS. The study was a case-control study. A total of 125 consecutive patients who were treated surgically for idiopathic scoliosis between January 2001 and October 2004 and who were born on or after January 1, 1984, were invited; 108 agreed to participate. A total of 216 control subjects were selected randomly and anonymously, matched with respect to age and gender. For 279 adolescents, exact screening exposure and outcomes could be analyzed. Case subjects were recruited from 4 university and 6 nonuniversity Dutch hospitals; control subjects were recruited from all 37 municipal health services in the Netherlands. RESULTS. Screen-detected patients received diagnoses at a significantly younger age than did otherwise-detected patients (10.8 ± 2.6 vs 13.4 ± 1.7 years). In total, 32.8% of the surgically treated patients had been screened between 11 and 14 years of age, compared with 43.4% of the control subjects. The odds ratio for being exposed to screening was 0.64. In total, 28% of the patients were diagnosed as having scoliosis before 11 years of age. CONCLUSIONS. Our results showed no evidence that screening for scoliosis reduced the need for surgery. Abolishing screening seems justified, especially because the effectiveness of early treatment with bracing is still strongly debated. A randomized, controlled trial on the effectiveness of treating patients with idiopathic scoliosis with bracing is urgently needed.

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

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.

Screening for scoliosis: Do we have indications for effectiveness?

Objective: The effectiveness of screening for scoliosis has not been established. This study investigated whether patients with adolescent idiopathic scoliosis detected by screening are detected in an earlier stage of the clinical course, and whether these patients have better outcome than otherwise detected patients. Setting: The study is a retrospective follow-up study of patients with adolescent idiopathic scoliosis who had completed treatment with a brace, by surgery, or with a brace followed by surgery. Of the 143 patients (born on or after 1 January 1984) consecutively recruited from 12 hospitals in the Netherlands, 125 (87%) agreed to participate. Of these, 51 patients were treated with a brace only and 74 patients were operated on. Screening for scoliosis is carried out in 80% of Dutch children. Methods: Data on being screen detected or otherwise detected and Cobb angle at diagnosis were collected using youth health-care files, medical files and interviews by telephone with the patients. Results: About 55% of the patients were detected by screening (programme sensitivity). Screen-detected patients had a significantly smaller Cobb angle at diagnosis (28° versus 40°; P<0.01) and had a 73% lower chance of having had surgery (45% versus 75%; P<0.01) than otherwise-detected patients. Conclusion: In the present study, two essential prerequisites necessary for a screening programme for scoliosis to be effective have been met. However, definite proof of the effectiveness of screening still needs to be established because length bias and over-treatment bias cannot be ruled out using this design.

Effectiveness of screening for amblyopia and other eye disorders in a prospective birth cohort study

Objective To establish whether the current vision screening practice in the Netherlands is effective in preventing permanent visual loss and to estimate the sensitivity of the programme. Settings In the Netherlands, all children are invited for preverbal (1, 3, 6–9 and 14–24 months) and preschool (36, 45, and 60–72 months) vision screening. Screening attendance is high, but the effectiveness in reducing amblyopia is unknown. Methods In a 7-year cohort study, 4624 children born in the city of Rotterdam between 16 September 1996 and 15 May 1997 were followed through all routine vision screening examinations. At age seven, visual acuity (VA) of children still living in Rotterdam was assessed by study orthoptists. In case of VA > 0.1 logMAR in one or both eyes, two or more logMAR lines of interocular difference or eye disorders like strabismus, children underwent a more intensive eye examination. Results Attendance at the 9-month screening was 89%, decreasing to about 75% at later examinations. Of preverbal tests, 2.5% were positive, and of preschool tests, 10%. In total, 19% of children had a positive vision screening test at least once. Amblyopia prevalence was 3.4%. Sensitivity of the vision screening programme was 73% and specificity 83%. At age seven, 0.7–1.2% (confirmed vs final exam) of the children had a VA > 0.3 logMAR in the worse eye compared with 2–3.9% (in literature) reported prevalence in non-screening situations. Children who were less frequently screened had a higher chance of poor vision (>0.3 logMAR) at age seven. Conclusion The Dutch child vision screening programme may reduce the risk of persistent amblyopia (VA > 0.3 logMAR) at age seven by more than half.