Resumen de Programa de Cribado de Ambliopía en la isla de Gran Canaria.: fase de implantación

Matías García González

• español

  Objetivo: Implantar un sistema de detección precoz del ambliopía, que sea aplicado por enfermeras pediátricas de Asistencia Primaria.

  Método: Se realiza una formación a todos los enfermeros pediátricos de la isla de Gran Canaria, para realizar una toma de agudeza visual (AV) y grado de estereopsis (Optotipo Prevín y TNO), en niños de 3 y 4 años con autonomía para derivarlos al hospital.

  Resultados: Los enfermeros exploran 6.660 niños (3.386 de 3 años y 3.274 de 4); cobertura poblacional 39%-28% (3-4 a); aplicación del optotipo 98,6%-99,8% (3-4); aplicación del TNO 4a 97,5%; derivación 10,1%. Hipermetropía bajo cicloplejía en equivalente esférico mayor de 4,0 dioptrías (D) 1%-1,9% (3-4a); astigmatismo mayor de 2,0 D 1,7%-4,3%. Se compararon los datos con trabajo refractivo previo en los años 90. El test no presenta fenó- meno de aprendizaje. Se indicaron 44% de gafas, con 21% de falsos (+). La fiabilidad de los enfermeros fue del 80% para la toma de la AV y del 70% para ambos tests. Se obtiene un nomograma de la AV de dicha población.

  Conclusiones: La gran mayoría de los niños de tres y cuatro años desconoce su necesidad de portar gafas. Las pruebas presentan una muy alta detección de defectos astigmáticos susceptibles de tratamiento, e hipermetropía altas. La necesidad detectada de gafas es del 4,4% que añadido al existente muestra un total del 5% de la población. La fiabilidad de los exploradores está en un entorno el 70 -80% en esta fase de implantación

• English

  Objective: To implement a system for early detection of amblyopia, which is to be applied by primary care pediatric nurses.

  Method: All pediatric nurses in primary healthcare in Gran Canaria have been trained on measuring visual acuity and degree of stereopsis (Optotype Previn and TNO), in three and fouryear-olds, with autonomy to refer them to the hospital.Results: 6660 children were explored by nurses (3386 three-year-olds and 3274 four-year-olds) with a population coverage of 39% for 3-year-olds and 28% for the other group. Optotype application rate was of 98.6% for three-year-olds and 99.8% for the following group of age.

  TNO implementation rate for 4-year-olds 97.5%; 10.1% referral rate. Hyperopia detected under cycloplegia in spherical equivalent greater than 4.0 diopters (D) was 1% for 3-yearolds and raised to 1.9% for 4-year-olds. Astigmatism over 2.0 D was 1.7% for 3 year-olds and 4.3% for the other group. Data were compared with previous refractive work in the 90s. The test showed no learning phenomenon. Glasses were prescribed to 44% of referred patients, and 21% of them happened to be false positives. The reliability of nurses reached 80% when measuring visual acuity and 70% when both tests were considered as a whole. A visual acuity nomogram of this population was obtained as a result of this study.

  Conclusions: The vast majority children in these groups of age are not able to identify their need to wear glasses. The tests shows a very high astigmatic detection of defects susceptible to treatment, as well as high hyperopia detection. The need for glasses detected reached 4.4%, which added to the existing sample a 5% of the population. The reliability of explorers has been estimated to reach 70-80% at this stage of implementation.