Vision Screening in Belgian Children: Too Much or Not Enough?

PURPOSE: To describe the vision screening procedures in the three Belgian linguistic communities and present Belgian screening results. METHODS: Analyses were carried out on 636 260 Belgian children between 2009 and 2016. Pre-school children were tested once or twice, while schoolchildren were tested seven or eight times. RESULTS: 57-83% of Belgian pre-school children and close to 100% of school children were tested. Proportions of referrals varied between 9% and 15% for pre-school children and 6-18% for school children. Proportions of failed or doubtful examinations (i.e., incomplete examinations or those with unreliable results) decreased from 1% to 10% in pre-school to 1-4% in school children. Proportions of true positive referrals (36-83%) at the pre-school level varied between linguistic communities. Estimated costs of pre-school screening appeared to be lower in the Flemish community. However, the cost of the ophthalmologist's time per pre-school child with a confirmed diagnostic was probably lower in the French community, as a result of a higher proportion of true referrals. CONCLUSION: Compared to screening programs in 10 developed countries, at the pre-school level, population coverage was lower in the French community, and comparable in the other communities. Proportions of referred children were similar. True positive referrals were comparable in the French community, but below results in other countries in the other communities. At the school level, population coverages were in the higher range of results compared to other countries. Proportions of referrals were below the results of other countries in the Flemish community, and comparable in the rest of the country