Review of school vision screening guidelines

To examine the diversity in paediatric vision and hearing screening programmes in Europe. Themes for comparison of screening programmes derived from literature were used to compile three questionnaires on vision, hearing, and public health screening. Tests used, professions involved, age, and frequency of testing seem to influence sensitivity, specificity, and costs most. Questionnaires were sent to ophthalmologists, orthoptists, otolaryngologists, and audiologists involved in paediatric screening in all EU full-member, candidate, and associate states. Answers were cross-checked. Thirty-nine countries participated; 35 have a vision screening programme, 33 a nation-wide neonatal hearing screening programme. Visual acuity (VA) is measured in 35 countries, in 71% of these more than once. First measurement of VA varies from three to seven years of age, but is usually before age five. At age three and four, picture charts, including Lea Hyvarinen, are used most; in children over four, Tumbling-E and Snellen. As first hearing screening test, otoacoustic emission is used most in healthy neonates, and auditory brainstem response in premature newborns. The majority of hearing testing programmes are staged; children are referred after 1-4 abnormal tests. Vision screening is performed mostly by paediatricians, ophthalmologists, or nurses. Funding is mostly by health insurance or state. Coverage was reported as >95% in half of countries, but reporting was often not first-hand. Largest differences were found in VA charts used (12), professions involved in vision screening (10), number of hearing screening tests before referral (1-4), and funding sources (8).

The purpose of this study is to assess the predictive ability of the test-positive findings of an elementary school vision screening program, conducted by 2nd-year optometry students, in identifying children with eye or vision disorders. A modified version of the Modified Clinical Technique (MCT) vision screening was administered to elementary children from a below-average socioeconomic neighborhood in Houston, Texas. Comprehensive eye and vision examinations were provided to the available children who failed the vision screening. The screening was administered by groups of 2nd-year optometry students with the assistance of a 4th-year optometry student, and supervised by a faculty member licensed to practice optometry. The follow-up examinations were provided by supervised 4th-year optometry students in a clinical setting based at the elementary school. Positive predictive values calculated from the screening and examination findings estimate the probability that a failure on one or more of the screening tests would identify children with eye or vision disorders. Sixty-nine percent of the test-positive children examined were found to be true positives by the criteria developed in a study of vision screening methods in Orinda, California from 1954 through 1956. The predictive ability of this study's test-positive findings for identifying eye and vision disorders was found to be less than the predictive ability of the Orinda Study findings. This reduced predictive ability of the present study resulted in a larger number of children being overreferred for examinations than had occurred in the Orinda Study. The reduction in the ability of the test-positive findings of the current study's screening program to identify accurately children with eye and vision problems is most likely due to the limited experience of the optometry students conducting the screening program. The inability of this retrospective study to evaluate the accuracy of the test-negatives is a major limitation in assessing the total effectiveness of this vision screening program. Although the present study may indicate some value in optometry students conducting elementary vision screening programs, a prospective study which could assess the predictive ability of both test-positive and test-negative findings, as well as determine the sensitivity and specificity of the screening program, is needed to assess more fully the effectiveness of school vision screening programs using professional students.

To develop a method to identify preschools with the greatest need for vision screening, correlations between socioeconomic status, preschool capacity, and rates of pediatric vision screenings performed by a community vision screening program were investigated. Geoinformatics mapping software was used to visually display the areas of greatest need. Vision screening data from a community vision screening program, child care facility data from California Department of Social Services, and income data from the U.S. Census Bureau through ArcGIS software (Esri) were collected. When possible, data were consolidated at the ZIP code level. Kolmogorov-Smirnov analysis was used to determine correlations between data elements. Licensed child care facilities were scored on a scale (from 1 to 5) based on the socioeconomic status of the ZIP code and the facility capacity. The scoring system prioritized larger facilities in lower income communities to most efficiently use vision screening program resources. There was a positive correlation between the capacity of the child care facility and the median household income (P = .005). Second, we found a positive correlation between child care capacity and the median household income (P = .005). Licensed child care facilities were mapped and colored using GIS software according to their cumulative score. Challenges to vision screening in under-served communities include the lack of child care facilities and smaller facility size. The use of a scoring system and mapping software can direct vision screening programs to reach a greater number of children with the most efficient use of resources. [J Pediatr Ophthalmol Strabismus. 2022;59(6):375-379.].

Background: In low-resource areas, where frequent eye checks are not common like in other parts of the world, refractive errors rank among the most prevalent causes of avoidable childhood visual impairment. Vision screening programs in schools suggest a fundamental platform of early detection and correction. The purpose of this study was to evaluate the distribution and spectrum of refractive errors in schoolchildren and to highlight the significance of ophthalmic screening conducted in the community in primary preventive health care. Methods: The descriptive cross-sectional study was conducted between March and July 2024 in coordination with local government schools and the Department of Community Medicine. Stratified random sampling was used to select 1200 children aged 6-16 years in urban and rural schools. Visual acuity was performed by trained optometrists on the Snellen chart, with retinoscopy, and subjective refraction in patients with VA of less than 6/9. SPSS version 26.0 was used to analyze data. The chi-square and ANOVA tests were used to determine associations between refractive errors and demographic variables. Results: Among 1200 children, 186 (15.5%) had refractive errors. Most prevalent refractive error types were myopia (110 (59.1%)), astigmatism (45 (24.2%)), and hyperopia (31 (16.7%)). The prevalence was higher in urban children (p = 0.003) and in children aged 13-16 years (p = 0.001). Conclusion: The prevalence of uncorrected refractive errors among school-going children is significant and mostly undiagnosed. Primary healthcare strategies that incorporate regular screening at schools should be implemented to prevent unnecessary visual disability and improve educational outcomes.

Vision screening at an early age in children is important as it can identify aspects in the visual system that may need to be managed to enable a child to function optimally at school. The National School Vision Screening Programme was discontinued in many provinces of South Africa, often due to a lack of financial resources or adequately trained personnel. This action has resulted in the majority of children not having a visual examination during their school career. In a few instances where vision screenings are performed, these are usually limited to visual acuity (VA) evaluation alone; an endeavour that may miss many significant visual problems. The purpose of this article is to highlight the need for vision screening to be conducted in schools and for the screening protocols to include the various accommodative tests. A retrospective analysis of the amplitudes of accommodation, accommodative facility and accuracy of accommodation findingsfrom a primary school vision screening of 264 children between 6 and 13 years was undertaken in this study. Data was captured and analysed with Microsoft Excel. The ages of the children ranged from 6 to 13 years with a mean of 9.38 years (SD = 1.85). One hundred and thirty eight (52.3%) were males and 126 (47.7%) females. A significant number of the children failed the monocular accommodative amplitude tests (24%), binocular accommodative amplitude test (26%), the accommodative facility (30%) and the MEM test (27%). These results highlight the need for a more comprehensive vision screening exercise rather than VA alone as this approach would have missed more than a quarter of the children who had other visual problems that could impact on their ability to perform optimally at school.

SIGNIFICANCE:Despite significant evidence supporting the utility of vision screening for identifying children who need further evaluation by an eye care professional, there is considerable variability in screening guidelines along with a lack of consensus for monitoring and reporting outcomes. This article provides updated vision screening recommendations for pre-school-age children (aged 3 to <6 years) in the United States.PURPOSE:The goal of vision screening programs is to identify, refer, and help ensure eye examinations for children who may have vision disorders, such as significant uncorrected refractive errors, amblyopia, strabismus, reduced visual acuity, and other vision and eye health problems. This article provides an update to the 2015 recommendations for vision screening in pre-school-age children in the United States, which were developed by the National Expert Panel to the National Center for Children’s Vision and Eye Health (NCCVEH) at Prevent Blindness.METHODS:Recommendations for vision screening for pre-school-age children were developed by the NCCVEH and published in 2015. The updated recommendations in this article were developed through a targeted literature review (PubMed and Science Direct) and expert opinion from the committee, which approved the final recommendations.RESULTS:The committee recommends that vision screening programs have follow-up systems to ensure that referred children receive comprehensive eye examinations. In addition, screening programs should consist of observation, threshold or critical line (age-specific minimal acuity line to pass) distance visual acuity, binocular critical line near visual acuity, and stereopsis, all of which should be performed annually. Instrument-based screening may be used in place of distance visual acuity and stereopsis, though additional research is needed to guide the recommendation for specific devices.CONCLUSIONS:The NCCVEH recommends that children aged 3 to <6 years have their vision screened annually to identify potential eye health and vision disorders. These updated vision screening recommendations provide lay screeners with a standardized approach for detecting vision problems and ensuring timely intervention and treatment. The NCCVEH will continue to provide vision screening updates at http://nationalcenter.preventblindness.org.

Preschool Vision Screening: Where We Have Been and Where We Are Going

Clinical relevance Children in socioeconomically disadvantaged communities often do not access follow-up eye care services when referred from vision screenings; whether this is due to lack of availability is not known. This paper highlights the need for vision and eye care for vulnerable children with practicing clinical optometrists well placed to provide vision care. Background Vision impairments develop from a young age and may inhibit learning experiences and impact life outcomes. Vision screening to detect and refer vision abnormalities supports children in their education and prevents minor vision impairments from worsening. This research describes outcomes from a vision screening programme for 4– to 5-year-olds delivered in Queensland, Australia. Methods The programme involved all prep children from participating schools in Queensland. Vision screening was conducted with the Parr 4 m Visual Acuity Test and Welch Allyn Spot Vision Screener. A cross-sectional study design was adopted. Descriptive data analyses explored the frequency of vision screening and referral outcomes. Inferential analyses examined associations between vision screening and referral outcomes with socio-economic indexes for areas (SEIFA) scores . Results Of 71,003 prep students screened, 4,855 (6.8%) received a referral recommendation. A higher proportion of children who received a referral recommendation was from more disadvantaged locations (?2 = 109.16, p < 0.001). Of the students referred, 3,017 were seen by an eye health professional. Further vision assessment of students by an eye health professional revealed that 43.3% of the referred children were diagnosed with a vision abnormality, 18.9% had no vision abnormality and 37.7% had an ‘undetermined’ diagnosis. A higher proportion of children confirmed with a vision abnormality were from more disadvantaged locations (?2 = 52.27, p < 0.001). Conclusion It is important that vision screening programmes target disadvantaged populations and support families of children who require further health assessment to access health services.

PURPOSE: To evaluate and implement a school based child vision screening program, which would identify the causes of blurred vision, improve vision with glasses, and increase teachers’ awareness of eye care. METHODS: Primary school vision screenings took place in 155 schools in two districts of Oudomxay Province in November and December 2016. The children were initially screened by teachers trained in vision screening using Snellen chart at 6 meters and trained in how to prevent conditions such as conjunctivitis and eye injury. The results of the screening vision tests of all children were sent to Oudomxay Provincial Hospital Eye Unit by teachers. A team comprised of one ophthalmologist and one optometrist followed up with students identified with vision impairment at the schools to perform additional vision tests and eye exams. Children confirmed with refractive errors were provided glasses and those diagnosed with cataract and glaucoma were referred to the Ophthalmology Unit of the hospital. RESULTS: In total, 16,982 children (F 8,273) aged 5-14 years old were screened. The vision impairment with available correction (one and both eyes) of 133 children (0.78%), and included 40.60% of children requiring spectacle provision. Other ocular abnormalities included corneal scar (32.22%), posterior segment disease (23.08%), cataract (3.76%), and glaucoma (1.50%). 155 primary schools teachers were trained in vision screening. The vision of 45 children was improved with eyeglasses for refractive error. This number is lower compared to that of neighboring countries. CONCLUSION: Trained school teachers can play an important role in the prevention of childhood blindness.

Background: A vision-screening program is effective in prevention of vision impairment. The validity of vision screening conducted by nurses, medical assistants, and teachers has been previously reported. However, the validity of preschool teachers in conducting external eye observations in preschool children has not been widely investigated. This study aimed to determine validity of preschool teachers in conducting external eye observation tests, including the observation of behavior and external eye health, in preschool children.Methods: In this cross-sectional study, preschool teachers from Kemajuan Masyarakat kindergarten in Klang Valley, Malaysia, were randomly allocated to the study (n = 30) or control (n = 30) groups. The study group underwent theory training with an optometrist and practical sessions with preschool children on vision screening, while the control group received only brief verbal instructions on steps to conduct the screening. After the briefing, teachers from both groups conducted vision screening tests at their kindergartens on preschool children aged 4–6 years. The same vision screening procedure was repeated in the same children by optometrists to verify results of the teachers. Results: A total of 700 preschool children were screened by 60 preschool teachers and optometrists. Teachers from the study and control groups displayed high validity in screening for external ocular health, including sensitivity (66.67% versus 66.67%), specificity (95.21% versus 95.54%), and negative predictive value (99.41% versus 99.69%). The positive predictive value was slightly higher in the study group (19.05%) than in the control group (11.76%). Conclusions: Preschool teachers competently observed external eye health in preschool children. A training module for vision screening is important, and a revision of the current training module is needed. Empowering preschool teachers could help in the early detection and intervention necessary in needy children. This could reduce the nationwide prevalence of visual impairments.

Effectiveness of the Lea Symbols and Random Dot E in a large preschool vision screening program

Photoscreening

AimMuch existing data on childhood refractive error prevalence in India were gathered in local studies, many now dated. The aim of this study was to estimate the prevalence, severity and...

Background: Refractive error is a leading cause of visual impairment among school-aged children globally, yet population-specific determinants remain inadequately characterized in resource-limited settings.Objective: This study sought to quantify the prevalence of refractive error and develop predictive models identifying sociodemographic, environmental, dietary, and behavioral determinants among school-going children in Mathura, Uttar Pradesh. Methods:A cross-sectional study was conducted among 2,000 school children aged 6-16 years.Comprehensive vision screening was performed, and data on sociodemographic characteristics, housing conditions, dietary patterns, lifestyle factors, and academic variables were collected through structured questionnaires.Multivariable logistic regression and elastic net regularized regression were used to identify independent predictors of refractive error. Results:The prevalence of refractive error was 24.1% (482/2,000).In multivariable analysis, urban residence (adjusted OR 1.71, 95% CI: 1.31-2.22,p<0.001) and increasing age (adjusted OR 1.14 per year, 95% CI: 1.08-1.21,p<0.001) were the strongest independent predictors.Weekly intake of green leafy vegetables showed a modest positive association (adjusted OR 1.43, 95% CI: 1.07-1.93,p=0.018).Socioeconomic status, parental education, nutritional status, anemia, screen time, and sleep duration were not significantly associated with refractive error after adjustment.Elastic net regression confirmed age (OR 1.20), class grade (OR 1.17), and urban residence (OR 1.15) as primary drivers. Conclusions:Refractive error among school children in this population is predominantly influenced by age and urban residence rather than traditional socioeconomic or nutritional factors.These findings emphasize the need for strengthened school-based vision screening programs, particularly targeting older children in urban settings, and highlight the role of environmental and behavioral exposures in refractive error development.

Purpose:To compare whether free spectacles or only a prescription for spectacles influences wearing rates among Tanzanian students with un/undercorrected refractive error (RE).Methods:Design: Cluster randomised trial.Setting: 37 secondary schools in Dar...