Improving access to vision screening in urban Philadelphia elementary schools

Comparison of the pediatric vision screening program in 18 countries across five continents

“…1). The final analysis was performed on 36 articles that reported implementation in 18 countries from 5 continents (Table 2), comprising North America ( n = 2),19, 27, 28, 29, 30, 31, 32, 33, 34, 35 Asia ( n = 8),3, 21, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46 Oceania ( n = 2),16, 17 Europe ( n = 4),6, 20, 47, 48, 49, 50 and Africa ( n = 2) 51, 52. Objectives of screening program were dissected based on target age groups according to their learning stages and target conditions.…”

“…Screening for binocular vision and/or ocular health (Type II) including general observation, Hirschberg test, pupillary reflex, red reflex, stereotest, and questionnaire were implemented in ten countries (Australia, Canada, Italy, Japan, South Korea, the Netherlands, the United Kingdom, the United States, Egypt, and Iran) 6, 16, 27, 45, 46, 47, 48, 55. Analysis on vision charts used and the testing distance (Table 4) revealed that seven countries (39%) used either Snellen or Tumbling E chart only3, 37, 39, 43, 44, 51, 52; while six countries (33%) used an age-appropriate vision chart (Lea symbol, Sheridan Gardiner, HOTV, and Keeler Crowded LogMAR) 6, 16, 20, 28, 33, 50. Two countries (the Netherlands and New Zealand) used non-validated vision charts (Amsterdam Picture Chart and Parr Chart) where the outcome might be doubtful and limit comparison with clinical findings using other validated vision chart 17, 47.…”

“…Eleven countries (61%) were found to have used cut-off referral of 6/9 or 6/12 regardless of the target age group 3, 16, 17, 20, 21, 43, 44, 45, 51, 56. Three countries (the United States, Italy, and South Korea)6, 33, 46 lowered the cut-off referral criteria with an increasing target age group, and one country (the United Kingdom) used a lower cut-off referral criteria for uncrowded LogMAR chart 50 Table 4Implementation breakdown based on the types of visual acuity tests used in vision screening, testing distance, and screeners in 18 countries.CountryScreenerVisual acuity chartTesting distanceCut-off referralAustraliaTrained staffHOTV chart Sheridan Gardiner3 or 6 m6/9CanadaPhysician, nurse, trained staffHOTV chart, Lea symbolsNot mentionedNot mentionedCroatiaOphthalmologistLea Symbol3 m6/9EgyptTrained staffSnellen, Tumbling ENot mentioned6/12IndiaTrained staffTumbling E3 m or 6 m6/12 or 6/9IranNurse, Trained staffTumbling E6 m6/9 or 6/12ItalyNurse, physician, orthoptistLea symbol3 m6/9 (3 years old)6/7.5 (5 years old)IsraelNurseTumbling E6 m6/12JapanParentLandolt C2.5 m6/12MalaysiaNurseSnellen6 m6/9The NetherlandsOrthoptist, physician and nurseLandolt C/Amsterdam Picture Charta5 m6/7.5New ZealandTrained technicianParr Charta4 m6/12OmanNurseSnellen chart, LogMAR chart3 mNot mentionedSouth AfricaNurseTrained technicianSnellen, Tumbling ENot mentioned6/12South KoreaParentPicture chart…”

Evaluation of Vision Referral Program With School-Aged Children and Their Parents/Guardians

“…There are several interventions that have been successful in improving the follow-up rates. Interventions include (a) providing on-site care at the school (Diao et al, 2016;Chu et al, 2015;Griffith et al, 2016;Hark et al, 2016;PCCY, 2011), (b) providing no-cost eye exams and/or eyeglasses (Griffith et al, 2016;Hark et al, 2016;Manny et al, 2012;PCCY, 2011;Priya et al, 2015), (c) involvement of teachers in screening and referral process (Priya et al, 2015), (d) follow-up phone calls and/or letters to families after referral letter mailed (Kemper et al, 2012;Neville et al, 2015), and (e) use of an electronic database to track referrals (Hartman, Block, & Wallace, 2015;Kemper et al, 2012).…”

“…Vision abnormalities are one of the most prevalent chronic conditions of childhood and can impact educational performance and a child's self-concept (Kemper, Helfrich, Talbot, & Patel, 2012). One in five children between the ages of 1 and 17 years has compromised vision (Diao et al, 2016;Ethan & Basch, 2008;Hark et al, 2016). The most common eye disorders among school-aged children are refractive errors such as myopia (nearsightedness), hyperopia (farsightedness), and astigmatism with prevalence rates of 9%, 13%, and 15-28%, respectively, for children ages 5-17 years (Multi-Ethnic Pediatric Eye Disease Study Group, 2010).…”