Results of vision screening of 6‐year‐olds at school: a population‐based study with emphasis on screening limits

Abstract

. Purpose: To evaluate newly introduced vision screening of 6‐year‐olds in the preschool class with special regard to screening criteria. Methods: Monocular visual acuity (VA) testing in 6‐year‐olds by school nurses as part of preventive health care was introduced in Sweden 2003. Children with VA < 0.8 (logMAR 0.1) or symptoms are referred to eye clinics where VA testing, cover testing, cycloplegic autorefraction and ophthalmoscopy are performed. The present screening limit of 0.8 (logMAR 0.1) was evaluated in relation to a limit of 0.65 (logMAR 0.2). All children in the City of Gothenburg starting preschool class in 2003 were included. Results: A total of 127 schools with 3885 pupils participated. Of these, 255 pupils (6.6%) were referred and 236 underwent an ophthalmological examination. Children with a VA of 0.65 (logMAR 0.2) in the worse eye constituted 74.5% of those who had failed the screening; more than half of these were found to have VA ≥ 0.8 (logMAR 0.1) in the clinic. Many were not refracted in cycloplegia and only 6.7% were found to have significant ametropia. The criteria for the prescription of glasses varied; 13.4% of these children were prescribed glasses for insignificant refractive errors. Conclusions: Six‐year‐olds with VA of 0.65 (logMAR 0.2) rarely have defects that require treatment and the screening criterion of 0.8 (logMAR 0.1) is probably too demanding for effective utilization of available resources. Retest before referral and refraction in cycloplegia of all children with reduced VA or visual symptoms are recommended.

A review of the evidence on the effectiveness of children's vision screening

“…2000; Hard et al . 2002; Hard 2007). Referral criteria were generally selected in accordance with the effect on the sensitivity and specificity of the programme, rather than the effect on functional vision, which some would argue is the more important determinant.…”

“…Few studies focused exclusively on screening during the neonatal period, and those that did were of lower quality. The available literature (Weinstock et al 1998) and many professional guidelines [American Academy of Pediatrics 1996 (reaffirmed 2007); American Academy of Ophthalmology 2002, 2007 suggested that a check for congenital eye conditions should occur within the first 3 months from birth, ideally as close to birth as practicable. How this should be performed, and whether this should be considered a screen or part of expected clinical practice requires further clinical research.…”

“…The referral criteria recommended for use in determining pass or fail of a vision screen were dependent upon the age selected for universal screening (generally less than 6/9 in either eye for a 3-year-old and 6/9 or less in either eye for a 4-6-yearold) (Williamson et al 1995;Lim et al 2000;Hard et al 2002;Hard 2007). Referral criteria were generally selected in accordance with the effect on the sensitivity and specificity of the programme, rather than the effect on functional vision, which some would argue is the more important determinant.…”

Vision screening in preschoolers: the New South Wales Statewide Eyesight Preschooler Screening program

“…[99] It was found that children with visual acuity of 6/9 in the worse eye constituted 74.5% of those who had failed the screening. More than half of these were found to have visual acuity ≥6/7.5 in the clinic.…”

Importance of vision screening in children regardless of socioeconomic status

“…Preschool and school vision screening is part of government health programmes in many countries but referral criteria may somewhat vary. [1][2][3][4] In this report vision screening was carried out on a selected sample of children from socioeconomically secure families with a high level of parental education at a private school in Rome (Ambrit International). Medical forms were completed by parents and a pediatric assessment of children was performed every year.…”