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Results of vision screening of 6-year-olds at school: a population-based study with emphasis on screening limits
1Institute of Neuroscience and Physiology, Department of Ophthalmology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden. annalena.hard@oft.gu.se
Insights
Sweden's vision screening for 6-year-olds may be too strict. Lowering the visual acuity (VA) threshold to 0.65 (logMAR 0.2) identified few treatable conditions, suggesting the current 0.8 (logMAR 0.1) criterion is inefficient.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Sweden introduced universal vision screening for 6-year-olds in preschool in 2003.
- The screening involves monocular visual acuity (VA) testing by school nurses.
- Referrals are made for VA < 0.8 (logMAR 0.1) or visual symptoms.
Purpose of the Study:
- To evaluate the effectiveness of the current vision screening criteria for 6-year-olds.
- To compare the existing screening limit (VA < 0.8) with a potential lower limit (VA < 0.65).
Main Methods:
- A cohort of all children entering preschool class in Gothenburg in 2003 was studied.
- Visual acuity (VA) testing was performed by school nurses.
- Children referred underwent comprehensive eye examinations, including VA testing, cover testing, cycloplegic autorefraction, and ophthalmoscopy.
Main Results:
- Out of 3885 pupils, 255 (6.6%) were referred, and 236 examined.
- 74.5% of referred children had a VA of 0.65 (logMAR 0.2) in the worse eye; over half achieved VA >= 0.8 in the clinic.
- Only 6.7% had significant ametropia, and 13.4% received glasses for minor refractive errors.
Conclusions:
- A VA threshold of 0.65 (logMAR 0.2) rarely identifies treatable conditions in 6-year-olds.
- The current screening criterion of 0.8 (logMAR 0.1) may be overly stringent, impacting resource efficiency.
- Recommendations include retesting before referral and cycloplegic refraction for all children with reduced VA or symptoms.
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 > or = 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.
