Related Experiment Video
Updated: Jun 22, 2026
Using an Automated Hirschberg Test App to Evaluate Ocular Alignment
Published on: March 24, 2020
Vision screening among northern Israeli Jewish and Arab schoolchildren
Liora Ore1, Hanna J Garzozi, Ada Tamir
1Ministry of Health, Northern District, Nazareth Illit, Israel. liorao@netvision.net.il
Insights
Vision abnormality affects over 20% of Israeli schoolchildren, highlighting the need for effective vision screening. This study evaluated the illiterate E-chart
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Uncorrected refractive error is the primary cause of childhood visual impairment globally.
- A 2002 screening project in Israel assessed the illiterate E-chart's effectiveness for identifying schoolchildren needing eye exams.
- The project focused on both Jewish and Arab student populations.
Purpose of the Study:
- To outline the objectives, design, and preliminary findings of a visual screening initiative.
- To determine the prevalence of vision abnormalities within the studied school population.
Main Methods:
- A cross-sectional, population-based study involving first and eighth graders in 70 northern Israeli schools (2002-2003).
- Visual acuity (VA) was measured using the illiterate E-chart by nurses.
- Ophthalmologists conducted comprehensive eye exams, including retinoscopy, and determined referral needs based on predefined criteria.
Main Results:
- Out of 1975 students, 31% exhibited abnormal VA (worse than 6/6 in one eye).
- A quarter of students had a VA of 6/12 or worse in both eyes.
- The prevalence of vision abnormality was 22.4% (ophthalmologist evaluation) to 26.1% (severity scores/referral criteria).
Conclusions:
- Vision abnormalities represent a significant public health concern among schoolchildren in northern Israel.
- The project provides crucial data on screening effectiveness, test reliability, and validity for policy-making.
- Evidence supports the need for clinical guidelines on referral criteria and optimal VA cutoffs for school vision screening.
Background:
Uncorrected refractive error is the leading cause of visual impairment in children. In 2002 a screening project was launched in Israel to provide data on the effectiveness of the illiterate E-chart in identifying Jewish and Arab schoolchildren in need of a comprehensive eye examination.
Objectives:
To present the aims, design and initial results of the visual screening project and the prevalence of vision abnormality in the study population.
Methods:
A cross-sectional population-based study was conducted during 2002-2003 among first- and eighth-graders in 70 schools in northern Israel. The nurse's test included use of the illiterate E-chart to measure visual acuity. The medical examination included vision history, clinical eye examination, VA and retinoscopy. The ophthalmologist's evaluation as to whether a child needed a referral for, diagnostic procedures, treatment and/or follow-up was recorded and compared with explicit referral criteria formulated after data collection.
Results:
Of 1975 schoolchildren, 31% had abnormal VA, defined as VA worse than 6/6 in at least one eye, and a quarter had VA equal or worse than 6/12 in both eyes. The prevalence of vision abnormality among the children was 22.4% when based on the evaluation of the field ophthalmologist and 26.1% when based on two sets of explicit severity scores and referral criteria.
Conclusions:
Vision abnormality is a significant health problem among northern Israeli schoolchildren. This project is unique in scope and importance, providing evidence to assist policy making with regard to vision screening for schoolchildren (including data on test reliability and validity) and optimal VA cutoff level, and confirming the need for clinical guidelines regarding referral criteria.
