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Feasibility of a school-based vision screening program to detect undiagnosed visual problems in kindergarten children
Mayu Nishimura1, Agnes Wong2, Helen Dimaras2
1Department of Ophthalmology and Vision Sciences (Nishimura, Wong, Dimaras), The Hospital for Sick Children; Department of Ophthalmology and Vision Sciences, Faculty of Medicine (Wong, Dimaras), University of Toronto; Institute of Health Policy Management and Evaluation (Wong, Maurer), and Division of Clinical Public Health (Dimaras), Dalla Lana School of Public Health, University of Toronto; Child Health Evaluative Sciences Program and Centre for Global Child Health (Dimaras), Sick-Kids Research Institute, Toronto, Ont.; Department of Psychology, Neuroscience & Behaviour (Nishimura, Maurer), Faculty of Science, McMaster University, Hamilton, Ont. mayu.nishimura@sickkids.ca.
Insights
School-based vision screening effectively identifies kindergarten children with visual problems, enabling early treatment. This program significantly improves detection rates compared to previous methods, ensuring better visual development.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Undetected visual problems can impede children's development and learning.
- Scaling up school-based vision screening is crucial for early identification and treatment.
Purpose of the Study:
- To assess the feasibility of a large-scale, school-based vision screening program for kindergarten children.
- To identify and facilitate treatment for visual impairments in young children.
Main Methods:
- Prospective cohort study in 43 Ontario schools across 15 communities.
- Screening included photoscreeners, visual acuity, stereoacuity, and eye alignment tests.
- Passive consent model achieved 89% screening participation.
Main Results:
- 10.7% of 4811 screened children had a visual problem, including amblyopia and refractive errors.
- 516 children detected with visual issues, 67.2% receiving their first eye exam.
- High follow-up rates (68.9%) for optometry examinations were observed.
Conclusions:
- In-school vision screening is an effective strategy for early detection of visual problems in children.
- The program successfully identified at-risk children for timely intervention before grade 1.
- Passive consent significantly increased screening participation compared to active consent.
Background:
Visual problems can negatively affect visual development and learning but often go undetected. We assessed the feasibility of scaling up a school-based screening program to identify and treat kindergarten children with visual problems.
Methods:
We conducted a prospective cohort study offering vision screening to junior (JK) and senior kindergarten (SK) children attending 43 schools in 15 Ontario communities. Screening comprised photoscreeners and tests of visual acuity, stereoacuity and eye alignment. Children who failed any test were referred for a comprehensive eye examination, with treatment as needed (e.g., glasses).
Results:
Using a passive consent model, 89% of children were screened compared with 62% using an active consent model (p < 0.001). Referral rates to an optometrist varied across schools (mean referral rate for children in JK 53%, range 25%-83%; mean referral rate for children in SK 34%, range 12%-61%). Among 4811 children who were screened, a visual problem was detected in 516 (10.7%), including 164 (3.4%) with amblyopia and 324 (6.7%) with clinically significant refractive errors. For 347 (67.2%) of the children with a visual problem, this was their first eye examination. Rescreening in Year 2 did not lead to detection of additional problems among children who passed screening in Year 1. Regardless of location (child's school or optometrist's office), 1563 (68.9%) of children attended the follow-up optometry examination. Most of the children who were surveyed (291 of 322, 90.4%) indicated that they enjoyed vision screening.
Interpretation:
Many children in Ontario with a visual problem were not being identified by the status quo in 2015-2017. We found that in-school vision screening with follow-up eye examinations is an effective strategy for identifying at-risk children and placing them in eye care before grade 1.
