Refractive amblyogenic risk factors in private and public school children

Purpose: To assess refractive amblyopia risk factors in Lebanese children aged 3 to 6 years through school-based automated vision screenings, comparing outcomes between public and private schools. Methods: A school-based vision screening was conducted across multiple regions in Lebanon, including 990 children aged 3 to 6 years from both public and private schools. Trained personnel utilized the Plusoptix S12 photoscreener for vision screening. Referral criteria were based on established guidelines set by the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), and data were analyzed to determine the prevalence of refractive errors and to compare between school types. Results: The study revealed a high referral rate of 17.6%, with significant differences observed between public and private schools (27.7% vs. 13.6%, p<.001). Astigmatism was the most prevalent refractive error (8.2%), followed by myopia (2.2%) and hyperopia (1.3%). Public schools exhibited higher rates of astigmatism, hyperopia, and myopia compared to private schools. Significant regional variations were also noted, with schools in the capital Beirut having the highest referral rate (23.1%) and Mount Lebanon showing the lowest prevalence of astigmatism (4.9%). Conclusion: The rate of referral in our cohort was 17.6% according to the AAPOS referral criteria with astigmatism being the most common refractive error. The referral rate was higher in public schools compared to private ones, highlighting the need for structured and comprehensive vision screening programs in Lebanon, particularly targeting public school children.