Re: Children's Eye Screening South Australia (CESSA): diagnostic performance of a vision screening programme for...

The evaluation of the Children's Eye Screening South Australia (CESSA) programme highlights the need to move beyond measuring screening coverage alone and toward assessing whether children with vision disorders receive timely diagnosis, treatment and follow-up. While the combination of distance visual acuity testing and photorefraction improves detection of refractive errors and amblyopia risk factors, the broader challenge is ensuring that screening functions as an accountable child-health pathway. We propose that future school vision screening programmes report implementation outcomes including equity of reach, referral completion, spectacle uptake and functional educational benefit alongside conventional diagnostic performance measures. With the projected global rise in childhood myopia and increasing digital screen exposure, school vision screening should be integrated into preventive, learning-linked public health strategies. Furthermore, screening programmes must address ethical concerns related to access to refraction services, spectacles and follow-up care to avoid widening existing inequities. We suggest that international benchmarks evolve toward an audit-ready "screen-confirm-correct-follow" framework that transparently measures outcomes across the continuum of care. Such an approach would strengthen accountability, improve child eye health outcomes and support progress toward global vision-care targets.