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Diagnostic Accuracy of Teacher-Administered School Vision Screening: A Systematic Review and Meta-Analysis
Mariana Cunha1, Amélia Fernandes Nunes2, Marco Miguel2
1Health Sciences Research Centre (CICS-UBI), University of Beira Interior, Covilhã, Portugal. mariana.cunha@ubi.pt.
Purpose:
To determine the diagnostic performance (sensitivity [SE] and specificity [SP]) of vision screening conducted by teachers compared to a gold-standard visual examination performed by eye care professionals for identifying refractive errors in children.
Methods:
This systematic review and meta-analysis searched PubMed, Web of Science and Scopus for studies involving children aged 4-18 years. Methodological quality was assessed using the QUADAS-2 tool, and diagnostic accuracy was synthesised using a Bivariate Random-Effects Model.
Results:
Nineteen articles (24 study arms) were included, involving approximately 5.7 million children and 34,500 teachers. Global meta-analysis revealed a pooled SE of 76.8% (95% CI: 62.4%, 86.9%), SP of 93.6% (95% CI: 85.7%, 97.3%) and area under the curve (AUC) of 0.92. Low-risk studies showed more conservative values (SE: 72.1% [95% CI: 57.2%, 83.4%]; SP: 96.0% [95% CI: 89.3%, 98.5%]) compared to high/unclear risk investigations (SE: 80.1% [95% CI: 55.6%, 92.8%]; SP: 90.8% [95% CI: 71.4%, 97.5%]). Additionally, (1) studies using a 6/12 cutoff showed more consistent diagnostic performance (minimum SE: 72.6%); (2) sensitivity was significantly higher in younger children (89.29%) than in adolescents (45.45%) and (3) studies specifying a cycloplegia protocol reported superior performance, with SE > 92.0% and SP > 72.0%. Overlapping confidence intervals and bias variability suggest that diagnostic accuracy depends on both reference standard rigour and teacher training/motivation.
Conclusion:
Vision screening by teachers is a viable strategy with high potential. Studies using a 6/12 cutoff demonstrated more consistent diagnostic performance, although this may reflect differences in study quality. The success of the programme depends on solid practical training and rigorous validation protocols. Involving all classroom teachers proves to be the preferred strategy for maximising early detection, while the selected teachers model stands out for its greater logistical feasibility. Continuous teacher training remains essential for the sustainability of vision screening programmes.
