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Ellen Svarverud, Trine Langaas, Helle K Falkenberg; The Effectiveness of Vision Screening for Visual Problems in School Children. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5569.
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© ARVO (1962-2015); The Authors (2016-present)
As an integral part of their clinical training, Norwegian optometry students participate in vision screening in Kongsberg’s 13 primary schools for children aged 7, 10 and 15 years. The screening is a unique agreement between the optometry department and the municipality as no national guidelines exists for eye examinations in school children after the age of four years. The screening includes a symptom questionnaire and assessment of best corrected visual acuity (BCVA), retinoscopy, phorias, convergence, accommodation, ocular motility, and stereo and color vision. All children failing the screening criteria are referred to the departmental clinic for a full eye examination. This study aims to validate the vision screening scheme with regards to relevance of criteria and the ability to correctly identify children who need vision treatment and follow up.
Screening records from 7658 children aged 7 (34%), 10 (34%) and 15 (33%) years between 2002 and 2012 were evaluated. Records from children referred to the clinic were analyzed with regards to reasons for referral and the outcome of the full eye examination.
1126 (14.7%) children were referred. The most frequent reason for referral was visual symptoms (39%, 53% and 33% for 7, 10 and 15 year olds, respectively). Significant hypermetropia was measured in 14%, 16% and 9% of the 7, 10 and 15 year olds, and myopia in 3%, 7% and 16%. Other reasons for referral were reduced BCVA in the 7 year olds (15%), reduced accommodation, convergence and stereo vision in the 7 and 10 year olds (15-18%), while these reasons for referral were less frequent in 15 year olds (10-11%). Of the 856 who attended the clinic, treatment or further follow up was recommended in 594 (69%) cases. The number of true referrals increased with age and was 63%, 77% and 86% for 7, 10 and 15 year olds, respectively.
Our results suggest that visual screening correctly identifies many school children who have undetected visual problems, and that visual problems differ across age groups. However, the false referral rate is high in the youngest age group, which may be due to insufficient routines and lack of experience in assessing vision in young children. Currently, improvements to the vision screening scheme include discussion of criteria for referral, student training prior to screening, check lists for supervisors and screening facilities.
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