Vision Screening in Low-Income First Graders in São Paulo, Brazil: The Vision of the Future Program

Abstract

Purpose: : Vision screening in school children is a widespread method of identifying uncorrected refractive errors and other visual disorders in this population. The Vision of the Future Program is a governmental initiative to provide diagnosis and treatment for visual disorders for all children registered in the first grade of elementary public schools in São Paulo City, Brazil. Our purpose is to identify the major visual abnormalities in a subset of low-income first graders of the eastern zone of São Paulo and to provide access to eye care services for those in need.

Methods: : Teachers were trained to administer tests of visual acuity (VA) and external inspection of the eyes in the classroom. Criteria for referral to a comprehensive ophthalmic exam at the local hospital were: VA ≤ 20/32 and/or an inter-ocular acuity difference ≥ 2 lines in the Snellen printed chart; manifest strabismus or other remarkable eye signs (red eyes, itchy eyes) or broken glasses. Informed consent was obtained from all participants’ guardians before an eye examination including VA testing with retro-illuminated logMAR tumble E chart, ocular motility, and examination of the external eye, anterior segment, and media. Children with presenting VA of 20/32 or worse in either eye underwent cycloplegic refraction and fundus examination.

Results: : A sample of 236 public schools was included with a total of 27,117 registered and screened first graders. Reduced vision and/or other eye disorders were identified in 6,008 (22.2%) children who were referred to our hospital. A total of 2,944 (response rate of 49.0%) children underwent ophthalmic examination. Normal or near-normal presenting visual acuity (VA) of 20/32 or better in either eye was found in 1,142 (38.8%) examined participants. Uncorrected refractive errors needing prescription were found in 1,466 (49.8%) among the referrals. Visual morbidity statistics was: 242 (8.2%) diagnosed with blepharitis, 178 (6.0%) with amblyopia, 159 (5.4%) with strabismus, 60 (2.0%) with conjunctivitis and 35 (1.2%) with other eye disorders (corneal disease followed by congenital cataract, retinal conditions, ptosis, optic nerve disease and tumors).

Conclusions: : The screening indicates the presence of significant visual morbidity in this group of first graders with a major need for glasses. Further studies are needed to follow-up the compliance with recommended treatment and/or spectacle wear, despite providing immediate access to eye care.

Keywords: screening for ambylopia and strabismus • amblyopia • clinical (human) or epidemiologic studies: prevalence/incidence