Background: Visual disorders have been reported to be higher among children with intellectual disability (ID) than among their peers without special needs; however, prevalence data on visual problems in children in Saudi Arabia are scarce. Aims: The aim of this study is to report the prevalence and causes of undiagnosed, correctable visual impairment in children with ID. Materials and Methods: A cross-sectional study of students enrolled in special educational needs schools in the western region of Saudi Arabia in April 2018. Teller visual acuity (VA) assessment and refractive errors were noted. Participants with mild to profound ID underwent detailed ophthalmologic examinations, including cycloplegic refraction, full orthoptic workup, biomicroscopy, and funduscopy. Results: A total of 61 students participated in this study. Ocular findings in decreasing prevalence were as follows: Subnormal VA (n = 41, 67.2%), refractive errors (n = 31, 51.7%), fundus anomalies (n = 13, 22%), significant strabismus (n = 9, 14.8%), abnormal head posture (n = 8, 13.3%), nystagmus (n = 3, 4.9%), anterior segment abnormality (n = 3, 4.9%), and extraocular motility abnormality (n = 2, 3.3%). Astigmatism was found in 22 cases (36.7%), followed by hyperopia (n = 13, 21.7%), myopia (n = 10, 16.7%), and anisometropia (n = 5, 8.3%). Students with syndromic ID had significantly more moderate-to-severe subnormal VA (P < 0.001) and myopic shift on cycloplegic refraction (P = 0.014 right eyes and P = 0.004 left eyes) than those with nonsyndromic ID. Conclusions: A considerable proportion of ID children have significant visual disorders. This emphasizes the need for adequate diagnostic and therapeutic national eye care services for children with ID.

PURPOSE: This study aimed to determine whether the plusoptiX vision screener (PVS) can be used to detect amblyogenic risk factors (ARFs) as defined by the American Association for Paediatric Ophthalmology and Strabismus Vision Screening Committee guidelines (2013) for automated vision screening devices. METHODS: In this cross-sectional study, children attending a special needs school underwent screening with the PVS and complete ophthalmologic examinations. Ophthalmologic examinations were used as the gold standard to compute the prevalence, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and testability. RESULTS: Forty-four children with special needs (mean age, 8.5 years; range, 4–18 years) were included. The PVS recommended referral of 31 cases (referral rate 70%). Thirty-nine of the 44 children (89%) met the referral-positive threshold for strabismus, reduced vision and/or amblyogenic factors on examination. The plusoptiX had a sensitivity of 40% (confidence interval [CI] 7%–83%), specificity of 78% (CI 55%–85%), PPV of 15% (CI 3%–46%), and NPV of 90.3% (CI 73%–97%). The PVS underestimated refractive errors by 0.67 to 0.71 D in the right ( P < 0.001) and left eyes ( P = 0.002). Testability was relatively low, with the PVS at 75% compared to the gold standard examination at 100%. CONCLUSION: We found that although the plusoptiX photoscreener might be a useful tool in pediatric vision screening, it might not perform as well in children with intellectual disabilities. Utilization of the PVS as a single screening device may fail to identify a considerable proportion of young children with ARFs or amblyopia.