Agreement and diagnostic accuracy of vision screening in children by teachers, community eye‐health workers and vision technicians

Marmamula, Srinivas; Khanna, Rohit C; Mettla, Asha Latha; Pehere, Niranjan K; Keeffe, Jill; Yameneni, Dushyant K; Rao, Gullapalli N

doi:10.1111/cxo.12559

Cited by 18 publications

(13 citation statements)

References 15 publications

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“…1). The final analysis was performed on 36 articles that reported implementation in 18 countries from 5 continents (Table 2), comprising North America ( n = 2),19, 27, 28, 29, 30, 31, 32, 33, 34, 35 Asia ( n = 8),3, 21, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46 Oceania ( n = 2),16, 17 Europe ( n = 4),6, 20, 47, 48, 49, 50 and Africa ( n = 2) 51, 52. Objectives of screening program were dissected based on target age groups according to their learning stages and target conditions.…”

Section: Resultsmentioning

confidence: 99%

“…Objectives of existing pediatric vision screening programs varied with different age groups and conditions 3, 6, 16. Inconsistencies in implementation were commonly observed in the testing approach3, 17, 18, 19 and vision screeners 3, 20, 21. Pediatric vision screening programs often received an ad hoc level of support from governing authorities and financial allocation due to lack of evidence in the cost findings and the effectiveness of the program 10 .…”

Section: Introductionmentioning

confidence: 99%

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Comparison of the pediatric vision screening program in 18 countries across five continents

Chen

Bakar

Arthur

2019

Journal of Current Ophthalmology

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PurposeIncorporating mass pediatric vision screening programs as part of a national agenda can be challenging. This review assessed the implementation strategy of the existing pediatric vision screening program.MethodsA search was performed on PubMed, EBSCO host MEDLINE Complete, and Scopus databases encompassing the past ten years for mass pediatric screening practice patterns that met the selection criteria regarding their objectives and implementation. Results were analyzed from 18 countries across five continents.ResultsEight countries (44%) offered screening for distance visual acuity only, where the majority of the countries (88%) used either Snellen or Tumbling E chart. High-income countries initiated screening earlier and applied a more comprehensive approach, targeting conditions other than reduced vision only, compared with middle-income countries. Chart-based testing was most commonly performed, with only three countries incorporating an instrument-based approach. Lack of eyecare and healthcare practitioners frequently necessitated the involvement of non-eyecare personnel (94%) as a vision screener including parent, trained staff, and nurse.ConclusionsImplementation of a vision screening program was diverse within countries preceded by limited resources issues. Lack of professional eyecare practitioners implied the need to engage a lay screener. The limitation of existing tests to detect a broader range of visual problems at affordable cost advocated the urgent need for the development of an inexpensive and comprehensive screening tool.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of the pediatric vision screening program in 18 countries across five continents

Chen

Bakar

Arthur

2019

Journal of Current Ophthalmology

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“…12 , 13 In these screening programs, many different eye charts are employed and visual acuity is measured by different people: teachers, nurses, certified medical assistants, public health care workers, students, and other lay-people. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 Mobile and computer applications have been developed to improve and increase the consistency of checking visual acuity in children’s screening programs. Some of these applications have been investigated through peer-reviewed publications.…”

Section: Introductionmentioning

confidence: 99%

“…There have been many studies evaluating the assessment of visual acuity by lay screeners in vision screening programs. 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 The goal of those studies is to refer children with decreased visual acuity below an aged-based critical line for further examination by an eye care provider. Now, we are shifting the narrative to explore the use of the visual acuity as measured by these methods as a visual acuity that an ophthalmologist will use for their evaluation and decision-making process.…”

Section: Introductionmentioning

confidence: 99%

Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

Silverstein

Williams

Brown

et al. 2021

American Journal of Ophthalmology

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: Purpose With the recent rise of teleophthalmology due to coronavirus disease, we are in need of accurate and reliable methods of checking visual acuity remotely. We compare the visual acuity as measured by the GoCheck Kids application, HOTV with the amblyopia treatment study (ATS), and our clinic protocol. Design This is a prospective, comparison of visual acuity assessment methods. Methods Established patients (aged 3-18) in the practice of a single pediatric ophthalmologist were eligible. Visual acuity was measured by: 1) GoCheck Kids mobile application (by patient’s family member), 2) HOTV-ATS (by study personnel), and 3) regular clinic protocol (by ophthalmic technician). To assess agreement between measures of acuity, intraclass correlations with 95% confidence intervals were computed. Results Fifty-three children participated. The mean difference between GoCheck Kids and HOTV-ATS acuities (0.094) was significantly different (p<0.001); the intraclass correlation (ICC) was 0.55 (95% CI: 0.40, 0.68). The mean difference between GoCheck Kids and chart acuities (0.010) was not significantly different (p=0.319); ICC: 0.59 (95% CI: 0.45, 0.71). The mean difference between HOTV-ATS and chart acuities (0.084) was significantly different (p<0.001); ICC: 0.66 (95% CI: 0.53, 0.76). The percent of eyes with visual acuity as measured by GoCheck Kids that was within 1 line of the HOTV-ATS and chart acuity was 65.3% and 86.7%, respectively. Conclusions GoCheck Kids as checked by a family member provides a modest correlation of visual acuity compared to the chart screen and a fair correlation of visual acuity compared to HOTV-Amblyopia Treatment Study protocol, though a vast majority are within 1 line.

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“…Screening by optometrist and community workers is a definite option 2 , 3 , 23 though screening by teachers is easier in terms of compliance of the students, continuity of the program over years, and overall low opportunity cost. Additionally, teachers could better motivate children for subsequent visit to ophthalmic personnel and monitor the impact of treatment on their performance in studies.…”

Section: Discussionmentioning

confidence: 99%

Tribal Odisha Eye Disease Study (TOES # 2) Rayagada school screening program: efficacy of multistage screening of school teachers in detection of impaired vision and other ocular anomalies

Panda

Das

Nayak

et al. 2018

OPTH

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PurposeTo describe program planning and effectiveness of multistage school eye screening and assess accuracy of teachers in vision screening and detection of other ocular anomalies in Rayagada District School Sight Program, Odisha, India.MethodsThis multistage screening of students included as follows: stage I: screening for vision and other ocular anomalies by school teachers in the school; stage II: photorefraction, subjective correction and other ocular anomaly confirmation by optometrists in the school; stage III: comprehensive ophthalmologist examination in secondary eye center; and stage IV: pediatric ophthalmologist examination in tertiary eye center. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of teachers for vision screening and other ocular anomaly detection were calculated vis-à-vis optometrist (gold standard).ResultsIn the study, 216 teachers examined 153,107 (95.7% of enrolled) students aged 5–15 years. Teachers referred 8,363 (5.4% of examined) students and 5,990 (71.6% of referred) were examined in stage II. After prescribing spectacles to 443, optometrists referred 883 students to stage III. The sensitivity (80.51%) and PPV (93.05%) of teachers for vision screening were high, but specificity (53.29%) and NPV (26.02%) were low. The specificity and NPV, in general, were higher in ocular anomaly detection but varied from disease to disease.ConclusionMultistage school screening is rapid and comprehensive in a resource-limited community. Regular training and periodic reinforcement of teachers for vision assessment and other ocular anomaly identification are required for further success of the strategy.

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Agreement and diagnostic accuracy of vision screening in children by teachers, community eye‐health workers and vision technicians

Abstract: There was no significant difference in the agreement and diagnostic accuracy of CEHWs and teachers compared to those of the vision technician. There was a large variability among teachers, which needs to be considered in school vision screening programs.

Cited by 18 publications

References 15 publications

Comparison of the pediatric vision screening program in 18 countries across five continents

Comparison of the pediatric vision screening program in 18 countries across five continents

Teleophthalmology: Evaluation of Phone-based Visual Acuity in a Pediatric Population

Tribal Odisha Eye Disease Study (TOES # 2) Rayagada school screening program: efficacy of multistage screening of school teachers in detection of impaired vision and other ocular anomalies

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