Visual acuity screening in schools: A systematic review of alternate screening methods

Figures & data

Table 1. Summary of 30 included studies of school-based visual acuity testing

S. No.	Article (Country)	N	Age group	Study method	VA testing personnel	Diagnostic examination
1	Adhikari et al. (2013) (Nepal)	2,000	5–16	A cross-sectional prevalence study	Ophthalmic team	Ophthalmic team
2	Ajaiyeoba et al. (2005) (Nigeria)	1,144	5–19	School based field study	Teachers & nurses	Ophthalmologists
3	Aldebasi (2014) (Saudi Arabia)	5,176	6–13	A cross-sectional prevalence study	Ophthalmic team	Ophthalmic team
4	Sartika Apulina et al. (2011) (Indonesia)	23,427	7–15	Prospective study alternate teacher models	Teachers & class teachers	Refractionists
5	Bagchi et al. (2008) (India)	45,087	5–15	Retrospective analysis of school screening program performance	Teachers (219)	Optometrist
6	Faran (1992) (Saudi Arabia)	3,590	6–17	School screening performance study	Nurses	Ophthalmic team
7	Fotouhi et al. (2007) (Iran)	5,544	7–15	A cross-sectional prevalence study/random sampling	Ophthalmic team	Ophthalmic team
8	He et al. (2014) (China)	9,512	6–10	Random sampling	Ophthalmic team	Ophthalmic team
9	Jin et al. (2015) (China)	4,416	6–12	A cross sectional prevalence study	Ophthalmic team	Ophthalmic team
10	Kemper et al. (1999) (United States)	2,726	5–10	A cross sectional prevalence study	The certified screeners (nurses + lay volunteers	Team at base hospital
11	Khandekar et al. (2004) (Oman)	1,719	7–13	A cross sectional prevalence study	School nurses	National eyehealth care supervisors
12	Khandekar et al. (2004) #631(Oman)	416,157	6–17	Review of cross sectional data, school screening performance	Trained physicians	Ophthalmic team
13	Kumah et al. (2013) (Ghana)	2,454	12–15	Random cluster sampling, cross sectional prevalence study	Ophthalmic team	Ophthalmic team
14	Limburg et al. (1999) (India)	5,390,000	5–15	Prospective study school screening performance	Teachers (32,865)	Refractionists
15	Limburg et al. (1995) (India)	46,672	10–14	Prospective study school screening performance	Teachers (292)	Refractionists (only 1,385 screened)
16	Lindquist et al. (2011) (Australia)	8,201	12–20	Prevalence study, random sampling	Refractionists	Refractionists
17	Lu et al. (2008) (China [Tibetan])	1,084	6–14	Cohort study	Ophthalmic team	Ophthalmic team
18	Okoye et al. (2013) (Nigeria)	2,092	6–16	A cross sectional prevalence study	Ophthalmic assistant	Ophthalmic team
19	Ore et al. (2009) (Israel)	1,975	6–7 & 13−14	A cross-sectional school screening performance	Nurse	Ophthalmic team
20	Pizzarello et al. (1998) (United States)	5,851	11–14	A cross-sectional study of screening performance	Parent volunteers & school nurse	Optometrist
21	Priya et al. (2015) (India)	80,463	6–17	A prospective, non-randomized controlstudy of alternative school screening methodologies	Teachers	Ophthalmic team
22	Rewri et al. (2013) (India)	7,411	10–19	Pilot study of self-assisted vision examination (SAVE)	Self-assisted by school children	Optometrist
23	Rushood et al. (2013) (Sudan)	671,119	6–15	School-based survey/total coverage survey	Optometrists	Ophthalmic team
24	Rustagi et al. (2012) (India)	1,123	11–17	Intervention study	Single experienced optometrist	Ophthalmologist
25	Saxena et al. (2015) (India)	9,838	5–14	A cross-sectional study alternate VA thresholds	Teachers	Primary eye care worker
26	Sharma et al. (2008) (China)	1,892	11–17	School-based survey/Cluster-based random sampling	32 class teachers	Ophthalmic team
27	Sudhan et al. (2009) (India)	77,778	7–15	School screening performance study	530 Teachers	Ophthalmic assistant
28	Tananuvat et al. (2004) (Thailand)	6,898	6–7	School based study/Prevalence study	Ophthalmic team	Ophthalmic team
29	Teerawattananon et al. (2014) (Thailand)	5,885	5–12	Cross-sectional descriptive and analytical study	Teachers	Ophthalmic team
30	Wedner et al. (2008) (Tanzania)	6,904	11–25	Cluster randomized selection, prevalence study	Ophthalmic team	Ophthalmic team

Table 2. Summary of controlled studies of visual acuity screening methods involving school teachers

Article (country)	N	Age range	Study methods	Screening personnel	Students per teacher (average)	VA level	Screen positive	True positive	Ocular pathology	Refractive Error	Compliance rate	Time between screening & examination
Sartika Apulina et al. (2011) (Indonesia)	23,427	7–15	A prospective, non-randomized control	Selected teachers	STs 135	20/40	23%	16.4%	1.5	22%	N/A	Unknown
			study of alternative school screening methodologies	Most class teachers	MTs 28		24%	16.6%	3.4%	22%	N/A
Priya et al. (2015) (Southern India)	80,463	6–17	A prospective, non-randomized control	Selected teachers	STs 247	20/30	6387(16%)	1554 (4%)	0.9%	3%	12%	1–6 months
			Study of alternative school screening methodologies	All class teachers	ACTs 52		3806 (9%)	2231 (6%)	1.6%	4%	59.2%	1–2 weeks
Saxena et al. (2015) (Northern India)	9,838	5–14	A cross-sectional study alternate VA thresholds	Teachers	Unknown	20/30	17.3%	10.6%	Unknown	Unknown	Unknown	Unknown
						20/40	9.6%	6.6%

Table 3. Summary of included observational studies of school screening programs, teachers or school nurse screeners

Article (Country)	N	Age group	Screening method	Initial VA Screening personnel	Students per Screener	VA measured using	VA Level	Screen positive (VA level)	Follow-up Diagnostic Examinations by	True positive	RE (%)	Compliance rate	Time to complete total programme
Ajaiyeoba et al. (2005) (Nigeria)	1,144	5–19	School based field study	Teachers & nurses	Unknown	Snellen’s Chart	20/60	60 (5%)	Ophthalmologists	49 (4%)	10 (0.87%)	Unknown	Unknown
Bagchi et al. (2008) (India)	45,087	5–15	Retrospective analysis of school screening program performance	Teachers	229	Snellen’s Chart	20/40	2,126 (4.71%)	Optometrist	1,856 (4.11%)	1,819 (4.03%)	Unknown	45–180 days
Kemper et al. (1999) (United States)	2,726	5–10	Cross sectional study prevalence	The certified screeners (nurses + lay volunteers)	Unknown	HOTV chart	20/50	209 (8%)	Team at base hospital	209 (8%)	106 (4%)	Unknown	Unknown
Khandekar et al. (2004) (Oman)	1,719	7–13	Review of cross sectional data, school screening performance	School nurses	Unknown	Snellen E acuity test	20/30	87 (5%)	National eye health care supervisors	74 (4.30%)	33 (2%)	Unknown	Unknown
Limburg et al. (1999) (India)	5,390,000	5–15	Prospective study, school screening performance	Teachers (32,865)	164	Snellen’s distant vision E chart	20/30	230,282 (4%)	Refractionists	81,937 (1.5%)	50,096 (1%)	Spectacles 96.5%	Unknown
Limburg et al. (1995) (India)	46,672	10–14	Prospective study, school screening performance	Teachers (292)	160	Snellen’s distant vision E chart	20/30	2,125 (5%)	Refractionists (only 1385 screened)	822 (2%)	593 (1%)	Unknown	Unknown
Pizzarello et al. (1998) (United States)	5,851	11–14	Cross-sectional study of screening performance	Parent volunteers	Unknown	Snellen’s Chart	20/40	1,614 (28%)	Licensed optometrist.	1,096 (19%)	1,082 (18%)	Unknown	3 months
Sharma et al. (2008) (China)	1,892	11–17	School-based survey/Cluster-based random sampling	Class teachers	60	Snellen’s chart	20/40	985 (52%)	Ophthalmic team	674 (36%)	674 (35.6%)	Unknown	Unknown
Sudhan et al. (2009) (India)	77,778	7–15	School screening performance study	Teachers	147	Illiterate E card	20/30	3,822 (4.91%)	Ophthalmic assistant	1,242 (1.80%)	496 (1%)	Unknown	1 year
Teerawattananon et al. (2014) (Thailand)	5,885	5–12	Cross-sectional descriptive and analytical study	Teachers	24	Snellen chart	20/40	624 (11.5%)	Ophthalmic team	425 (7%)	363 (6%)	Unknown	Unknown

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