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

Abstract

Background

To compare the agreement and diagnostic accuracy of vision screening conducted by trained community eye‐health workers (CEHWs) and teachers with reference to vision technicians in Movva Mandal (sub‐district) in Krishna District in the Indian state of Andhra Pradesh.

Methods

As part of a large epidemiological study on visual impairment in children, vision screening was conducted in all the schools in a sub‐district. The children were screened using a screening card with 6/12 tumbling E optotypes by trained CEHWs, teachers and a vision technician. Teachers were included if they had screened at least 100 children and had at least five children identified with visual impairment.

Results

Of a total 6,197 children from 75 schools, 4,929 children were screened by all three categories of examiners (one vision technician, five CEHWs and 79 teachers). The overall agreement between the vision technician and CEHWs was 0.84 (95 per cent CI: 0.79–0.9) with a range of 0.77–0.9. Overall sensitivity of CEHWs to detect visual impairment was 83.3 per cent (95 per cent CI: 73.6–90.6) with a range of 71.4–87.1 per cent. Overall agreement of the five teachers with the vision technician was 0.81 (95 per cent CI: 0.74–0.88) with a range of 0.32–0.92. The overall sensitivity of teachers to detect vision problem was 72.3 per cent (95 per cent CI: 61.4–81.6) with a range from 20 per cent to 85.7 per cent and specificity was near 100 per cent.

Conclusion

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.

Key words:

• vision screening
• school children
• diagnostic accuracy
• agreement

ACKNOWLEDGEMENTS

The authors are grateful to all the teachers who have participated in the study. Our thanks are due to all the children who were enrolled in the study. The authors also thank Mr PV Kiran and the Kode Venkatadri Campus (LVPEI) team for all their administrative and logistic support for the study. Dr Sreedevi Yadavalli is acknowledged for her language input on the earlier version of the manuscript.

This study is funded by Lions Clubs International, SightFirst research grant and Hyderabad Eye Research Foundation, India.

Additional information

Funding

Lions Clubs International, SightFirst research grant

Hyderabad Eye Research Foundation, India