Continued care and provision of glasses are necessary to improve visual and academic outcomes in children: Experience from a cluster-randomized controlled trial of school-based vision screening

Objective To assess the effectiveness of a kindergarten vision screening program by randomly assigning schools to receive or not receive vision screening, then following up 1.5 years later. Methods Fifty high-needs elementary schools were randomly assigned to participate or not in a vision screening...

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Bibliographic Details
Published in:Canadian journal of public health 2024-08, Vol.115 (4), p.688-698
Main Authors: Nishimura, Mayu, Wong, Agnes, Maurer, Daphne
Format: Article
Language:English
Subjects:
Amblyopia - diagnosis
Amblyopia - epidemiology
Astigmatism
Child
Child, Preschool
Children
Cluster Analysis
Eye examinations
Eyeglasses
Female
Humans
Kindergarten
Male
Medical screening
Medicine
Medicine & Public Health
Original
Original Article
Program Evaluation
Public Health
School Health Services
Schools
Screening
Vision
Vision Disorders - epidemiology
Vision Screening
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Summary:Objective To assess the effectiveness of a kindergarten vision screening program by randomly assigning schools to receive or not receive vision screening, then following up 1.5 years later. Methods Fifty high-needs elementary schools were randomly assigned to participate or not in a vision screening program for children in senior kindergarten (SK; age 5‒6 years). When the children were in Grade 2 (age 6‒7 years), vision screening was conducted at all 50 schools. Results Contrary to expectations, screened and non-screened schools did not differ in the prevalence of suspected amblyopia in Grade 2 (8.6% vs. 7.5%, p  = 0.10), nor prevalence of other visual problems such as astigmatism (45.1% vs. 47.1%, p  = 0.51). There was also no difference between screened and non-screened schools in academic outcomes such as the proportion of children below grade level in reading (33% vs. 29%) or math (44% vs. 38%) ( p  = 0.86). However, more children were wearing glasses in screened than in non-screened schools (10.2% vs. 7.8%, p  = 0.05), and more children reported their glasses as missing or broken (8.3% vs. 4.7%, p  = 0.01), suggesting that SK screening had identified successfully those in need of glasses. Examination of individual results revealed that 72% of children diagnosed and treated for amblyopia in SK no longer had amblyopia in Grade 2. Conclusion The prevalence of amblyopia and other visual problems was not reduced in Grade 2 by our SK vision screening program, perhaps because of poor treatment compliance and high attrition. The results suggest that a single screening intervention is insufficient to reduce visual problems among young children. However, the data from individuals with amblyopia suggest that continuing vision care and access to glasses benefits children, especially children from lower socioeconomic class.
ISSN:0008-4263
1920-7476
1920-7476
DOI:10.17269/s41997-024-00884-8