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Xichang Pediatric Refractive Error Study (X-PRES) Report No. 6

Abhishek Sharma, MBBS; Liping Li, PhD; Yue Song, MD, PhD; Kai Choi, PhD; Dennis S. C. Lam, MBBS, MD, FRCOphth; Mingzhi Zhang, MD; Mingwei Zheng, MBBS; Zhongxia Zhou, MD; Xiaojian Liu, MPH; Bin Wu, MBBS; Nathan Congdon, MD, MPH

Arch Ophthalmol. 2008;126(10):1434-1440.

Objective  To assess and improve the accuracy of lay screeners compared with vision professionals in detecting visual impairment in secondary schoolchildren in rural China.

Methods  After brief training, 32 teachers and a team of vision professionals independently measured vision in 1892 children in Xichang. The children also underwent vision measurement by health technicians in a concurrent government screening program.

Results  Of 32 teachers, 28 (87.5%) believed that teacher screening was worthwhile. Sensitivity (93.5%) and specificity (91.2%) of teachers detecting uncorrected presenting visual acuity of 20/40 or less were better than for presenting visual acuity (sensitivity, 85.2%; specificity, 84.8%). Failure of teachers to identify children owning but not wearing glasses and teacher bias toward better vision in children wearing glasses explain the worse results for initial vision. Wearing glasses was the student factor most strongly predictive of inaccurate teacher screening (P < .001). The sensitivity and specificity of the government screening program detecting low presenting visual acuity were 86.7% and 28.7%, respectively.

Conclusions  Teacher vision screening after brief training can achieve accurate results in this setting, and there is support among teachers for screening. Screening of uncorrected rather than presenting visual acuity is recommended in settings with a high prevalence of corrected and uncorrected refractive error. Low specificity in the government program renders it ineffective.

Author Affiliations: Department of Ophthalmology and Visual Science, The Chinese University of Hong Kong, Hong Kong (Mr Sharma and Drs Lam and Congdon); Department of Public Health, Oxford University, Oxford, England (Mr Sharma); Shantou University Medical College, Shantou, China (Dr Li and Mr Liu); Joint Shantou International Eye Center, Shantou (Drs Song, Lam, Zhang, Zhou, and Congdon and Ms Zheng); Centre for Epidemiology and Biostatistics, Chinese University of Hong Kong School of Public Health (Dr Choi); and Xichang Eye Center, Xichang China (Mr Wu).