Vision screening for correctable visual acuity deficits in school-age children and adolescents

What is the aim of this review?
The aim of this Cochrane Review was to find out if vision screening of school-age children and adolescents reduces the number of children who need spectacles but who either don't have any or who are wearing the wrong prescription.

Key messages
Vision screening and provision of free spectacles improves the number of children who have and wear the spectacles they need. In lower-income settings, ready-made spectacles may provide a useful alternative to expensive custom-made spectacles.

What was studied in the review?
Worldwide, an unmet need for corrective spectacles is the leading cause of reduced vision in children; short-sightedness (unable to see objects in the distance clearly) has become the commonest eye condition. Reduced vision may affect academic performance and therefore choice of occupation and socio-economic status in adult life. It can also be associated with other symptoms such as headaches. Vision screening programmes designed to identify children who need spectacles have therefore been introduced into schools. Such programmes improve access to health care for some children who would not otherwise have it, but the value of these screening programmes is debatable. This review was therefore designed to collect and evaluate any evidence regarding how well such programmes are working.

What are the main results of the review?
Cochrane Review authors found seven relevant studies. These studies tested ways of improving the take-up of spectacle prescriptions given as part of a screening programme. Five studies were from China, one from India and one from Tanzania. These studies compared: vision screening with free spectacles with vision screening alone; vision screening with education with vision screening alone; and vision screening and ready-made spectacles with vision screening and custom-made spectacles.

The review shows that:

• There are no studies comparing vision screening with no vision screening (evidence gap).
• Vision screening with provision of free spectacles results in more children wearing spectacles after screening compared with giving the children a prescription on its own (high-certainty evidence). Children in the free-spectacle group had better educational attainment (low-certainty evidence).
• Vision screening with health education designed to increase spectacle uptake did not appear to improve the number of children wearing spectacles after screening compared with no education (moderate-certainty evidence).
• Ready-made and custom-made spectacles appear to give similar visual results and similar spectacle wearing (moderate- and high-certainty evidence).

How up-to-date is this review?
Cochrane Review authors searched for studies that had been published up to 3 May 2017.