Feasibility and accuracy of school-led vision screening in primary and secondary school students within the United Kingdom

Optom Vis Sci. 2026 Feb;103(2):e70020. doi: 10.1002/ovs2.70020.

ABSTRACT

PURPOSE: Vision screening occurs once in United Kingdom (UK) children on school entry, but has recently been withdrawn in some areas. Consequently, significant refractive error and/or vision problems may go undetected. School-led vision checking, where school staff assess vision, is increasingly advocated by the International Agency for the Prevention of Blindness. This study investigates the accuracy of school-led vision checking in UK school students.

METHODS: School personnel were trained to conduct vision checks on their students. These involved external observation of the eyes for obvious abnormalities, as well as monocular distance (3 m) and near vision assessments (33 cm), equivalent to 0.2 logMAR. Equipment required to complete the checks was provided to schools. Optometrists repeated the assessments on average within 3 weeks to determine the accuracy of the school-led checks. Failure criteria were habitual vision >0.20 logMAR (<4 of 5 letters correct) in one or both eyes, at distance or near, and/or the presence of any ocular abnormality.

RESULTS: One thousand and one children (45.7% female) from eight primary (6-8 years n = 233) and three secondary (11-13 years n = 768) schools participated. Overall sensitivity and specificity of distance vision and ocular abnormality checks were 87.2% and 88.9%, respectively. Corresponding values for sensitivity and specificity were 95.8% and 88.1% for primary schoolchildren and 84.3% and 89.2% for secondary schoolchildren. High negative predictive values in both primary (99.3%) and secondary (97.4%) schools indicate school staff correctly identified most children with distance vision problems. With near vision results included, sensitivity and specificity reduced to 80.6% and 82.2%, respectively, in the whole cohort (87.1% and 83.2% in primary schoolchildren and 78.5% and 81.6% for secondary schoolchildren) because of an increase in false positives.

CONCLUSIONS: The vision screening assessment battery utilized within this study requires refinement; however, school-led vision screening is feasible and can correctly identify UK school children with and without vision problems with sensitivity and specificity of >80%.

PMID:41926785 | DOI:10.1002/ovs2.70020