| Summary: | Purpose: Visual acuity (VA) screening in schools has been widely adopted by eye programs around the world. This review evaluates the efficacy and cost of alternate VA screening methods to identify school-age children with undetected visual deficits due to refractive error and other visual disorders. Methods: Published studies were identified from Ovid MEDLINE, MEDLINE In-Process, and EMBASE for trials from 1974 to March 2015 as well as from reference and author searches. All controlled studies were included. Data extraction tables were developed a priori for key screening test performance indicators, including compliance. Results: Three trials met the inclusion criteria, two comparing alternate teacher models and one compared teachers to primary eye care workers using three different VA thresholds. School vision screening using “all class teachers” (ACTs) found significantly fewer screen-positive children than select teachers (STs) (9.9 vs. 16.6% [p < 0.001] respectively) and significantly more children with visual disorders (5.7 vs. 4.0% [p < 0.001] respectively) at 30% of the cost and improved compliance. Teachers performed similarly to primary eye care workers in detecting children with visual disorders with 6/12 the optimal cut-off level. Conclusions: Using detection of children with visual disorders as outcome, evidence supports school screening using “ACTs” and a 6/12 VA threshold. Using the proportion of students with visual disorders who attend follow up at the referral hospital within three months as outcome, one study supports use of ACTs. Using cost per child detected with visual disorders as outcome, one study supports use of ACTs.
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