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Evaluation of ‘vision screening’ program for three to six-year-old children in the Republic of Iran

Background: Since 1996, vision screening of three to six-year-old children is conducted every year in Iran. We present outcomes of project review held in August 2006. Materials and Methods: Kindergarten teachers examined vision by using Snellen's illiterate ‘E’ chart. They used torchlight to detect strabismus. On a repeat test, if either eye had vision <20/30, the child was referred to the optometrist. A pediatric ophthalmologist examined and managed children with strabismus or amblyopia. Provincial managers supervised the screening program. The evaluator team assessed the coverage, yield, quality and feasibility, and cost-effectiveness of vision screening, as well as magnitude of amblyopia, and its risk factors. Result: In 2005, 1.4 million (67%) children were examined in all provinces of Iran. Opticians examined 90,319 (61%) children with defective vision that were referred to them. The prevalence of uncorrected refractive error, strabismus and amblyopia was 3.82% (95% CI 3.79 – 3.85), 0.39% (95% CI 0.38 – 0.40) and 1.25% (95% CI 1.24 – 1.26) respectively. Validity test of 7,768 children had a sensitivity of 74.5% (95% CI 72.7 – 76.3) and specificity of 97.2% (95% CI 96.7 – 97.7). The cost of amblyopia screening was US $ 1.5 per child. While the cost of screening and treating one child with amblyopia was US $ 245. Conclusion: A review of the vision screening of children in Iran showed it with screening and useful exercise and had a yield of 1:21. The coverage of vision screening was low and the management of children with amblyopia, low vision and refractive error needed strengthening.