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.


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.


RESULTS
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.


CONCLUSIONS
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.
Ophthalmologist and Epidemiologist, Low Vision Care expert, Advisor, Eye and Ear Health care, Ministry of Health, Oman. rajshpp@omantel.net.om
Rajiv
R
Khandekar
Noa
N
Parast
Ashraf
A
Arabi
D000550:Amblyopia / Q000175:diagnosis* / Q000453:epidemiology; D001766:Blindness / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015351:Vision Screening / Q000458:organization & administration*; D015354:Vision, Low / Q000175:diagnosis* / Q000453:epidemiology