title: Validation of performance of certified medical assistants in preschool vision screening examination.
abstract: BACKGROUND
  Preschool vision screening examination is still a new concept in Nepal. There is a need for developing cost-effective tools for detecting amblyogenic factors in Nepalese children. Certified medical assistants (CMA) are health personnel who work in village health posts.
  
  
  OBJECTIVE
  To find out the effectiveness of vision screening by certified medical assistants using simple tools like an HOTV chart and the Red Reflex test.
  
  
  METHODS
  A cross sectional and validation study was carried out in two phases. In the first phase, 20 CMAs from each Village Development Centre (VDC) of the Bhaktapur District were given training on visual acuity test by using an HOTV chart, Bruckner test by using a retinoscope and the test for ocular alignment by a torch light. In the second phase, children aged 3 - 7 years were examined by trained certified medical assistants in five remote VDCs of Bhaktapur District. These children underwent the gold standard examination by two pediatric ophthalmologists blind to the CMAs± findings.
  
  
  RESULTS
  The mean age of children was 5.26 ± 376 years. The overall sensitivity of certified medical assistants examination was 58 % and the specificity was 98 %. While comparing the test characteristics of different examination tools, the HOTV test was found to be the most effective one with the sensitivity of 80 % and the specificity of 98 %.
  
  
  CONCLUSIONS
  Vision screening by certified medical assistants can help in detection and early referral of children having amblyogenic risk factors with high sensitivity. The HOTV test is the most effective one with high sensitivity and specificity. In developing countries like Nepal,where access to regular eye examination is a rare possibility, preschool vision screening using the HOTV test can be effective.
authors.affiliation: Tilganga Institute of Ophthalmology, Gaushala Kathmandu, Nepal. srji_a@yahoo.com
authors.forename: S
authors.initials: S
authors.lastname: Adhikari
authors.forename: U
authors.initials: U
authors.lastname: Shrestha
mesh_terms: D000488:Allied Health Personnel / Q000592:standards*; D000550:Amblyopia / Q000175:diagnosis*; D002568:Certification / Q000592:standards; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009390:Nepal; D015397:Program Evaluation; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014786:Vision Disorders / Q000175:diagnosis*; D015351:Vision Screening / Q000379:methods* / Q000592:standards*