title: Reducing visual deficits caused by refractive errors in school and preschool children: results of a pilot school program in the Andean region of Apurimac, Peru.
abstract: BACKGROUND
  Refractive error is defined as the inability of the eye to bring parallel rays of light into focus on the retina, resulting in nearsightedness (myopia), farsightedness (Hyperopia) or astigmatism. Uncorrected refractive error in children is associated with increased morbidity and reduced educational opportunities. Vision screening (VS) is a method for identifying children with visual impairment or eye conditions likely to lead to visual impairment.
  
  
  OBJECTIVE
  To analyze the utility of vision screening conducted by teachers and to contribute to a better estimation of the prevalence of childhood refractive errors in Apurimac, Peru. Design : A pilot vision screening program in preschool (Group I) and elementary school children (Group II) was conducted with the participation of 26 trained teachers. Children whose visual acuity was<6/9 [20/30] (Group I) and ≤ 6/9 (Group II) in one or both eyes, measured with the Snellen Tumbling E chart at 6 m, were referred for a comprehensive eye exam. Specificity and positive predictive value to detect refractive error were calculated against clinical examination. Program assessment with participants was conducted to evaluate outcomes and procedures.
  
  
  RESULTS
  A total sample of 364 children aged 3-11 were screened; 45 children were examined at Centro Oftalmológico Monseñor Enrique Pelach (COMEP) Eye Hospital. Prevalence of refractive error was 6.2% (Group I) and 6.9% (Group II); specificity of teacher vision screening was 95.8% and 93.0%, while positive predictive value was 59.1% and 47.8% for each group, respectively. Aspects highlighted to improve the program included extending training, increasing parental involvement, and helping referred children to attend the hospital.
  
  
  CONCLUSIONS
  Prevalence of refractive error in children is significant in the region. Vision screening performed by trained teachers is a valid intervention for early detection of refractive error, including screening of preschool children. Program sustainability and improvements in education and quality of life resulting from childhood vision screening require further research.
authors.affiliation: Entretodos Foundation, Zaragoza, Spain; Public Health Research Group, University of Alicante, Alicante, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Latorre-Arteaga
authors.affiliation: Public Health Research Group, University of Alicante, Alicante, Spain; Department of Community Nursing, Preventive Medicine and Public Health, and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Observatory of Public Policies and Health (OPPS), University of Alicante, Alicante, Spain; Diana.Gil@ua.es.
authors.forename: Diana
authors.initials: D
authors.lastname: Gil-González
authors.affiliation: Centro Oftalmológico Monseñor Enrique Pelach, Abancay, Peru.
authors.forename: Olga
authors.initials: O
authors.lastname: Enciso
authors.affiliation: Dublin Institute of Technology, Dublin, Ireland.
authors.forename: Aoife
authors.initials: A
authors.lastname: Phelan
authors.affiliation: Public Health Research Group, University of Alicante, Alicante, Spain; Departamento de Óptica, Farmacología y Anatomía, Universidad de Alicante, Alicante, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: García-Muñoz
authors.affiliation: Centro Oftalmológico Monseñor Enrique Pelach, Abancay, Peru.
authors.forename: Johannes
authors.initials: J
authors.lastname: Kohler
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D010568:Peru / Q000453:epidemiology; D010865:Pilot Projects; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D012572:School Health Services; D015351:Vision Screening / Q000379:methods*; D014792:Visual Acuity
keywords: preschool children; primary school children; refractive errors; teachers; vision screening