Children’s Eye Screening South Australia (CESSA): diagnostic performance of a vision screening programme for 7–9-year-olds

Abstract

Clinical Relevance: Standardised paediatric vision screening programmes enable timely detection of refractive errors and other amblyopia risk factors. School-based programmes that use appropriate referral thresholds for distance visual acuity, combined with photorefraction, can improve detection of amblyopia and refractive errors in children. Background: The Children’s Eye Screening South Australia study evaluated the performance of a vision screening protocol for detecting common vision disorders in a school-based sample of children aged 7–9 years, while characterising prevalent vision conditions in this population. Methods: A total of 159 children from 15 schools underwent school-based screening, including distance and near vision, retinoscopy, photorefraction, stereoacuity, heterophoria and ocular alignment. All children who failed screening, and 10% of those who passed, underwent a comprehensive cycloplegic eye examination to establish a clinical diagnosis against which screening outcomes were compared. Screening test accuracy was evaluated using predefined fail criteria and diagnostic performance using the area under the curve (AUC) of Receiver Operating Characteristic curves. Results: Twenty-eight children (17.6%) failed screening, and cycloplegic eye examination confirmed a vision disorder in 27 children (17.0% of the total sample), 16.4% had significant refractive errors and 2.5% had suspected amblyopia. Standard distance vision fail criteria (≥0.26 logMAR) demonstrated low sensitivity (33.3%), but improved to 59.3% using > 0.04 logMAR. Retinoscopy and photorefraction showed high screening test accuracy (AUC, 0.91 and 0.86). Combining distance vision with photorefraction significantly improved accuracy (AUC, 0.87, p < 0.001), with modest, non-significant gains from adding stereoacuity or heterophoria. Conclusions: Seventeen percent of a school-based sample of South Australian children aged 7–9 years were identified as having vision disorders, such as refractive errors and amblyopia risk factors, effectively detected using a combination of vision measurement and photorefraction. These findings support improved vision surveillance in children in South Australia, which could include an instrument-based vision screening programme with appropriate thresholds.