No doctors needed: a teacher-led approach to early detection of visual problems

Abstract

Background . Children’s visual health represents a major public health concern, particularly in low- and middle-income countries where access to specialized eye care is limited. In Morocco, the scarcity of eye care professionals poses a significant challenge to implementing large-scale school-based vision screening programs. Objective : this study aimed to evaluate the effectiveness of a low-cost vision screening method – a teacher-administered observational vision screening test – as an alternative approach for the early detection of visual impairment in primary school children. Materials and methods . The study included 143 children aged 6–12 years from two Moroccan primary schools. Teachers assessed vision-related signs and symptoms using a structured behavioral checklist comprising ten predefined indicators. Each child received a cumulative score, which was used to determine the level of risk for visual impairment and the need for referral. All participants subsequently underwent a comprehensive ophthalmological examination performed by an ophthalmologist and an orthoptist. Diagnostic accuracy was assessed using sensitivity, specificity, and predictive values. Results . The screening method identified 36 children as being at risk for visual impairment, of whom 28 were clinically confirmed, corresponding to a prevalence of 19.6 % in the study population. The method demonstrated high diagnostic performance: sensitivity – 100 %, specificity – 93.0 %, positive predictive value (PPV) – 77.8 %, negative predictive value (NPV) – 100 %, and overall accuracy – 94.4 %. Agreement between teacher-based screening results and clinical diagnosis was high (κ = 0.84). Conclusion . The findings indicate that, with minimal training, teachers can effectively identify children at risk of visual impairment using a simple observational screening method without direct involvement of medical personnel. This approach represents a practical, scalable, and cost-effective strategy for school-based vision screening in resource-limited settings.