Comparison of vision screening results between trained teachers and general practitioners among elementary school students in rural Bali: A cross-sectional study

Abstract

Context: Visual impairment is a major healthcare burden worldwide. The vision screening program was supposed to be conducted routinely; however, the shortage of healthcare personnel posed a significant challenge. Aims: This study was conducted to compare the visual acuity examination results of elementary school students when examined by trained teachers as lay screeners and general practitioners (GPs). Settings and Design: This was a cross-sectional study involving 2056 students from 19 elementary schools under one primary healthcare center in Gianyar. Materials and Methods: All students included in the study underwent a basic visual acuity test using the Snellen’s Chart at a distance of 6 m. The test was performed two times, once by teachers and once by GPs. Statistical Analysis Used: Data analysis was performed using Cohen’s Kappa interrater reliability. Results: The total number of study participants was 2056 students. The mean age of the screened students was 9.43 ± 1.69 years, and most of them were male (52.4%). The estimated number of children needing further eye examination and referred to the ophthalmologist was 253 (12.31%). The agreement between visual acuity examinations conducted by teachers and GP was found to be almost perfect, as indicated by Kappa values of 0.859 for the right eye, 0.856 for the left eye, and 0.878 for both eyes, and these were statistically significant (P < 0.001). Conclusions: The high agreement value of visual acuity examination between teachers and GP shows the feasibility of involving teachers as lay vision screeners, which can elevate the number of children screened.