Review Article

Review of school vision screening guidelines

Ingrid T. Metsing, Rekha Hansraj, Wanda Jacobs, Elsabe W. Nel
African Vision and Eye Health | Vol 77, No 1 | a444 | DOI: | © 2018 Ingrid Thokozile Metsing, Rekha Hansraj, Wanda Jacobs, Elsabe Wanda Nel | This work is licensed under CC Attribution 4.0
Submitted: 12 March 2018 | Published: 22 October 2018

About the author(s)

Ingrid T. Metsing, Department of Optometry, University of Johannesburg, South Africa
Rekha Hansraj, Discipline of Optometry, University of KwaZulu-Natal, South Africa
Wanda Jacobs, Department of Nursing, University of Johannesburg, South Africa
Elsabe W. Nel, Department of Nursing, University of Johannesburg, South Africa


Background: Vision screenings are important in identifying visual anomalies likely to disrupt the physical, intellectual, social and emotional development of children. School health services globally include vision screenings, complementing a variety of associated screening services.

Aim: This review article provides evidence for content, provision and efficacy of the vision screening services for children of school-going age and reports on the current practice of children’s vision screenings worldwide including in South Africa.

Methods: Studies were identified from PubMed, Ebscohost and Science Direct with the search terms utilised during the selection of electronic articles and journals for the review. The target population includes children of school-going age from 6 to 19 years without previously known conditions associated with visual anomalies and learning-related problems. The quality of vision screening programmes and policies for the school-going age children in different countries were evaluated using Wilson and Jungner criteria.1

Results: Vision screening programmes worldwide appear to support comprehensive vision screening methods among pre-schoolers (from birth to ≤ 6 years vs. children of school-going age). The development of vision screening procedures in some countries in the United States of America (USA) was found to be grounded on epidemiologic findings and principles. These may have contributed towards the formulation of national vision screening guidelines for pre-schoolers that supported the detection of amblyopia and its associated conditions such as strabismus, anisometropia and myopia. School-going children’s vision screenings are not supported worldwide as research has shown that there is lack of benefits for detecting other visual anomalies such as vergence and accommodative dysfunctions. This is despite evidence provided by the literature reviewed that an association exists between prevalent accommodation and vergence dysfunctions including poor ocular motilities and poor near-vision, among children of school-going age with poor academic performance.

Conclusion: The guidelines worldwide support school vision screenings, especially for the pre-schoolers by the school health nurses, with other programs having considered the teachers, optometrists or orthoptists as the appropriate personnel to conduct the school vision screenings. There is still a need for the effectiveness of the school vision-screening programmes to be investigated related to the importance of detecting convergence and accommodative dysfunctions for the school going age children.


Visual anomalies; vision screening; accommodative dysfunction; vergence dysfunction; amblyopia; preschool; school going age; vision screening guidelines; vision screening policies


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Crossref Citations

1. Critical appraisal of Australian and New Zealand paediatric vision screening clinical practice guidelines using the AGREE II tool
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