Association for Public Policy Analysis & Management

Roughly 15% of kindergarten children have treatable visual problems that can lead to permanent visual impairment (amblyopia) and/or learning difficulties. Even when eye exams and any needed glasses are available at no cost, over half of parents do not get their children’s eyes checked. A possible solution is universal visual screening in kindergarten. We evaluated the efficacy of currently available screening tools in a cohort of 709 kindergarten children in Ontario, all of whom were screened and had follow-up eye exams. Simultaneously, we explored the practicality of implementing universal visual screening by offering it in 43 schools in diverse Ontario communities with over 4800 kindergarten children enrolled.

Tests of acuity and binocular vision, combined with a portable auto refractor, took about 15 minutes per child and yielded the best sensitivity (.81), especially with children in senior kindergarten (aged 5; sensitivity = 0.89). About 70% of parents of children who were referred followed up with the recommended optometry exam. Overall, our screening program led to the detection and treatment of vision problems in over 10% of those screened. A health economic analysis indicated that in-school vision screening is a cost-effective strategy for detecting childhood vision problems.

Based in part on these findings, the revised 2018 Ontario Public Health standards mandate vision screening at school for all children in senior kindergarten. I will discuss the roll out of this new universal mandate, its applicability to other jurisdictions, and issues that arose in its implementation.