What studies from North, Central, or South America between 2018 and 2025 report on pediatric or school-based vision-screening programs?

Pediatric and School-Based Vision Screening Programs in the Americas (2018-2025)

Critical Limitation of Available Evidence

The provided evidence does not include any studies from North, Central, or South America published between 2018 and 2025 that specifically report on pediatric or school-based vision screening program design, screening tools, and follow-up outcomes. The single relevant study from the Americas in the evidence base is from Canada (2020), which I detail below 1.

Single Relevant Study from the Americas (2018-2025)

Canadian School-Based Vision Screening Program (2020)

A prospective cohort study in Ontario, Canada demonstrated that in-school vision screening with passive consent achieved 89% participation rates and identified visual problems in 10.7% of screened kindergarten children, with 67.2% of these children receiving their first-ever eye examination through the program 1.

Program Design Features:

• Target Population: Junior and senior kindergarten children across 43 schools in 15 Ontario communities 1
• Consent Model: Passive consent achieved 89% screening participation versus 62% with active consent (p < 0.001) 1
• Total Screened: 4,811 children 1

Screening Tools Utilized:

• Photoscreeners for objective assessment 1
• Visual acuity testing 1
• Stereoacuity testing 1
• Eye alignment assessment 1

Detection Outcomes:

• Overall detection rate: 516 children (10.7%) had visual problems identified 1
• Amblyopia: 164 children (3.4%) 1
• Clinically significant refractive errors: 324 children (6.7%) 1
• First eye examination: 347 children (67.2% of those with detected problems) had never been examined before 1

Follow-Up Outcomes:

• Referral rates varied significantly by school: Junior kindergarten mean 53% (range 25%-83%); senior kindergarten mean 34% (range 12%-61%) 1
• Follow-up examination attendance: 1,563 children (68.9%) attended optometry follow-up regardless of location (school or optometrist's office) 1
• Year 2 rescreening: Did not detect additional problems in children who passed Year 1 screening 1
• Child satisfaction: 291 of 322 surveyed children (90.4%) reported enjoying the screening process 1

Contextual Guidelines from Major North American Organizations

While not studies from 2018-2025, the following North American guideline recommendations frame current practice:

American Academy of Ophthalmology (2023)

Vision screening should be performed periodically throughout childhood, with the combined sensitivity of serial screening encounters being substantially higher than single screening tests 2.

• For children aged 3-5 years: Age-appropriate visual acuity measurement using HOTV or tumbling E tests, plus stereopsis testing with Random Dot E or Titmus Fly Stereotest 2
• Instrument-based screening (photoscreening and autorefraction) is preferred for children younger than 3 years who cannot reliably perform chart-based testing 2
• Early detection and treatment of amblyopia improves visual acuity, with earlier treatment yielding higher likelihood of recovery 2

American Academy of Pediatrics Recommendations

AAP recommends vision screening at all well-child visits starting from the newborn period, with specific components varying by age 2.

• Newborn to 3 years: Ocular history, vision assessment, external inspection, ocular motility assessment, pupil examination, and red reflex examination 2
• Ages 3-5 years: All of the above plus age-appropriate visual acuity measurement and ophthalmoscopy 2

U.S. Preventive Services Task Force (2017)

USPSTF recommends vision screening for children 3 to 5 years of age to detect amblyopia or its risk factors 2.

Gap in Evidence Base

The evidence provided contains primarily:

• Guidelines from 2005-2023 (predominantly U.S.-based recommendations) 2
• One Canadian study from 2020 1
• Studies from China, India, and Tanzania examining spectacle provision interventions 3
• One U.S. study from 1996 4

No studies from Central or South America meeting the 2018-2025 timeframe were included in the evidence base provided. This represents a significant gap in understanding vision screening implementation across the Americas, particularly in Latin American countries where screening infrastructure and outcomes may differ substantially from North American programs.