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

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.

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