Vision Screening Failure Increases Among Children Are a Cause For Concern

Vision screening failure has increased in the last 7 years in pediatric patients aged 4 to 5 years, according to a UK-based retrospective study published in Ophthalmic and Physiological Optics.

Researchers included 110,076 children from 515 schools (age range, 4-5 years) in the cross-sectional analysis between 2016 and 2022. The team evaluated trends in unaided monocular visual acuity and defined vision screening failure as visual acuity worse than 0.20 logarithm of the minimum angle of resolution (logMAR) in each eye. The number of children screened each year ranged between 10,990 (2020/2021) and 19,184 (2016/2017) and the proportion of boys (50.1%-51.3%) and girls (48.7%-49.9%) was consistent throughout the study duration, except in the school year ending in 2022, the report shows.

Between the school years ending in 2016 and 2019, the trendline for the percentage of children failing the screening for both eyes was flat (7.6%, 8.5%, 7.5%, and 7.8% for 2016, 2017, 2018, and 2019, respectively; P =.47). However, the last 3 years of the investigation, which were affected by the COVID-19 pandemic, witnessed an increasing trend in failure rates (8.7%, 8.5%, and 9.3% for 2020, 2021, and 2022, respectively; P =.056). This trend reached significance in the chi-squared analysis (P <.001).

This pattern was not observed among participants who were under the care of a primary or secondary eye care practitioner — in fact, the trendline was in the opposite direction, but was not statistically significant (P =.11).

“[E]ven at the young age of 4–5 years, there are possible signs of increasing rates of reduced bilateral vision in England over the last 7 years based on a large data set from an unselected population,” according to the study authors. “It seems most likely that this is attributable to an increasing occurrence of myopia.”

The failure to collect data in a clinical setting is an acknowledged limitation to the research. 

Disclosure: This research was supported by Hoya. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.