Objectives. The validity (sensitivity and specificity) of a preschool visio
n screening program was measured over a 3-year period to determine how well
strabismus and significant refractive errors could be detected.
Methods. Public health nurses were trained to administer tests of visual ac
uity, stereoacuity, and ocular alignment. Failure on any test, visual acuit
y of 6/9 or less, stereoacuity of less than 100 seconds of arc, or an appar
ent misalignment of the eyes resulted in referral to an eye care practition
er. An age-matched control was also referred. Analysis of practitioner repo
rts used predefined study-based criteria for ocular abnormalities.
Results. More than 1100 children were screened each year. The annually calc
ulated prevalence of vision problems ranged between 10.5% and 13.8%. The es
timated sensitivity varied from 60.4%, to 70.9% (specificity, 69.6% to 79.9
%). The yield indicated that a very high percentage of children with vision
problems were identified for the first time.
Conclusions. The validity of this screening is comparable to that of other
school screenings. The limitations are predictable. Consideration should be
given to replacing visual acuity tests with a rapid, objective measure of
refractive error and ocular alignment.