Sensitivity and Specificity of Preschool Vision Screening in Iran

  • Hassan HASHEMI Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran
  • Abbasali YEKTA Dept. of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
  • Ebrahim JAFARZADEHPUR Dept. of Optometry, Iran University of Medical Sciences, Tehran, Iran Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
  • Hadi OSTADIMOGHADDAM Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
  • Amir ASHARLOUS Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, IranRefractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
  • Payam NABOVATI Dept. of Optometry, Iran University of Medical Sciences, Tehran, Iran Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran
  • Mehdi KHABAZKHOOB Dept. of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Vision screening, Amblyopia, Schoolchildren, Sensitivity, Specificity, Iran


Background: To determine the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the National Vision Screening Program for 7 yr old children in Iran.

Methods: In this cross-sectional study, eight cities in Iran were selected through multistage cluster sampling. Selected cities were Sari, Birjand, Ardabil, Mashhad, Bandar Abbas, Dezful, Yazd, and Arak, in Iran in 2013. Totally, 4614 schoolchildren were selected, 4106 of which participated in the study. An optometrist at the school site conducted all vision tests. Results were compared against those recorded on each child’s health card. Those with an uncorrected visual acuity worse than 20/25 in at least one eye screened positive for a vision problem.

Results: 8.49% [95% confidence interval, 7.65 to 9.39] of the examinees had a vision problem. The sensitivity rate of the school entry screening was 38.15% (95% CI, 33.01 to 43.50) and the specificity rate was 93.11 (95%CI 92.25 to 93.90). The positive and negative predictive values were 33.93 (29.24 to 38.88) and 94.19 (93.39 to 94.93), respectively. Sensitivity and specificity rates did not significantly differ between boys and girls. For the uncorrected visual acuity tested by public health care workers compared to optometrists, the area under the ROC surface was 0.741 (P<0.001). The best-associated criterion was an uncorrected visual acuity more than 0.05 LogMAR with 67.3% sensitivity and 74.7% specificity.

Conclusion: The validity of the school entry vision screening by health workers is low. To reduce false negative rates, some supplementary examinations such as refraction and near visual acuity measurements as well as further training of screeners should be considered.



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How to Cite
HASHEMI H, YEKTA A, JAFARZADEHPUR E, OSTADIMOGHADDAM H, ASHARLOUS A, NABOVATI P, KHABAZKHOOB M. Sensitivity and Specificity of Preschool Vision Screening in Iran. Iran J Public Health. 46(2):207-215.
Original Article(s)