ArticleBMC ophthalmology2026
Undiagnosed visual disorders among first-grade children in Türkiye: a school-based photoscreening cross-sectional study with cost analysis.
Article in BMC ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTürkiye's national vision screening programme relies on LEA Symbol acuity testing by family health workers at primary-care centres, with no instrument-based or school-based component and was formalised only months before the COVID-19 pandemic (March 2020) disrupted preventive services. This study evaluated the clinical yield and cost implications of school-based photoscreening among first-grade children.
methodsA two-phase, district-wide, school-based cross-sectional study was conducted in Devrek district, Zonguldak Province, Türkiye (May 2022). All 509 first-grade students across seven primary schools were targeted for screening with the Plusoptix S12R photoscreener. Screen-positive children underwent comprehensive ophthalmic examination including cycloplegic refraction and best-corrected visual acuity assessment. Confirmatory examination failure levels followed the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) 2021 guidelines; amblyopia was defined according to American Academy of Ophthalmology Preferred Practice Pattern criteria. A provider-perspective cost analysis was performed using opportunity costs in euros.
resultsOf 509 children, 467 were screened (91.7% coverage). Eighty-seven (18.6%) met referral criteria; 55 (63.2%) completed comprehensive examination. Nineteen (34.5% of examined) met AAPOS-2021 criteria for at least one target condition, with astigmatism > 1.75 D being the most prevalent condition (20.0%). Spectacles were prescribed to 45 children (81.8%), of whom 39 (86.7%) had no prior spectacle history. Three children (5.5%) met criteria for confirmed amblyopia and an additional 11 (20.0%) were classified as having subnormal visual acuity below the national age-norm (not meeting amblyopia criteria). All three confirmed cases were newly detected. Total programme cost was €1,844 (€3.95/child screened; €47.3/newly identified treatable condition).
conclusionsSchool-based photoscreening at school entry revealed a substantial burden of previously undiagnosed visual disorders in a Turkish district where, amid post-pandemic disruption to preventive services, national-programme delivery and outcomes were not retrievable for the cohort. More than six in seven children requiring spectacles (86.7%) were previously unknown to the healthcare system. Because no individual national-programme results were available, the incremental yield over routine care could not be quantified. These findings support evaluating instrument-based screening within Türkiye's school health framework.
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