Visual Acuity Assessment through the School Health Program: impacts and proposals for improvement

Abstract

Introduction: Refractive errors are very common in childhood and are often detected and treated late, impairing health and academic development. The Visual Acuity Assessment of the School Health Program (AAV-PSE; Avaliação da Acuidade Visual do Programa Saúde na Escola) aims to conduct an ophthalmological screening and alert parents to the need for further investigation. The Porto Olhar Alegre (PPOA) project provides free eyeglasses to children and adolescents in the city of Porto Alegre, state of Rio Grande do Sul, Brazil. Objective: To determine the prevalence of visual impairments among elementary school students at a public school through the AAV-PSE conducted at a Health Unit and the follow-up action (referral for an ophthalmological consultation and to the PPOA). Methods: This is a descriptive observational study involving 135 students in the 1st and 3rd grades who were systematically evaluated using the Snellen chart in Porto Alegre in 2022 and 2023. Additionally, in 2023, 42 students from other grades were evaluated after pre-screening (selectively referred by teachers). Referrals to ophthalmology and the PPOA for students with abnormal AAV-PSE results were reviewed based on the Appointment Management System of the Unified Health System and data provided by the Municipal Health Secretariat. Results: Among the 49 first- and third-year students with abnormal screening results (36.2% of those evaluated), 32 received a referral for an ophthalmology consultation following active search, and 24 had a confirmed appointment. Six were consulted in the private sector, and four obtained eyeglasses through the PPOA. Regarding students in other grades, 21 (50% of those evaluated) had abnormal AAV-PSE results; eight were referred to an ophthalmologist through the Unified Health System, four had consultations, and two obtained eyeglasses through the PPOA. Conclusions: The AAV-PSE visual screening detected a high number of children with untreated visual impairments, reinforcing the importance of this initiative by health units, especially in contexts of greater vulnerability. The additional and selective evaluation of students from other grade levels referred by teachers expanded detection rates. The active search for children with visual impairments reinforced the recommendation that parents seek referral to ophthalmology, resulting in increased demand for the service. The joint effort by the school and the Health Unit to publicize the availability of free eyeglasses through the PPOA needs to be strengthened. Strengthening of eye health policies, such as monitoring systems and facilitating access to specialized consultations and the PPOA, could be developed by the Municipal Health Secretariat through a school eye health care pathway.