Vision Outcomes of a Vision Screening Program among Schoolchildren in Zimba, Zambia


Jordan J. Huang*, Jaxon J. Huang*, Joshua M. Huang, Paul Y.C. Huang, Andrea K. Steeves, Stephen Y.L. Huang, Katherine Y.C. Huang, Brighton Kamuteku, Belita Zulu, William F. Astle, John T. Huang and Peter T. Huang


Development of the visual cortex is complete at the age of 8 to 10 years old. Impairment of vision during childhood can hamper a child’s intellectual and behavioural growth and impact future success. Particularly within the remote, rural regions of Zimba, Zambia, access to routine childhood eye checkups is limited due to factors such as lack of healthcare access, low financial resources to fund eyecare interventions, and remotely located eye clinics. Specifically, a school-mandated vision screening program may help bridge these potential barriers to eye care and reduce the incidence of unidentified vision impairment amongst schoolchildren. Further, the establishment of a vision screening program amongst school children shows great promise as an efficient and cost-effective method of detecting treatable visual impairment. The purpose of this study was to determine the prevalence of visual acuity impairment and external eye abnormalities in school-aged children in Zimba, Zambia.


Vision screening was performed in children 5 to 18 years old (grades kindergarten to grade 9) between July - August 2019. The vision screening program involved the assessment of visual acuity, pupil size, colour vision, and reading vision. An external eye examination of the eyelids, orbit, cornea, and iris was also performed. Screening failures were defined as any child presenting with a visual acuity of 20/40 or worse or ≥2-line interocular difference between eyes. School children who failed an external eye examination of the eyelids, orbit, cornea, and/or iris were also referred to the eye clinic.


Of 676 schoolchildren screened, a total of 3.70 % (25 / 676) schoolchildren did not pass the vision screening program and were referred to the local ophthalmology clinic for further assessment. 1.33 % (9 / 676) did not pass the vision screening criterion for visual acuity. 2.51 % (17 / 676) did not pass the vision screening criterion based on external eye examination. One student failed both the visual acuity and external eye exam. Mild vision impairment (visual acuity between 20 / 40 to 20 / 60) was the most common amongst schoolchildren, comprising 55.56 % (5 / 9) of visual acuity failures. Corneal/conjunctival scars were the most common external eye abnormalities amongst schoolchildren, comprising 47.06 % (8 / 17) of external eye exam failures.


Our study is the first to report on visual acuity impairment and external eye abnormalities amongst schoolchildren in Zimba, Zambia. Compared to other regions around the world, a low percentage of schoolchildren failed the established vision screening program.