Individual and School-Level Factors Associated with Suspected Pediatric Eye Disorders and Referral Adherence in an Enhanced School-Based Vision Screening Program in Ghana

The GO-SCREEN prospective cohort pilot study was conducted in a public and private school in Kumasi, Ghana. Demographic data (e.g., sex, age) of children was extracted from school enrollment records where available, as well as during in-person interviews with children. Near and distance visual acuity for the right, left and both eyes was obtained with and without existing prescription (if applicable) using the Lea symbols in a well-illuminated room measuring 6 meters (20 feet) distance. Near visual acuity was tested at the participants’ habitual reading distance. Pinhole examination was performed for participants whose visual acuities were 20/40 or worse for children aged 4 years, and 20/30 or worse for children older than 4 years. The refractive state of participants was estimated with a handheld photoscreener (PlusoptiX S12C, software version 8.0.3.0; plusoptiX GmbH, Nuremberg, Germany) in a separate room with less illumination. The photoscreener is a portable, non-invasive device that estimates refractive status. A pen light was used to assess the external eye structures and anterior segment, while a direct ophthalmoscope was used to examine the optic nerve and macula of both eyes through an undilated pupil.