Validity of external observation examination by teachers during vision screening for preschool children

Background: A vision-screening program is effective in prevention of vision impairment. The validity of vision screening conducted by nurses, medical assistants, and teachers has been previously reported. However, the validity of preschool teachers in conducting external eye observations in preschool children has not been widely investigated. This study aimed to determine validity of preschool teachers in conducting external eye observation tests, including the observation of behavior and external eye health, in preschool children.Methods: In this cross-sectional study, preschool teachers from Kemajuan Masyarakat kindergarten in Klang Valley, Malaysia, were randomly allocated to the study (n = 30) or control (n = 30) groups. The study group underwent theory training with an optometrist and practical sessions with preschool children on vision screening, while the control group received only brief verbal instructions on steps to conduct the screening. After the briefing, teachers from both groups conducted vision screening tests at their kindergartens on preschool children aged 4–6 years. The same vision screening procedure was repeated in the same children by optometrists to verify results of the teachers. Results: A total of 700 preschool children were screened by 60 preschool teachers and optometrists. Teachers from the study and control groups displayed high validity in screening for external ocular health, including sensitivity (66.67% versus 66.67%), specificity (95.21% versus 95.54%), and negative predictive value (99.41% versus 99.69%). The positive predictive value was slightly higher in the study group (19.05%) than in the control group (11.76%). Conclusions: Preschool teachers competently observed external eye health in preschool children. A training module for vision screening is important, and a revision of the current training module is needed. Empowering preschool teachers could help in the early detection and intervention necessary in needy children. This could reduce the nationwide prevalence of visual impairments.