Visual Acuity Assessment through the School Health Program: Impacts and Proposals for Improvement

Abstract

Introduction: Refractive errors are common in childhood and are often detected and treated late, impairing health and school performance. The Visual Acuity Assessment of the School Health Program (AAV-PSE) aims to conduct ophthalmologic screening and alert parents to the need for further evaluation. The Porto Olhar Alegre (PPOA) project provides free eyeglasses to children and adolescents in the city of Porto Alegre. Objective: To determine the prevalence of visual impairments in elementary school students from a public school through the AAV-PSE conducted by a local Health Unit (HU), as well as the outcomes of this action (referral to ophthalmologic consultation and the PPOA). Methods: Descriptive observational study involving 135 first- and third-grade students in Porto Alegre in 2022 and 2023. Additionally, 42 students from other grades were selectively screened in 2023 upon teacher referral. Referrals to ophthalmology and to the PPOA for students with abnormal AAV-PSE results were reviewed using the Brazilian public health scheduling system (SUS) and data provided by the Municipal Health Department (SMS). Results: Visual alterations were detected in 49 students (36.2%) from 1st and 3rd grades. Initially, 19 children (38.78%) were referred to ophthalmologic evaluation via SUS. After active follow-up by health units, 32 children (65.3%) received a referral, and 24 (48.9%) had their appointments confirmed. Additionally, 6 students (12.2%) sought private consultation. Four children (10.5%) obtained eyeglasses through PPOA. Among students from other grades, 21 (50%) had visual changes, 8 were referred to SUS ophthalmology, 4 attended appointments, and 2 received eyeglasses from PPOA. Conclusions: The AAV-PSE visual screening identified a high number of untreated visual alterations, reinforcing the importance of this initiative, especially in vulnerable settings. Selective screening of students from other grades, based on teacher recommendations, enhanced case detection. Active outreach to families promoted follow-through with ophthalmologic referrals. The joint effort by schools and health units to raise awareness about the free eyeglasses provided by PPOA should be strengthened. Policies focused on school eye health—such as monitoring systems and improved access to specialized care and the PPOA—should be developed by SMS within a structured school eye care pathway.