Vision screening in school children from low-income areas of Sao Paulo city: Frequency and causes of visual impairment and blindness

Main Article Content

Eduardo Parente Barbosa Arthur Gustavo Fernandes Rodrigo Galvao Viana Solange Rios Salomao Mauro Campos


Objective: The purpose of this study was to investigate frequency and causes of visual impairment in school-aged children from low-income areas of Sao Paulo evaluated by the “Ver na Escola” project, an initiative from São Paulo city government in partnership with a local non-governmental organization, launched aiming to offer free-of-charge visual screening and treatment to children enrolled in public schools.

Methods: Vision screening included presenting VA, ocular motility, and automated dynamic refraction assessment. Children referred for the ophthalmologist were submitted to automated and subjective static refraction, best-corrected VA, slit lamp, and fundus examination.

Results: A total of 17972 children were included in the study. Our findings show a frequency of visual impairment and blindness of 14.6% considering presenting VA decreasing to 1.3% after appropriate refractive correction. The main causes of visual impairment and blindness were uncorrected refractive errors (96.77%), amblyopia (0.88%), and retinal abnormalities (0.37%).

Conclusion: The frequency of visual impairment and blindness in the population under study was 14.6% mainly due to uncorrected refractive errors. These results support the need for expanded and perennial refractive services through school-based programs associated with provision of spectacles. These initiatives should be sustainable and pursued by health and school authorities to provision of screening and eye care for those in need.

Article Details

How to Cite
BARBOSA, Eduardo Parente et al. Vision screening in school children from low-income areas of Sao Paulo city: Frequency and causes of visual impairment and blindness. Medical Research Archives, [S.l.], v. 9, n. 4, apr. 2021. ISSN 2375-1924. Available at: <>. Date accessed: 14 may 2021. doi:
Research Articles


1. Yawn BP, Lydick EG, Epstein R, Jacobsen SJ. Is school vision screening effective? J Sch Health. 1996;66(5):171-5.
2. Kaur G, Koshy J, Thomas S, Kapoor H, Zachariah JG, Bedi S. Vision Screening of School Children by Teachers as a Community Based Strategy to Address the Challenges of Childhood Blindness. J Clin Diagn Res. 2016;10(4):NC09-14.
3. Marmamula S, Khanna RC, Mettla AL, Pehere NK, Keeffe JE, Yameneni DK, et al. Agreement and diagnostic accuracy of vision screening in children by teachers, community eye-health workers and vision technicians. Clin Exp Optom. 2018;101(4):553-559.
4. Pizzi LT, Snitzer M, Amos T, Prioli KM, Steele D, Levin AV. Cost and effectiveness of an eye care adherence program for Philadelphia children with significant visual impairment. Popul Health Manag. 2015;18(3):223-31.
5. Ethan D, Basch CE, Platt R, Bogen E, Zybert P. Implementing and evaluating a school‐based program to improve childhood vision. J Sch Health. 2010;80(5):340-5.
6. Alvi RA, Justason L, Liotta C, Martinez-Helfman S, Dennis K, Croker SP, et al. The Eagles Eye Mobile: assessing its ability to deliver eye care in a high-risk community. J Pediatr Ophthalmol Strabismus. 2015;52(2):98-105.
7. Johnson C, Majzoub K, Lyons S, Martirosyan K, Tattersall P. Eyes that thrive in school: a program to support vision treatment plans at school. J Sch Health. 2016;86(5):391–6.
8. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020: the right to sight. Bull World Health Organ. 2001;79(3):227-32.
9. Muhit M, Karim T, Islam J, Hardianto D, Muhiddin HS, Purwanta SA, et al. The epidemiology of childhood blindness and severe visual impairment in Indonesia. Br J Ophthalmol. 2018;102(11):1543-9.
10. World Health Organization. Preventing blindness in children, report of a WHO/IAPB scientific meeting. Geneva: World Health Organization; 2000; Report No: WHO/PBL/00.77.
11. World Health Organization. World report on vision. Geneva: World Health Organization. 2019; Licence: CC BY-NC-SA 3.0 IGO.
12. Warren DH. Blindness and children: an individual differences approach. 1994. Cambridge: University Press.
13. Chanfreau J, Cebulla A. Educational attainment of blind and partially sighted pupils. 2009; London: RNIB.
14. Toledo CC, Paiva AP, Camilo GB, Maior MR, Leite IC, Guerra MR. Early detection of visual impairment and its relation with school effectiveness. Revi Assoc Med Bras. 2010;56(4):415–9.
15. Augestad LB. Self-concept and self-esteem among children and young adults with visual impairment: A systematic review. Cogent Psychol. 2017;4:1.
16. Rainey L, Elsman EBM, van Nispen RMA, van Leeuwen LM, van Rens GHMB. Comprehending the impact of low vision on the lives of children and adolescents: a qualitative approach. Qual Life Res. 2016;25(10):2633–43.
17. GBD 2019 Blindness and Vision Impairment Collaborators; Vision Loss Expert Group of the Global Burden of Disease Study. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. Lancet Glob Health. 2020:S2214-109X(20)30425-3.
18. Maul E, Barroso S, Munoz SR, Sperduto RD, Ellwein LB. Refractive Error Study in Children: results from La Florida, Chile. Am J Ophthalmol. 2000;129(4):445–54.
19. Negrel AD, Maul E, Pokharel GP, Zhao J, Ellwein LB. Refractive error study in children: sampling and measurement methods for a multi-country survey. Am J Ophthalmol. 2000;129(4):421–6.
20. Murthy GV, Gupta SK, Ellwein LB, Muñoz SR, Pokharel GP, Sanga L, et al. Refractive error in children in an urban population in New Delhi. Invest Ophthalmol Vis Sci. 2002;43(3):623–31.
21. Salomão SR, Cinoto RW, Berezovsky A, Mendieta L, Nakanami CR, Lipener C, et al. Prevalence and causes of visual impairment in low-middle income school children in Sao Paulo, Brazil. Invest Ophthalmol Vis Sci. 2008;49(10):4308-13.
22. Naidoo KS, Raghunandan A, Mashige KP, Govender P, Holden BA, Pokharel GP, et al. Refractive error and visual impairment in African children in South Africa. Invest Ophthalmol Vis Sci 2003;44(9):3764-70.
23. Paudel P, Ramson P, Naduvilath T, Wilson D, Phuong HT, Ho SM, et al. Prevalence of vision impairment and refractive error in school children in Ba Ria - Vung Tau province, Vietnam. Clin Exp Ophthalmol. 2014;42(3):217-26.
24. Goh PP, Abqariyah Y, Pokharel GP, Ellwein LB. Refractive error and visual impairment in school-age children in Gombak District, Malaysia. Ophthalmology. 2005;112(4):678-85.
25. Vieira JK, Rezende GX, Anastácio LB, Freitas Filho RT, Benevides HCC, Fonseca JM, et al. Prevalence of visual disorders in school children. Rev Bras Oftalmol. 2018;77(4):175-9.
26. Czepita D, Mojsa A, Ustianowska M, Czepita M, Lachowicz E. Role of gender in the occurrence of refractive errors. Ann Acad Med Stetin. 2007;53(2):5‐7.
27. Guo L, Yang J, Mai J, Du X, Guo Y, Li P, et al. Prevalence and associated factors of myopia among primary and middle school-aged students: a school-based study in Guangzhou. Eye. 2016;30(6):796-804.
28. Gilbert C, Bowman R, Malik AN. The epidemiology of blindness in children: changing priorities. Community Eye Health. 2017;30(100):74-7.
29. Ribeiro L, Silva RM. Special education in Brazilian educational policies: A historical approach. Educ Policy Anal Arch. 2019;21.
30. Baptista CR. Public policy, Special Education and schooling in Brazil. Educ Pesqui. 2019;45:e217423.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.