About 10% of Kindergarten Children Have a Visual Problem Interview with:
Mayu Nishimura

Department of Ophthalmology and Vision Sciences
Director of Research
Kindergarten Vision Screening Program What is the background for this study?

Children’s visual problems are difficult to identify without formal tests but most parents do not realize the importance of early eye checks nor are they aware that well-child visits to the family doctor/pediatrician are not enough. We are researchers at McMaster University (Hamilton, ON) and SickKids Hospital (Toronto, ON) who examined if it is possible to implement a vision screening program for kindergartners in diverse Ontario communities. Below are the main findings:

  • We screened nearly 5000 kindergarten children in 15 communities and found that 11% of screened children had a visual problem, with 2/3 of the children being identified for the first time.
  • There was great support for the program from the children, parents, teachers, and optometrists.
  • Screening required 15-20 minutes per child and cost $10/child.
  • When parents received a letter permitting them to opt out of screening, 4% did so. When parents were required to return a signed letter to opt in, 30% did not.
  • Referral rates varied across schools but were higher for children in junior kindergarten (average 53%) than children in senior kindergarten (average 34%).
  • Successful treatment depends on the parents’ awareness of the importance of eye exams and glasses, and access to optometrists and glasses without worrying about costs. What should readers take away from your report?

Response: About 1 in 10 kindergarten children have a visual problem, and without a school-based vision screening program many of those children would not be treated. Screening at the school, with follow-up support such as pre-booking the optometrist’s appointment and payment for needed glasses, is important for the timely treatment of children’s visual problems. What recommendations do you have for future research as a result of this work?

Response: Future research should examine the most effective strategies to ensure that children receive and continue with the recommended treatment (such as wearing the glasses for reading and replacing broken glasses).

Any disclosures?

The authors have no financial interests to disclose. More details about our project can be found at:


Feasibility of a school-based vision screening program to detect undiagnosed visual problems in kindergarten children in Ontario
Mayu Nishimura, Agnes Wong, Helen Dimaras and Daphne Maurer
CMAJ July 20, 2020 192 (29) E822-E831; DOI:



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Last Updated on July 20, 2020 by Marie Benz MD FAAD