Accuracy and agreement of vision screening by secondary school students in Dass, Nigeria
Medical hypothesis, discovery & innovation in optometry,
Vol. 7 No. 3 (2026),
31 October 2026
,
Page 133-145
https://doi.org/10.51329/mehdioptometry254
Abstract
Background: Training school students to screen vision and communicate eye-health messages may extend the reach of community eye-care initiatives. This study assessed the screening accuracy and agreement of trained senior secondary school students relative to ophthalmologist classifications among adults in Dass, North-East Nigeria.Methods: This community-based study evaluated screening accuracy and agreement between trained senior secondary school students and ophthalmologists among adults in Dass, North-East Nigeria, between July and September 2021. Ninety students were randomly selected from three schools and received three hours of training from two qualified ophthalmologists. Each student approached four eligible adults from their household or adjacent households through non-probability recruitment. Adults were eligible if they were aged 18 years or older and had resided locally for at least six months. Screening procedures were adapted from the World Health Organization Primary Eye Care Training Manual and comprised visual acuity testing at the 6/12 threshold and assessment of conjunctival appearance, cornea/lens appearance, eye size, and ocular alignment. Ophthalmologist classifications served as the reference standard. Sensitivity, specificity, positive and negative predictive values, overall agreement and Cohen’s kappa were calculated from five aggregate participant-level 2 × 2 tables.
Results: All 90 students participated, and 358 of 360 recruited adults were assessed (99.4%), including 234 women (65.4%). Students classified 143 adults (39.9%) as having impaired visual acuity, compared with 88 (24.6%) classified by the ophthalmologists. Visual acuity screening had 71.6% sensitivity, 70.4% specificity, 44.1% positive predictive value, and 88.4% negative predictive value, with Cohen’s kappa = 0.347. Sensitivity, specificity and kappa were 91.0%, 85.3%, and 0.701 for conjunctival assessment; 80.2%, 67.0%, and 0.377 for cornea/lens assessment; and 70.0%, 94.0%, and 0.640 for eye-size assessment, respectively. Ocular-alignment assessment had 25.0% sensitivity, 93.4% specificity, and kappa = 0.171, detecting six of 24 reference-positive classifications. Conjunctival assessment had the highest sensitivity and kappa, whereas eye-size assessment had the highest overall agreement (89.9%).
Conclusions: Screening accuracy and agreement varied substantially by task. Conjunctival assessment showed the highest sensitivity and agreement beyond chance, whereas ocular-alignment assessment missed most reference-positive findings. These findings warrant caution before wider implementation of student-led screening. Future studies should evaluate standardised training and screening procedures, retained competence, referral completion, and clinical outcomes.
- vision screening
- health education
- students
- sensitivity and specificity
- Nigeria
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