Optometrist-led vision screening: Enhancing child eye health in underserved district schools within Karachi

Background: Vision impairment among school-aged children, from uncorrected refractive errors, represents a major public health concern. In Pakistan, organized school-based vision screening programs are limited, and there is insufficient evidence regarding their effectiveness. This study evaluates an optometrist-led, school-based vision screening intervention designed to enhance early detection, awareness, and correction of refractive errors among children in a group of underserved schools in Karachi. Methods: A quasi-experimental study was conducted in Azam Basti, Karachi, targeting five low resource schools. Lady health workers received structured training from optometrists to screen visual acuity and detect ocular misalignment in 5–17-year-old students. Students with visual acuity <6/9 and/or obvious ocular pathology were referred for a complete eye exam by an optometrist. The optometrist also delivered education sessions to students. Baseline and 6-month post-intervention surveys assessed changes in knowledge, attitudes, and practices among students. Results: A total of 384 students were screened with 72 (18.8%) identified as having refractive visual impairment; they were provided with prescription spectacles free of charge. Astigmatism (9.3%) and myopia (6.3%) were the most common refractive errors. Among primary students (grades 1–5), knowledge and eye health practices improved significantly post intervention (e.g., eye health knowledge: 31.3%–89.8%, p < 0.001). Among secondary students (grades 6–10) similar gains were noted (e.g., basic eye knowledge increased from 27.2% to 84.4% ( p < 0.001), and correct eye care habits improved from 46.2% to 99.4% ( p < 0.001)). Conclusions: Optometrist-led school screenings, including interactive student education combined with standardized lady health worker training to assist with initial screening, effectively enhanced detection and correction of refractive errors while promoting sustainable eye health practices. These findings support the integration of similar programs into school health policies to reduce avoidable childhood visual impairment in underserved urban community schools.