2014 Updated Recommendations for Preschool Vision Screening: Guidelines for Filipino Children Entering the Philippine Public School System
Leo D. P. Cubillan, MD, MPH Alvina Pauline D. Santiago, MD Toral D. Mehta, MS, MPH Jane Melissa L. Lim
Introduction: In 2004, the Philippine Guidelines on Periodic Health Examination (PHEX): Effective Screening for Diseases among Apparently Healthy Filipinos was published with recommendations for screening for vision impairment. Since that time, the Philippine education system has shifted to the K to 12 curriculum, and with full implementation of Republic Act 10157 (Kindergarten Education Act), Filipino children entered school earlier at age 5 years. This made the previous recommendations unenforceable in this new age group.
New Recommendations: The 2014 revised recommendations were: (1) Vision screening for amblyopia and strabismus is recommended for all children at least once using an age-appropriate chart (Level 2); and (2) Screening infants at 6 months of age for ocular problems, and at age 2 to 3 years, at 5 years, and every 1 to 2 years thereafter for visual acuity and ocular alignment may be done (Level 4).
Comment: The Philippine Eye Research Institute (PERI) incorporated the LEA Symbols in its vision screening kit, as the LEA Symbols was not only an age-appropriate chart but also had the added features of equal blurring of the optotypes precluding guesswork, and fulfilled the criteria set by international bodies. Included in this kit was a LEA symbol and number chart, right occluder glasses, left occluder glasses, and a 10-foot string to measure distance consistently. The vision screening kit has been pilot tested in several public schools and have gained the reputation for ease of use, reliability, and reproducibility.
Conclusion: The younger age of Filipino children at school entry, pegged at 5 years of age or more, meant that the initial recommendations for students age 7 years were no longer enforceable. The LEA symbols chart, now endorsed internationally as an effective preschool vision test, offered the advantages of being validated and having undergone repeated calibration; lacking in cultural bias as symbols were easy to recognize across cultures; and having the actual screening process akin to a “play” situation. Currently, the LEA symbols chart form part of the PERI Vision Screening kit and is available locally through the PERI.
Keywords: Preschool vision screening, Vision screening kit, LEA Symbols, LEA Numbers, Vision screening recommendations