A Health Ministry inquiry has found significant flaws in the conduct of eye examinations in schools, Haaretz has learned, with the least reliable examinations found to be those carried out on first- graders.
The research was carried out by a team that included northern district chief physician Dr Michal Cohen Dar and was led by Dr Liora Or, a Health Ministry researcher and a member of the Haifa University School of Public Health. It looked into eye examinations for 751 students in 30 schools in the north, from first to eighth grades. Such examinations are routinely carried out by school nurses.
The inquiry, conducted in 2003 when school nurses were directly employed by the ministry, had each student independently examined by two nurses. The eye tests were carried out using a sign with six rows of letters in descending order of size, which the students were asked to read.
Sixteen percent of the youngsters tested were diagnosed with eyesight problems by both nurses but in 22 percent of cases the nurses disagreed.
The ministry's survey concluded that differences between nurses were most frequent in the examinations of first graders. 28 of whom were given contradictory diagnoses.
The incidence of disagreement fell to just 17 percent among eighth-graders. Another noticeable discrepancy was that girls were more frequently misdiagnosed than boys, amounting to 28 percent, and Jewish students were more frequently misdiagnosed than Arabs.
Particularly low reliability was detected in eye examinations for students in the Safed area, with nurses coming up with different results 25 percent of the time compared to just 4 percent among students in the Jezreel valley.
One analysis of the data suggests that examinations carried out by veteran nurses were less reliable, with higher reliability seen in examinations done by young nurses with up to five years of experience. However, this discrepancy was later attributed to professional fatigue and did not recur in repeat checks.
The researchers concluded that "the reliability of eye examinations in schools needs to be improved, especially among first-graders." They went on to recommend a training program for school nurses to make the examinations more reliable and the examination results more valid.
In recent years school eye tests have been carried out by nurses from the Association for Public Health and a tender is in process to determine who will provide student health services next school year.
An internal report by the Health Ministry from October 2008 said that only 77 percent of students had their eyesight examined, but the Association for Public Health has since said that it increased the number of checks following the report.
The chairman of the Pediatric Ophthalmology Association, Dr Yair Morad of Assaf Harofeh Hospital, told Haaretz that school eyesight examination results can be only partly trusted.
"Some tests fail to recognize a child's need for spectacles, especially if the child is not cooperative," he said. "The main problem is recognizing far-sightedness problems. A child may need very powerful glasses and still be able to read all letters on a distant board."
He said that diagnosis became harder still when problems develop in both eyes simultaneously. He suggested that one solution could be carrying out examinations using pupil-expanding eye drops, although the cost could be prohibitive. His association recommends that parents carry out examinations using eye drops at an age as early as one year old in order to spot developmental problems and reduce the chances of them worsening at a later stage.
The Health Ministry said in a statement that its survey was "part of a process of self-examination motivated by a desire to learn and to improve. The article in question is a part of ongoing research. Only a few findings have been published and work on more articles is in progress."
