Stakeholders perspectives on a digital myopia screening program in children: a qualitative analysis

Casper van der Zee^1*Janneau LJ Claessens¹Petra T Rausch²Saskia M Imhof¹Ruth Marie Antoinette Van Nispen^3,4Robert PL Wisse^1,5Hilde PA van der Aa^3,4

• ¹University Medical Center Utrecht, Utrecht, Netherlands
• ²Bergman Clinics, Department of Ophthalmology, Naarden, Netherlands
• ³VU Amsterdam, Amsterdam, Netherlands, Netherlands
• ⁴Public Health Department, Amsterdam, Amsterdam, Netherlands, Netherlands
• ⁵Easee BV, Amsterdam, Netherlands

Purpose: Identifying barriers and opportunities to use a self-administered online refractive eye test by various stakeholders of a pediatric vision screening program.Methods: This qualitative study performed semi-structured interviews with myopic children and their parents, eye care professionals, and policymakers. Three topic lists were developed delineating themes to identify gaps, barriers, and opportunities. Interviews were anonymously recorded, transcribed, and coded using thematic analysis. Quantitative data was acquired from a concomitant clinical validation study.Results: In total, 14 interviews were conducted, of which seven with children and their parents, four with eye care professionals, and three with policymakers. Patients and parents were positive about the instructions and age-appropriateness. They noted the test could be designed more child friendly and preferred receiving feedback during the test. Eye care professionals and policymakers saw potential for using the test in children aged ≥12 without high refractive errors. Yet, they also underlined the false-positives rates, impacting care demand and costs. The population refraining from participation were expected to have higher health gains, yet including them was expected to be challenging without facilitating awareness.Conclusions: This qualitative study shows the perspectives for an online pediatric refractive screening. Patients and parents were open to self-administered screening and suggested improvements. Eye care professionals and policymakers were receptive to screening but also cautious, highlighting costs and scientific reliability. For better implementation, policymakers underlined the relevance of the screening criteria, while eye care professionals recommended targeting a specific population at risk that benefits most, rather than screening the whole population.