Mobile application-based tools in pediatric vision screening: A systematic review and meta-analysis of visual acuity assessment accuracy

Abstract

Introduction: Childhood vision impairment can have long-term adverse effects on health, education, and socioeconomic status. Early detection through school-based eye health programs is essential, but often limited by resource constraints. Mobile application-based visual acuity screening tools offer a potentially accessible solution for school-aged children. This systematic review and meta-analysis evaluated the diagnostic accuracy of such mobile applications for visual acuity screening in this population.Methods: The review followed PRISMA guidelines and was prospectively registered in the PROSPERO database. Methodological quality was assessed using the QUADAS-2 tool for cross-sectional studies and the Jadad scale for randomized controlled trials. Meta-analysis was performed using Meta-Disc and Review Manager software. Diagnostic performance was evaluated through sensitivity–specificity analysis and comparison of mean LogMAR values.Results: Six studies involving 2,891 participants were included. Both analytical approaches demonstrated favourable results for mobile application-based visual acuity screening compared with the reference standard. The S-ROC analysis yielded an AUC of 0.887, indicating strong diagnostic accuracy. The mean LogMAR difference was 0.02 (p = 1.0), showing no significant difference between mobile application-based and standard visual acuity assessments. Factors such as the use of trained examiners and adequate lighting were found to enhance screening accuracy.Conclusion: Mobile application-based visual acuity screening demonstrates reliable accuracy for assessing visual function in school-aged children. Its implementation in school-based screening programs may provide a practical and accessible solution, particularly in resource-limited settings, when supported by relevant sectors and stakeholders.