Implementation outcomes of a school-based visual screening program using the peek tool in low-resource settings in Pakistan

Visual impairment among school-aged children in low-resource settings can significantly impact their quality of life and education due to limited access to comprehensive eye care. This study reports outcomes of a school-based vision screening program using the Peek Capture smartphone app for vision screening and patient referral in two districts of Punjab, Pakistan. This was a retrospective, observational study. We analyzed primary programmatic data collected from children undergoing vision screening by School Health and Nutrition Supervisors in the districts of Chakwal and Layyah in Punjab, from January 2022 to September 2024. The Peek Capture platform enabled real-time tracking of program data, including referrals and follow-ups. Primary outcome measures included referral rates and follow-up adherence rates, which were analyzed by age group and gender. Statistical comparisons were made using the z-test for proportions and the Chi-squared test of independence. Among 151,456 children screened (54% female), 5.7% (n = 8,682) were referred to Rural Health Centers (RHCs), with higher referral rates in females (6.3% vs. 5.0%, p < 0.001) and older children aged 12–18 (7.9% vs. 4.2%, p < 0.001). Follow-up was completed by 47.1% (n = 4,091), with no significant gender difference but lower rates in older children (45.6% vs. 49.2%, p = 0.001). Among those who followed up, 73.3% (n = 2,999) were confirmed to have an eye condition. Glasses were prescribed in 71.5% of diagnosed cases. Hospital referrals were rare (1.8%) and did not vary by gender. This study demonstrates the feasibility of high-volume, school-based vision screening using a smartphone-based platform in low-resource settings, with strong diagnostic yield among those who followed up. However, the 47.1% follow-up rate highlights a critical implementation challenge. Modest age- and gender-related differences point to areas for targeted programmatic strengthening. Further research is needed to assess the cost-effectiveness and long-term impact of such programs.