Evaluation of the Mobile Eye Clinic Model for Screening and Treatment Access for Refractive Errors among Primary School Children in Khon Kaen Province

Abstract

Refractive error among school-aged children is a global public health problem. The World Health Organization reports that more than 19 million children under 15 years of age have visual impairment, most of which is correctable with eyeglasses when screening and treatment are provided in a timely manner. In Khon Kaen Province, the former centralized screening system achieved only 48.5% average coverage and a cascade attrition rate as high as 91.9%-that is, of every 100 children found to have refractive errors, only 8 actually received glasses-owing to barriers related to travel, referral, and personnel. The aim to evaluate the mobile eye clinic model for the screening of and access to treatment for refractive errors among primary school children in Khon Kaen Province This mixed-methods evaluation research applied the Logic Model framework and was conducted in four pilot districts, covering 14,965 primary school students in 279 schools from March to May 2025. Instruments comprised a visual examination record form, a satisfaction questionnaire (Cronbach's α = 0.91), and focus group discussions. Data were analyzed using descriptive statistics and content analysis. Results: Implementation followed the defined standards. Screening coverage rose to 100%; cascade attrition fell from 91.9% to 12.9%; and the number of children receiving glasses increased from 32.8 per year to 2,434 within three months (a 74-fold increase). Cycloplegic refraction (refraction performed with cycloplegic eye drops to relax the ciliary muscle) identified astigmatism as the most common condition (85.33%), followed by hyperopia (71.28%) and myopia (8.50%). Satisfaction was high across all dimensions (mean 4.09-4.36), and all underlying pain points were fully resolved. The model clearly improved access to care and reduced attrition, demonstrating strong potential for scaling at the regional health and national levels. It should therefore be incorporated into the benefit package for universal health coverage.