Prevalence of Visual Disorders among Urban Palestinian Preschool Children

Liana Labadi1, Reem Shahin2, Frank Eperjesi3, Yousef Al-Shanti2, Mohammad Shehadeh2, Ibrahim Taha4, *
1 Department of Optometry, Arab American University, Palestine
2 Department of Optometry, An-Najah National University, Nablus, Palestine
3 Department of Optometry, Aston University, Birmingham, UK
4 Department of Translational Medicine, The University of Pavia, Pavia, Italy

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© 2022 Labadi et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the University of Pavia, Translational Medicine; E-mail:



Childhood blindness is a major public health concern since 40% of visual disorders that can cause blindness among children are preventable. Vision screening programs among preschool children have been implemented in several countries as a tool for early detection and intervention of visual disorders. In Palestine, there is a lack of scientific data on the prevalence of visual disorders among children. In addition, vision-screening programs that are currently implemented are neither validated nor effective.


Using validated vision screening protocols, a cross-sectional study is conducted to determine the prevalence of visual disorders among urban Palestinian preschool children between the ages of 3 to 5 years in Nablus city.


All children attending eight preschools selected using single-stage cluster sampling technique, underwent a validated vision screening administered by trained eye care professionals. The screening protocol was based on a combination of clinical assessment adopted from the Modified Clinical Technique and the Vision in Preschoolers studies, including assessment of visual acuity, ocular alignment, depth perception, color vision, non-cycloplegic retinoscopy, and ocular health. A pass-fail criterion was used to refer all children who did not attend the vision screening for comprehensive eye examination, including cycloplegic retinoscopy and a dilated fundus exam. A chi-squared test was used to determine any association between visual disorders and their independent risk factors.


A total number of 764 children underwent vision screening. Out of the 290 children who did not attend the vision screening, 127 children responded to the referral call for comprehensive eye examinations. Refractive error was the most prevalent visual disorder with a prevalence of (29.37%), followed by amblyopia (4.10%), color vision deficiency (1.24%), strabismus (1.24%), and ocular health abnormalities (0.70%). There was no age (p=0.35) and gender (p=0.32) variation in children having refractive errors. Anisometropia was the leading cause for amblyopia (1.32%, n=7), followed by significant refractive error (1.13%, n=6) and strabismus (0.37%, n=2).


Refractive error was the most prevalent visual disorder affecting Palestinian preschoolers in Nablus. Anisometropia and significant refractive errors were found to be the major causes of amblyopia. Effective nationwide preschool vision screening programs should be implemented in Palestine to screen amblyogenic risk factors.

Keywords: Amblyopia, Blindness, Children, Pre-school, Vision Screening, Visual Disorders.