Mieru vision screening

Why screening

Uncorrected refractive error, needing spectacles and not having them, is the commonest cause of poor sight in children and one of the commonest in older people. The fix costs less than a school textbook. The difficulty is finding the people who need it, because most of them do not know. A child who has never seen the board clearly assumes nobody can; an older person assumes that fading sight is part of age.

Mieru, which means “can see”, takes the test to them. Teachers and community health workers learn to run a vision screening in two days. They test every child in a school, or every person over sixty-five who comes to a community centre, and refer anyone who fails to an optometrist, who usually visits the same school or centre within a fortnight. Spectacles are made in local workshops and delivered to the school or centre, free.

The chart Mieru uses has no letters. Each ring has a gap, and the person being tested shows which way it faces. The Landolt chart has been used in every Japanese school since the 1950s, and it works for small children, for people who read another script, and for people who cannot read at all.

What happens after the test

Screening is the cheap part. Most of the programme’s money goes on what follows: the optometrists, the spectacle workshops, the delivery, and above all the follow-up. Three months after spectacles are delivered, Mieru staff make unannounced visits to a sample of schools to see who is wearing them. The commonest reasons for not wearing them are breakage, teasing and a relative’s belief that spectacles weaken the eyes. Every school gets a spare pair for each child, and every teacher a short lesson in what to say about the last one.

Children who fail screening for reasons spectacles cannot fix, such as amblyopia, cataract or retinal disease, are referred to hospital. In FY2025, 0.9% of children screened were referred this way, and the programme pays for their transport and their first appointment.