Compliance with post-school vision screening referral: a systematic review

Purpose To estimate referral compliance rates and evaluate intervention effectiveness after post-school vision screening in children and adolescents. Methods We systematically searched PubMed, Embase, CINAHL, Web of Science and the Cochrane Library for studies published from January 2015 to December 2025. Eligible studies reported referral compliance data for school-aged populations. Study quality was assessed using the Effective Public Health Practice Project tool. Due to significant heterogeneity, a narrative synthesis was conducted. The review protocol was registered with PROSPERO (CRD420251268955). Results A total of 30 articles were included. Real-world referral compliance rates were suboptimal, with a median of 43.1% (range: 12.0–79.7%). Analysis of 14 intervention studies revealed three main strategies for improving compliance: the on-site care model which provided prescriptions for eyeglasses at school, the referral pathway model which provided clear instructions regarding the pathway to follow-up care, and the education model which provided health education and referral encouragement primarily. On-site care achieved relatively higher compliance rates (51.8–96.0%), whereas providing a clear referral pathway also benefited referral compliance (25.0–65.7%). However, the education model alone is insufficient to significantly improve compliance (21.3–24.5%). Conclusions Referral compliance is suboptimal and variable. It is crucial for settings to provide on-site care whenever feasible. Alternatively, establishing clear referral pathways is essential to ensure that children receive the appropriate eye care they need.