Development and pilot implementation of CERMATA: A digital referral-based vision screening platform for Indonesian primary school children.

BACKGROUND

Refractive error is a leading treatable cause of visual impairment among school-aged children, yet implementation of standardized school-based vision screening remains inconsistent in many low- and middle-income countries. CERMATA is a web-based digital platform that integrates the validated WHOeyes mobile application with referral management and program monitoring.

METHODS

This cross-sectional pilot implementation study evaluated the operational feasibility and preliminary screening performance of CERMATA in two primary schools participating in the initial implementation phase of the CERMATA program in Jakarta, Indonesia. Seventy-two children aged 9-12 years completed both CERMATA screening and standardized Snellen visual acuity assessment on the same day. Referral-level reduced visual acuity was defined as presenting visual acuity worse than 6/9 in either eye. Screening performance, agreement, and receiver operating characteristic (ROC) analysis were evaluated at the participant level using the poorer eye.

RESULTS

According to the Snellen reference assessment, 58 participants (80.6%) met the referral criterion. CERMATA demonstrated a sensitivity of 96.6%, specificity of 71.4%, positive predictive value of 93.3%, negative predictive value of 83.3%, and overall accuracy of 91.7%. Agreement with the reference assessment was substantial (κ = 0.719), and ROC analysis demonstrated excellent discrimination (AUC = 0.914; 95% CI, 0.83-1.00). All participants included in the screening performance analysis completed both assessments, supporting the operational feasibility of the screening workflow.

CONCLUSION

In this pilot implementation study, CERMATA demonstrated promising screening performance and operational feasibility for identifying reduced vision in older primary school-aged children. Larger multicenter implementation studies are warranted to confirm its performance, scalability, and integration into routine eye-care pathways before national-scale implementation.