# Current Challenges Supporting School-Aged Children with Vision Problems: A Rapid Review
## 8 Synthetizing the Results  
### Main Findings and Future Needs  
The goal of this study is to gain an understanding of the current state of research in stakeholders involved in vision screening for children and the use of state-of-art eye-tracking technology to support vision experts, and to fill the gaps in the present literature on the use of eye-tracking technology for new possibilities and future lines of research. After answering the research questions, the following points synthesize the sometimes contradictory findings and serve as a basic departure for further research:  
* For the first research question (i.e., who are the stakeholders influencing vision screening at schools?), seven primary vision experts and non-experts emerged from the literature: (i) orthoptists [33] (ii) optometrists [35] (iii) ophthalmologists [129] (iv) vision teachers [44] (v) nurses [150] (vi) parents (vii) volunteers [98].
* In most countries, routine vision screening starts at the age of 4 to 5 [49,151] or from 3 to 5 [95]. However, there are no uniform methodologies for vision screening [101,109,121].
* Many factors influence the low number of follow-up vision screenings for children, including parents' education, awareness, and social and economic factors [152,153, 38]. Amblyopia (lazy eye) is often neglected in children because of the mentioned factors and the local medical system [154].
* Basic terms such as vision, screening, and technology mean different things in different fields. To find correct and accurate search terms is difficult and time-consuming.
* Vision problems affect children's social and academic performances, and can be a reason for students to drop out from educational institutes [19,28]. Therefore, it is crucial to assess children's vision throughout the school period at different stages [155].
* The examined documents reflect the current obstacles faced by children in their schools. At this age, the guardians of students, the teachers, and the child may not be aware of vision deficits. Consequently, concerns related to children's vision cannot be communicated well between the children and the guardians, and after that, if the children have possible vision problems, between the guardians and other involved stakeholders.
* An important observation from the literature and whitepapers is that vision care is often limited to the screening or handling of a specific vision problem. The support for treatment approaches and the responsibilities of stakeholders to aid visual deficits are lacking. Often, many stakeholders need to be involved in the treatment of vision problems, but their collaboration is fragmented [28,39].  
\begin{table}
\begin{tabular}{l c c} \hline \hline
**Tool Name** & **Free** & **Paid** \\ \hline EventIDE [142] & & ✓ \\ Tobii Pro Lab [143] & & ✓ \\ SMI BeGaze [144] & & ✓ \\ Motions [145] & & ✓ \\ Psychology [143] & ✓ & \\ PyGaze [143] & ✓ & \\ OGAMA [146] & ✓ & \\ EMA Toolbox [147] & ✓ & \\ Gazepath [148] & ✓ & \\ PyTrack [149] & ✓ & \\ \hline \hline \end{tabular}
\end{table}
Table 6: Names of open-source and commercial tools for recording and analyzing the experimental study using eye-trackers.  
* Stakeholders do not widely use eye-tracking technology, even though the literature has shown the promising applications and benefits of ET in diagnosing OMD, nystagmus, and strabismus [33; 111; 129; 130].
* ET can collect eye movement metrics such as fixations, the number of fixations, saccades, microsaccades, and smooth pursuits [85; 140]. The objective data collected from ET are reliable, and studies demonstrate that such metrics are helpful in functional vision assessment (FVA) [33; 35].