{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:59:38Z","timestamp":1790791178817,"version":"4.1.0"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ford Foundation Indonesia"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201312 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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 (\u03ba\u2009=\u20090.719), and ROC analysis demonstrated excellent discrimination (AUC\u2009=\u20090.914; 95% CI, 0.83\u20131.00). All participants included in the screening performance analysis completed both assessments, supporting the operational feasibility of the screening workflow.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0359572","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:46:14Z","timestamp":1790790374000},"page":"e0359572","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and pilot implementation of CERMATA: A digital referral-based vision screening platform for Indonesian primary school children"],"prefix":"10.1371","volume":"21","author":[{"given":"Kianti Raisa","family":"Darusman","sequence":"first","affiliation":[{"name":"Indonesia Health Development Center (IHDC)","place":["Jakarta, Indonesia"]},{"name":"Health Collaborative Center (HCC)","place":["Jakarta, Indonesia"]},{"name":"Indonesian Ophthalmologist Association (PERDAMI)","place":["Jakarta, Indonesia"]},{"name":"Universitas Indonesia","place":["Jakarta, Indonesia"],"department":["Faculty of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1095-7343","authenticated-orcid":true,"given":"Alicia","family":"Kartika","sequence":"additional","affiliation":[{"name":"Indonesia Health Development Center (IHDC)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christella","family":"Caroline","sequence":"additional","affiliation":[{"name":"Health Collaborative Center (HCC)","place":["Jakarta, Indonesia"]},{"name":"Indonesian Ophthalmologist Association (PERDAMI)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanessa Audrey","family":"Wihardji","sequence":"additional","affiliation":[{"name":"Health Collaborative Center (HCC)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bunga","family":"Pelangi","sequence":"additional","affiliation":[{"name":"Health Collaborative Center (HCC)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9507-527X","authenticated-orcid":true,"given":"Ray Wagiu","family":"Basrowi","sequence":"additional","affiliation":[{"name":"Indonesia Health Development Center (IHDC)","place":["Jakarta, Indonesia"]},{"name":"Health Collaborative Center (HCC)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nila Faried","family":"Moeloek","sequence":"additional","affiliation":[{"name":"Indonesia Health Development Center (IHDC)","place":["Jakarta, Indonesia"]},{"name":"Health Collaborative Center (HCC)","place":["Jakarta, Indonesia"]},{"name":"Indonesian Ophthalmologist Association (PERDAMI)","place":["Jakarta, Indonesia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"issue":"2","key":"pone.0359572.ref001","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2015-010434","article-title":"Impact of visual acuity on developing literacy at age 4-5 years: A cohort-nested cross-sectional study","volume":"6","author":"A Bruce","year":"2016","journal-title":"BMJ Open"},{"key":"pone.0359572.ref002","article-title":"Impact of refractive errors on the academic performance of high school children of Lahore","author":"MZ Latif","year":"2022","journal-title":"Front Public Health"},{"key":"pone.0359572.ref003","doi-asserted-by":"crossref","first-page":"76","DOI":"10.62792\/ut.education.v7.i13-14.p2998","article-title":"Common causes of visual impairment in children: Literature review","volume":"7","author":"E Tateshi","year":"2025","journal-title":"Edu J Edu Res"},{"issue":"1","key":"pone.0359572.ref004","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1186\/s12886-020-01619-2","article-title":"Prevalence of reduced visual acuity among school-aged children and adolescents in 6 districts of Changsha city: A population-based survey","volume":"20","author":"M Liao","year":"2020","journal-title":"BMC Ophthalmol"},{"issue":"1","key":"pone.0359572.ref005","doi-asserted-by":"crossref","first-page":"63","DOI":"10.2471\/BLT.07.041210","article-title":"Global magnitude of visual impairment caused by uncorrected refractive errors in 2004","volume":"86","author":"S Resnikoff","year":"2008","journal-title":"Bull World Health Organ"},{"issue":"3","key":"pone.0359572.ref006","doi-asserted-by":"crossref","first-page":"278","DOI":"10.1111\/cxo.12953","article-title":"Do reduced visual acuity and refractive error affect classroom performance?","volume":"103","author":"S Hopkins","year":"2020","journal-title":"Clin Exp Optom"},{"issue":"2","key":"pone.0359572.ref007","article-title":"Vision screening for correctable visual acuity deficits in school-age children and adolescents","volume":"2","author":"JR Evans","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"issue":"11","key":"pone.0359572.ref008","doi-asserted-by":"crossref","first-page":"1988","DOI":"10.1038\/s41433-024-03032-1","article-title":"Priorities in school eye health in low and middle-income countries a scoping review","volume":"38","author":"A-A Harvey","year":"2024","journal-title":"Eye (Lond)"},{"issue":"2","key":"pone.0359572.ref009","doi-asserted-by":"crossref","first-page":"198","DOI":"10.4103\/2008-322X.183920","article-title":"Vision screening of younger school children by school teachers: A pilot study in Udaipur City, Western India","volume":"11","author":"P Rewri","year":"2016","journal-title":"J Ophthalmic Vis Res"},{"issue":"11","key":"pone.0359572.ref010","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1136\/bjo-2024-326726","article-title":"Current status of school vision screening-rationale, models, impact and challenges: A review","volume":"109","author":"J-A Little","year":"2025","journal-title":"Br J Ophthalmol"},{"issue":"8","key":"pone.0359572.ref011","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1001\/jamaophthalmol.2015.1468","article-title":"Development and validation of a smartphone-based visual acuity test (peek acuity) for clinical practice and community-based fieldwork","volume":"133","author":"A Bastawrous","year":"2015","journal-title":"JAMA Ophthalmol"},{"issue":"4","key":"pone.0359572.ref012","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s40123-021-00360-3","article-title":"Digital tools for the self-assessment of visual acuity: A systematic review","volume":"10","author":"JLJ Claessens","year":"2021","journal-title":"Ophthalmol Ther"},{"issue":"11","key":"pone.0359572.ref013","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-012799","article-title":"STARD 2015 guidelines for reporting diagnostic accuracy studies: Explanation and elaboration","volume":"6","author":"JF Cohen","year":"2016","journal-title":"BMJ Open"},{"issue":"6","key":"pone.0359572.ref014","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.fertnstert.2024.01.040","article-title":"A brief overview of pilot studies and their sample size justification","volume":"121","author":"AR Kunselman","year":"2024","journal-title":"Fertil Steril"},{"key":"pone.0359572.ref015","article-title":"Initial screening","volume-title":"IAPB School Eye Health Guideline","author":"International Agency for the Prevention of Blindness","year":"2024"},{"key":"pone.0359572.ref016","doi-asserted-by":"crossref","first-page":"15","DOI":"10.59747\/smjidisurabaya.v2i1.57","article-title":"Geographic distribution of ophthalmologist in East Java 2023","author":"KD Salsabila","year":"2024","journal-title":"SMJ IDI Surabaya"},{"key":"pone.0359572.ref017","author":"World Bank","year":"2026"},{"key":"pone.0359572.ref018","volume-title":"World report on vision","author":"World Health Organization","year":"2019"},{"issue":"2","key":"pone.0359572.ref019","doi-asserted-by":"crossref","first-page":"100126","DOI":"10.1016\/j.ajoint.2025.100126","article-title":"School-based eye health interventions for improving eye care and spectacles compliance in children in low- and middle-income countries: A scoping review","volume":"2","author":"GO Anokye","year":"2025","journal-title":"AJO Int"},{"key":"pone.0359572.ref020","doi-asserted-by":"crossref","first-page":"226","DOI":"10.36348\/sjm.2026.v11i06.003","article-title":"Teacher-Led School Vision Screening: A Feasibility Study Among Primary School Pupils","volume":"11","author":"M Bature","year":"2026","journal-title":"Saudi J Med"},{"issue":"11","key":"pone.0359572.ref021","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0259309","article-title":"Parents\u2019 reasons for nonadherence to referral to follow-up eye care for schoolchildren who failed school-based vision screening in Cross River State, Nigeria-A descriptive qualitative study","volume":"16","author":"L Lohfeld","year":"2021","journal-title":"PLoS One"},{"issue":"6","key":"pone.0359572.ref022","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1097\/OPX.0b013e3181a76e55","article-title":"Visual acuity norms in pre-school children: The multi-ethnic pediatric eye disease study","volume":"86","author":"Y Pan","year":"2009","journal-title":"Optom Vis Sci"},{"issue":"8","key":"pone.0359572.ref023","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1080\/08164622.2021.2003687","article-title":"The prevalence of refractive error in schoolchildren","volume":"105","author":"Z Tajbakhsh","year":"2022","journal-title":"Clin Exp Optom"},{"issue":"8","key":"pone.0359572.ref024","first-page":"1104","article-title":"Progression of myopia in children and teenagers: A nationwide longitudinal study","volume":"106","author":"D Tricard","year":"2022","journal-title":"Br J Ophthalmol"},{"issue":"1","key":"pone.0359572.ref025","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1167\/iovs.67.1.28","article-title":"Screening questions to identify low vision and acuity-defined legal blindness","volume":"67","author":"Y-H Wu","year":"2026","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"pone.0359572.ref026","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/j.ajo.2020.10.019","article-title":"Association of visual acuity with eye-related quality of life and functional vision across childhood eye conditions","volume":"223","author":"DA Leske","year":"2021","journal-title":"Am J Ophthalmol"},{"issue":"1","key":"pone.0359572.ref027","doi-asserted-by":"crossref","first-page":"15424","DOI":"10.1038\/s41598-026-46397-x","article-title":"Correlation analysis between visual factors and academic performance in Chinese children","volume":"16","author":"G Liu","year":"2026","journal-title":"Sci Rep"},{"issue":"13","key":"pone.0359572.ref028","doi-asserted-by":"crossref","first-page":"811","DOI":"10.3109\/08958378.2014.955932","article-title":"Screening tests: a review with examples","volume":"26","author":"LD Maxim","year":"2014","journal-title":"Inhal Toxicol"},{"issue":"1","key":"pone.0359572.ref029","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s12875-020-01365-w","article-title":"Exploring general practitioners\u2019 perceptions about the primary care gatekeeper role in Indonesia","volume":"22","author":"J Mulyanto","year":"2021","journal-title":"BMC Fam Pract"},{"issue":"1","key":"pone.0359572.ref030","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1186\/s12913-018-3745-y","article-title":"A categorisation of problems and solutions to improve patient referrals from primary to specialty care","volume":"18","author":"J Greenwood-Lee","year":"2018","journal-title":"BMC Health Serv Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359572","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T17:46:18Z","timestamp":1790790378000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0359572"}},"subtitle":[],"editor":[{"given":"Andrzej","family":"Grzybowski","sequence":"first","affiliation":[{"name":"University of Warmia","place":["POLAND"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":30,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0359572","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]}}}