They see, they learn: Pre-COVID-19 prevalence of refractive errors in school children in suburban areas of North India

Purpose: India has the largest population of youth in the world, thereby making them important contributors to the “India of Tomorrow”. Over 80% of knowledge gained is by the visual sense, thereby making school screening programs a necessity in our country. Data from the pre?COVID era, that is, 2017–18 was collected from close to 19,000 children in Gurugram, Haryana, a tier two city in National Capital Region, India. A similar prospective observational study is planned post COVID?19 (2022–23) for further analysis to depict the impact of COVID?19 in these areas. Methods: The program They See, They Learn was set at government schools in the area of operations (district of Gurgaon, Haryana), where the children and their families were unable to afford eye care services. All children who were screened underwent a comprehensive eye examination at the school premises itself. Results: A total of 18,939 students were screened over a period of 18 months, covering a total of 39 schools in the Gurugram belt, in the first phase of the program. Eleven point eight percent (n = 2254) of all school students had some form of refractive error. Girl students were found to have a higher refractive error rate (13.3%) compared to boy students (10.1%) across the schools screened. Myopia was the most common type of refractive error. Conclusion: School students require perfect vision or else they can be discouraged and may become a major burden to the economy of any developing nation. A school screening program aiming at populations that cannot afford such basic needs like spectacles is a must in all zones of the country

Profile of ocular conditions from school eye screening in Southern India

Purpose: To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu. Methods: The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6–17 years) between July 2016 and June 2019. The study followed a three?phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented. Results: Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22–2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21–1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10–8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37–6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12–6.23 P < 0.001) was common among males. Conclusion: The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow?up after school eye screening would safeguard the visual development of these children.

Tribal Odisha Eye Disease Study Report # 6. Opportunistic screening of vitamin A deficiency through School Sight Program in tribal Odisha (India)

Purpose: To explore the possibility of vitamin A deficiency (VAD) detection through School Sight Program (SSP) in a tribal district of Odisha, India. Methods: In a cross-sectional observational study, we tracked school children with ocular signs/symptoms of VAD to their villages. The ophthalmologist examined their under-5 siblings and other under-5 children in the village. Information pertaining to family belief and practices of food, water, sanitation, and the socioeconomic status of the family were collected. Results: The ocular features of VAD were detected in 207 of 4801 (4.3%) examined children. This included 70 children (mean age 11 ± 2.6 years) detected in the school, 22 siblings (mean age 3.2 ± 1.2 years) of these children detected at their home, and 115 children (mean age 3 ± 1.5 years) detected in their habitat. The average family size was 5.8 ± 2.02 and the birth order of the child with VAD was 2.3 ± 1.25. Most parents were farmer, living in asbestos-roofed house, depended on public underground water, and practiced open-air defecation. The distribution of VAD in 207 children was conjunctival xerosis (X1A = 207; 100% of VAD and 4.3% of all children), Bitot's spot (X1B = 169; 81.6% of VAD and 3.5% of all children), corneal scar (XS = 3; 1.4% of VAD and 0.06% of all children), and night blindness (XN = 35; 16.9% of VAD and 0.72% of all children). Conclusion: An opportunistic screening for detection of VAD through a SSP could be cost-effective and complement the existing strategy.

Analysis Of Prevalence And Factors Influencing Adolescent Idiopathic Scoliosis Among School Students In Thiruvallur District

Background: The occurrence of AIS is on a high, which necessitates preventive measures at the earliest for which screening is essential at the school level. Prevalence of AIS around the world is 0.4- 5.2 %. Scoliosis leads to problems such as cosmetic deformity, quality of life, visible disability, backache, personal growth, autonomy, and reduced respiratory function. These problems can be prevented if scoliosis is diagnosed and treated earlier. To screen for AIS among selected schools and to analyze factors influencing adolescent idiopathic scoliosis. Methods: A total of 3250 Students between age 11 to 15 years were screened for AIS from Thiruvallur district. The screening was performed at two levels using Adam’s forward bend test and scoliometer, respectively. A detailed analysis was performed on symptomatic AIS subjects (n=58) for various influencing factors and determinants. Results: The prevalence of AIS from 11- 15 years was 0.27%, 0.30%, 0.49%, 0.36% and 0.33% respectively. AIS-affected thoracic region (50%) of females (58%) with a predominant right sided curvature (55%). Bag type and weight, sitting posture in a classroom, study posture was found to influence AIS. Conclusion: This study emphasizes early screening of AIS for school children at the age of 11- 15 years based upon the high prevalence rates compared to global standards. Parents and teachers should be aware of the bag type and weight, sitting and studying posture for early prevention of AIS.

Severe scoliosis in an adolescent, benefits of early detection: a case report

Presentations of scoliosis to primary health care physicians are not rare. Challenges may arise when it comes to screening and who require treatment once diagnosed. Idiopathic scoliosis is a three-dimensional spine and trunk deformity that is considered the most common form of scoliosis in children. It commonly does not cause symptoms and may be overlooked. However, if there was progressive deformity and it remained untreated, it may cause serious complications. Apart from medical concerns, emotional and cosmetic worries due to visible deformity may lead to psychological and social effects. Despite advances in understanding scoliosis, there are still controversies when it comes to optimal screening and treatment of this condition. This case is about a thirteen years old female who presented with intermittent back symptoms and was found to have a severe form of idiopathic thoracolumbar scoliosis. Through this case, author will be discussing different aspects of scoliosis (prevalence, screening, diagnosis, and treatment options) with emphasis on psychological support and guidance to the physician on how to overcome this challenge.

Accuracy of noncycloplegic refraction performed at school screening camps

Purpose: The aim of this study was to compare noncycloplegic refraction performed in school camp with that performed in eye clinic in children aged 6� years. Methods: A prospective study of children with unaided vision <0.2 LogMAR who underwent noncycloplegic retinoscopy (NCR) and subjective refraction (SR) in camp and subsequently in eye clinic between February and March 2017 was performed. A masked optometrist performed refractions in both settings. The agreement between refraction values obtained at both settings was compared using the Bland朅ltman analysis. Results: A total of 217 eyes were included in this study. Between the school camp and eye clinic, the mean absolute error � standard deviation in spherical equivalent (SE) of NCR was 0.33 � 0.4D and that of SR was 0.26 � 0.5D. The limits of agreement for NCR were +0.91D to ? 1.09D and for SR was +1.15D to -1.06D. The mean absolute error in SE was ?0.5D in 92.62% eyes (95% confidence interval 88%�%). Conclusion: A certain degree of variability exists between noncycloplegic refraction done in school camps and eye clinic. It was found to be accurate within 0.5D of SE in 92.62% eyes for refractive errors up to 4.5D of myopia, 3D of cylinder, and 1.5D of hyperopia.

The Clinical Effectiveness of School Screening Programme for Idiopathic Scoliosis in Malaysia

Introduction: There is no large population size study on school screening for scoliosis in Malaysia. This study is aimed to determine the prevalence rate and positive predictive value (PPV) of screening programme for adolescent idiopathic scoliosis. Materials and Methods: A total of 8966 voluntary school students aged 13-15 years old were recruited for scoliosis screening. Screening was done by measuring the angle of trunk rotation (ATR) on forward bending test (FBT) using a scoliometer. ATR of 5 degrees or more was considered positive. Positively screened students had standard radiographs done for measurement of the Cobb angle. Cobb angle of >10° was used to diagnose scoliosis. The percentage of radiological assessment referral, prevalence rate and PPV of scoliosis were then calculated. Results: Percentage of radiological assessment referral (ATR >5°) was 4.2% (182/4381) for male and 5.0% (228/4585) for female. Only 38.0% of those with ATR >5° presented for further radiological assessment. The adjusted prevalence rate was 2.55% for Cobb angle >10°, 0.59% for >20° and 0.12% for >40°. The PPV is 55.8% for Cobb angle >10°, 12.8% for >20° and 2.6% for > 40°. Conclusions: This is the largest study of school scoliosis screening in Malaysia. The prevalence rate of scoliosis was 2.55%. The positive predictive value was 55.8%, which is adequate to suggest that the school scoliosis screening programme did play a role in early detection of scoliosis. However, a cost effectiveness analysis will be needed to firmly determine its efficacy.

A Four-year Follow-up Case of Oligomeganephronia Detected Early by School Screening Urinalysis

Oligmeganephronia is congenital hypoplasia of kidney with renal pathology showing very small number of nephrons with compensatory hypertrophy of the remaining glomeruli. A 7- year-old girl was referred to our nephrology clinic due to hematuria detected on school screening urinalysis and diagnosed as chronic renal failure and oligomeganephronia on renal biopsy. We are reporting the clinical and histomorphometric changes for the four years follow-up with review of literatures.

Diagnostic Significance of the Urine-Stick Test in Middle and High School Children in Seoul

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.

Diagnostic Significance of the Urine-Stick Test in Middle and High School Children in Seoul

PURPOSE: This study was performed to assess the diagnostic significance of the urine-stick test in detecting Diabetes Mellitus (DM) and to assess the clinical characteristics of adolescent diabetes. MEHTODS: A total of 926,208 middle and high school children participated. The urine-stick test was performed and those who showed glycosuria and, further studies such as evaluations of plasma glucose, triglyceride, cholesterol and C-peptide level done. We compared the clinical characteristics between the diabetes group and non-diabetes group. RESULTS: Among 926,208 students, 1,020 (0.11%) showed glycosuria. Among the 1,020 glycosuria positive subjects, 339 (33.2%) had further laboratory tests. Two hundred and sixty-eight cases (79.1%) were normal, 52 cases (15.3%) were newly diagnosed as DM, 9 cases (2.7%) were already diagnosed DM, 10 cases (2.9%) had an impaired glucose tolerance. The 52 newly diagnosed DM cases, whose postprandial 2 hour glucose level was more than 200m/dL, showed different fasting glucose levels. Thirty cases (57.7%) had a level of more than 140mg/dL, 11 cases (21.1%) were between 110 and 140mg/dL and 11 cases (21.1%) were at a level of less than 110mg/dL. Polydipsia, polyuria and polyphagia were frequent symptoms exibited by the DM group while weight loss and fatigue showed no significant difference between the DM and non-diabetes groups. Six cases were type 1 DM and 44 cases were type 2 DM. Being female, having a family history of DM and a higher BMI and higher diastolic blood pressure were significant risk factors for DM. CONCLUSION: The positive rate of glycosuria by the urine-stick test was 0.11%. Among glycosuria positive subjects 15.3% were newly diagnosed as DM. For the high risk group, an annual urine-stick test and a postprandial blood glucose test should be performed and a systematic referral system is necessary.