RESUMEN
Purpose: To understand/assess ocular and functional vision impairment in children with multiple disabilities with a functional vision assessment battery in addition to standard ophthalmic examinations in an outreach setting. Methods: Seven schools for children with special needs, 243 children in total, were screened for ocular disorders and functional vision impairment through school camps. Results: Among them, 37% had refractive errors needing spectacle correction. With standard ocular testing methods, the visual impairment was around 32%, but when functional vision was assessed, the functional vision impairment amounted to 70% in these children. The presence of functional vision impairment was found to be independent of the associated disability. Assessment of visual capacities such as visual closure, saccade pursuits, optic ataxia, and developmental milestones early on can help in suspecting the presence of CVI. Conclusion: Children with multiple disabilities are more at risk of functional vision impairment, which significantly impairs their ability to function in daily life. A complete functional vision assessment becomes essential to plan early intervention for these children. The significant proportion of vision impairment and functional vision loss in our study indicates the need for coordinated structured programs to address vision?related problems in children with multiple disabilities.
RESUMEN
Purpose: In India, teachers screen middle school children using the 6/9 Snellen's optotype. Recently, the National Program for Control of Blindness included primary school students also. The present cross-sectional study was planned to assess the inclusion of primary school students. Compliance to spectacles was ascertained after 6 months follow-up. Methods: Randomly selected 23 Government primary schools. A total of 30 teachers were nominated and given hands-on training in vision screening and recording formats. Teachers conducted vision screening of primary school students of their respective schools using the 6/12 Snellen's chart and referred students with subnormal vision to optometrist. Optometrist also validated the screening done by teachers. Optometrist screened the vision of 5% randomly selected children screened by teachers as having normal vision. Descriptive statistics used STATA version 13.0. Results: A total of 6056 students screened by the teachers. Sensitivity and specificity of teacher screening were 92.3% (confidence interval [CI] 88.6–95.0) and 72.6% (CI 68.2–76.6)), respectively. About 277 students underwent refraction and 186 prescribed spectacles. The prevalence of myopia, hypermetropia, and astigmatism is 2.5% (2.1–2.9), 0.6% (0.4–0.8), and 1.3% (1.0–1.6), respectively. Compliance to spectacles usage is 36%. Conclusion: Burden of refractive error in primary school is very low. Trained teachers can identify children with subnormal vision, but the false-positive rate is very high. Compliance to spectacle use among primary school children is also less. Vision screening by teachers prioritized in secondary schools and preschool screening should be done by more skilled eye care workers preferably optometrist.
RESUMEN
Aim: To assess the effectiveness of teachers in a vision screening program for children in classes 5th to 12th attending school in two blocks of a district of north central India. Materials and Methods: Ophthalmic assistants trained school teachers to measure visual acuity and to identify obvious ocular abnormalities in children. Children with visual acuity worse than 20/30 in any eye and/or any obvious ocular abnormality were referred to an ophthalmic assistant. Ophthalmic assistants also repeated eye examinations on a random sample of children identified as normal (approximately 1%, n=543) by the teachers. Ophthalmic assistants prescribed spectacles to children needing refractive correction and referred children needing further examination to a pediatric ophthalmologist at the base hospital. Results: Five hundred and thirty teachers from 530 schools enrolled 77,778 children in the project and screened 68,833 (88.50%) of enrolled children. Teachers referred 3,822 children (4.91%) with eye defects for further examination by the ophthalmic assistant who confirmed eye defects in 1242 children (1.80% of all screened children). Myopia (n=410, 33.01%), Vitamin A deficiency (n=143, 11.51%) and strabismus (n=134, 10.79%) were the most common eye problems identified by the ophthalmic assistant. Ophthalmic assistants identified 57.97% referrals as false positives and 6.08% children as false negatives from the random sample of normal children. Spectacles were prescribed to 39.47% of children confirmed with eye defects. Conclusions: Primary vision screening by teachers has effectively reduced the workload of ophthalmic assistants. High false positive and false negative rates need to be studied further.