Corresponding Email: dinesh.kaphle@gmail.com OCULAR FINDINGS OF SCHOOL SCREENING AND EYE CAMP IN NEPAL Kaphle D1, Sujakhu D2, Rana D3, Mishra R4, Paudel P5 Abstract Methods Prevalence of refractive error and strabismus in school students was 5.7% and 1% respectively. Type of Refractive Error: Simple Myopia (41%) followed by compound myopic astigmatism (34%) were the most common types of refractive error found among school students. (fig. 3) (N=50) Fig.3 Refractive Error in School Students Prevalence of myopia, hyperopia and astigmatism were found to be 2.4%, 1.1% and 2.2 % respectively in school children. Community Eye Camp Presenting Visual Acuity: About 79% of total patients had Visual acuity in the normal range (i.e. 6/12 or better). Further, 17% had VA of 6/18 to 6/60 and 4% had VA below 6/60. Ocular Problems: The most common ocular problem found at the eye camp was Presbyopia (22%) followed by refractive error (20%). Age related Cataract was found in 10% of the camp attendees. (fig.4) (N=301) PURPOSE: To find out the ocular problems encountered by school children and the general community of Dakshinkali village, Nepal through school screening and eye camp activities. METHODS: School screening was completed for 875 students, ranging in age from 5 to 16 years. A one day community eye camp was conducted for a total of 301 patients. An eye examination was given to all the students including visual acuity measurement, fundoscopy, binocular test and refraction if required. RESULTS: Three quarters of the students had normal visual acuity whereas 1% of them were legally blind. Refractive error accounted for 1/3rd of the eye problems followed by muscular imbalance, predominantly convergence insufficiency (28%) and ocular allergy (21%). Simple myopia was the most common type of refractive error in school children (41%) followed by simple myopic astigmatism (34%). There were significant numbers (4%) of people in the community who were living with legal blindness. Almost 10% of people had cataract. Study Sites: School screening was conducted in six schools of Dakshinkali VDC comprising of 875 students, aged 5 to 16 years. The one day eye camp was organized in one of the schools near the main market. Examination Procedures: An eye examination was given to all the students including visual acuity measurement, binocular test and fundoscopy. Non-cycloplegic retinoscopy and subjective refraction was done in required cases. Pre-operative evaluation for cataract patients was conducted and patients were referred to BPK Lions Centre for Ophthalmic Studies Hospital. A cut off visual acuity of less than 6/9 in either eye was used to define abnormal vision for school screening. For the eye camp cut off visual acuity of less than 6/12 was considered abnormal. An error of more than +1.00DS hyperopia, more than -0.50 DS of myopia and more than 0.50 DC of astigmatism were considered as refractive error. Data analysis was done using Microsoft excel 2007. Discussion The prevalence of myopia and hyperopia in school students (2.45% & 1.1% respectively) was found to be less than the amount (4.3% & 1.3% respectively) found by Nepal B P et al study1. However the prevalence of myopia, hyperopia and astigmatism (2.2%) was found higher than a study2 done in Malayan students (1.4%, 0.25, and 1.55% respectively). The prevalence of strabismus (1%) was found to be considerably less than that found by Ferebee (5%) in his study3 and almost same as found by Nepal B P et al study1 (1.6%). The prevalence of refractive error and cataract at eye camp was found to be 20% and 10% respectively which is less than the amount found by A Sherchan et al study4 (31.4% and 48.1% respectively). SM: Simple Myopia, CMA: Compound Myopic Astigmatism, SH: Simple Hyperopia SMA: Simple Myopic Astigmatism SHA: Simple Hyperopic Astigmatism Conclusion Results Almost 1% of school children were found to have legal blindness5 (presenting VA worse than 6/60). Refractive error is the most common (32%) type of eye problem in school students. There are significant numbers of people (4%) in the community, who are living with legal blindness5 (VA less than 6/60). Almost 10% of people are suffering from cataract. Regular vision screening especially refractive error screening is needed in school. More cataract screening programs are needed in the communities. School Screening Presenting Visual Acuity: Three quarters (75%) of students had visual acuity equal to or better than 6/18. (fig. 1) Introduction School screening and eye camps are generally organized in remote and rural parts of Nepal for conducting eye screening and providing eye care services. Dakshinkali Village Development Committee (VDC), located 30 km south of Kathmandu has only one primary eye care clinic in a primary health centre (PHC) for a population of 4268 , which runs once in a week by visiting eye care professionals from Kathmandu. There is no previous known study in Dakshinkali to determine the ocular conditions of school children and adult population. Although the actual number of children who are blind is much smaller than the number of adults blind, e.g., from cataract, the number of years lived with blindness by blind children is almost the same as the total number of ‘blind years’ due to age-related cataract. Type of Refractive Error: Simple hyperopia (28%) followed by simple myopia (26%) were the most common types of refractive error found at eye camp. (fig.5) Fig.4 Ocular Problems in Camp Patients References Fig.1 Presenting Visual Acuity in School Students Ocular Problems: Refractive error was the most common (32%) ocular problem of the school students followed by convergence insufficiency (28%). (fig. 2) (N=156) B P Nepal, S Koirala, S Adhikary et al. Ocular morbidity in school children in Kathmandu. Br J Ophthalmol 2003;87: 531-534 Mohidin N, Akhir, SM. Refractive errors in rural Malay schoolchildren in Malaysia ;Department of Optometry, Faculty of Health sciences, University Kebangsaan Malaysia Ferebee, A. Childhood vision: Challenge and opportunities: A policy brief. The Center for Health Care in Schools, George Washington University. Washington DC: 2004. A Sherchan, R P Kandel, M K Sharma et al. Blindness prevalence and cataract surgical coverage in Lumbini zone and Chitwan district of Nepal. Br J Ophthalmol 2010; 94: 161-166 http: //www.bpaindia.org/cited on 20 Feb.’08. WHO category of Visual Impairment. (N=96) Objective To determine the ocular problems among school children and adult population of Dakshinkali VDC, Nepal through school screening and eye camp activities. Fig.5 Refractive Error in Camp Patients Fig.2 Ocular problems in School Students 1. Malawi College of Health Sciences, Malawi, 2. Mechi Eye Care Centre, Jhapa,Nepal, 3. Eye Care Optical, Addu,Maldives 4. B P K Lions Centre for Ophthalmic Studies, Kathmandu, Nepal , 5. International Centre for EyeCare Education (Brien Holden Vision Institute), Sydney, Australia Corresponding Email: dinesh.kaphle@gmail.com