School Eye Health and Refractive Errors Hasan Minto

The Facts 2.2 billion children in the world 1 billion (every second child) lives in poverty 30% of children in developing countries are underweight In 2005, 72 million children of primary school age in the developing world were not in school - 57 percent of them were girls According to UNICEF, 22,000 children die each day due to poverty

A Case Study of MIEP Distribution by Diagnosis DiagnosisFrequency% Normal2117.9% Refractive Error3025.6% Corneal disease1512.8% Lens related1512.8% Retinal disease1311.1% Albinism1916.2% Other43.4% Total %

Comparison of Presenting and Corrected Distance Visual Acuities Presenting distance vision in the better eye Log MARCorrected distance vision in the better eye %≥ % %≥ % %≥ % %≤ % % %

Global Initiatives Education for All Millennium Development Goals Achieve universal primary education Health Promoting Schools Child Friendly Schools Focusing Resources on Effective School Health Water, Sanitation and Hygiene Food for Education Early Childhood Development

Components of School Health School nutrition-micronutrient and vitamin supplements Deworming - helminths Injuries HIV /AIDs Tobacco Drugs and alcohol Violence Counselling ???? EYE HEALTH 6

Eye conditions that can affect primary school age children 1. Allergic eye disease 2. Red sticky eyes (infective conjunctivitis) 3. Eye injuries 4. Refractive errors

Integrated Comprehensive School Eye Health Programs Eye health needsWhat can be done in schools and at home Measure of success Assessment and first aid kit Eye health needs in childrenTeachersCurriculum Within primary schools Within secondary schools At homeWho can helpIndicator 0-5 yrs6-10 yrs11-15 ys Allergies; red eye etc++ Causes, treatment and what not to do Hand and face washing Causes, treatment and what not to do Local health facility to diagnose, treat and or refer Tetracycline eye ointment Injuries−++ − Prevention and treatment Safe environment Local health facility to diagnose, treat and or refer Torch; sterile eye pads and tape Refractive error−+++− Symptoms; benefits of spectacle wearing Vision testing and referral of individuals with reading difficulties Vision testing by teachers with mechanisms to provide spectacles Information for parents about benefits of spectacle use Local eye unit; PTA; community leaders Visual acuity screening chart: 6/12 level; 3m rope. N8 reading test Trachoma (rural areas) −− Prevention and treatment Water supply and sanitation; face washing; leaky tin Refer for confirmation; treat with tetracycline eye ointment Clean hands and faces; use of latrines Tetracycline in kit Vitamin A deficiency (rural areas) +++++−− Prevention and treatment Nutrition; home gardening; hand washing and sanitation; deworming Clean hands and faces; use of latrines ---- Poor near vision+++ Poor distance vision+++ Other eye diseases e.g. glaucoma +

School Eye Health Identification and service delivery Vision testing Post treatment care - glasses, low vision devices Primary eye care; first aid, diagnosis and treatment Specific disease programmes; trachoma Teachers; vision testing, referral, mainly presbyopia Siblings and parents; vision testing, referral 9

Factors Considered Demographics Population % <16 Gender Primary school enrolment Primary school drop out Visual Acuity cut-off: < 6/12 or 6/9 Binocular or Monocular

FACTORS CONSIDERED Existence of school health programs Make sure ALL stake holders are “on board” with screening process Referral pathways Ensure adequate resources for follow-up Fresh partnerships Factors Considered

Strategies Three tier screening points: Child to child Teachers as first point of contact Itinerant Optometrist/Refractionists Referral to hospital Planning tools: Refractive services planning tool CBL need calculating tool Supporting Laws/Policies: Health Education

Link between visual health and learning SEHP enhances the quality of education by: Early identification and action for children Back up health referral system Ensures that the eye health of children and staff is included in the SHP Educate children and staff on how to become inclusive Summary