School children vision screening aims to reduce the burden of avoidable blindness because of refractive error. Vision screenings are typically designed to detect sub-normal and abnormal visual acuity-as quickly and cost-effectively as possible. Children who fail a vision screening (Visual acuity less than 6/9 or 20/40), are made aware of this and are encouraged to visit an eye doctor so that they can have their vision problem professionally diagnosed and treated with eyeglasses, contact lenses, medicine or surgery. Large scale vision screening is a means to screen school children in large numbers and identify those with vision impairment.

“Vision problems nearly affect 13.5 million children. Rates for vision problems increase a child’s age increase. A quarter of adolescents are reported to have eye problems.”

“Poor vision in childhood affects performance in school or at work and has a negative influence on the future of the child.”

Refractive errors cover eye disorders caused by an irregularity in the eye’s shape. Such a condition makes it difficult for the eye to focus clearly on images, resulting in blurred and impaired vision. It is the second leading cause of blindness in India (after cataract), and according to the World Health Organization, 153 million people worldwide live with visual impairment due to uncorrected refractive errors.

Refractive errors include problems like myopia (nearsightedness), hyperopia (farsightedness) and astigmatism (an irregularly curved cornea). Although refractive errors can’t be prevented, they can be treated after they are detected

Uncorrected refractive errors can hamper performance at school, reduce employability, productivity and generally impair quality of life. Yet the correction of refractive errors with appropriate spectacles is among the most cost effect interventions in eye health care.

Young children are unaware of how they should see and often time’s parents are unaware that their children have difficulties in seeing clearly. This creates a major demand for school vision screening and treatment.

Vision 2020-The right to sight, a global initiative launched by a coalition of non-government organization and WHO is to eliminate avoidable visual impairment and blindness on a global scale. As a step towards this, we can provide our hands to the required and needy.

The following may be indicative of a child experiencing a vision problem:

• Blurred or double vision
• Bringing objects closer to the them to see/read
• Eyes turning inward or outward
• Squeezing of eyes
• Headaches
• Worsening academic performance
• Losing place while reading
• Avoiding close work
• Holding reading material closer than normal
• Rubbing eyes
• Eyes tiring while reading or doing other schoolwork
• Turning or tilting head to use one eye only
• Making frequent reversals when reading or writing
• Using finger to maintain place while reading
• Consistently performing below potential

It is essential to check children’s vision when they are first born and again during infancy,preschool and school years. Screening can be performed by a pediatrician,family physician or other properly trained health care provider. It is also often offered at schools, community health centers or community events.

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend the following exams:

Newborn- An ophthalmologist, pediatrician, family doctor or other trained health professional should examine a newborn baby’s eyes and perform a red reflex test (a basic indicator that the eyes are normal). An ophthalmologist should perform a comprehensive exam if the baby is premature or at high risk for medical problems for other reasons, has signs of abnormalities or has a family history of serious vision disorders in childhood.

Infant- A second screening for eye health should be done by an ophthalmologist, pediatrician, other trained health professional at a well-child exam between six months and the first birthday.

Preschooler- Between the ages of 3 and 3½, a child’s vision and eye alignment should be assessed by a pediatrician, ophthalmologist, optometrist, orthoptist or person trained in vision assessment of preschool children.

Visual acuity should be tested as soon as the child is old enough to cooperate with an eye exam using an eye chart. Photo screening is another way to check visual acuity that does not require a young child to cooperate with the test. Either approach to testing will determine whether the child can focus normally at far, middle and near distances. Many children are somewhat farsighted (hyperopia) and few are nearsighted (myopia). Most children will not require glasses or other vision correction.

If misaligned eyes (strabismus), lazy eye (amblyopia), refractive errors (myopia, hyperopia, astigmatism) or another focusing problem is suspected in the initial screening, the child should have a comprehensive exam by an ophthalmologist. It’s important to begin treatment as soon as possible to ensure successful vision correction and life-long benefits.

School age-Upon entering school, or whenever a vision problem is suspected, children’s eyes should be screened for visual acuity and alignment by a pediatrician, ophthalmologist, optometrist, orthoptist or person trained in vision assessment of school-aged children, such as a school nurse. Nearsightedness (myopia) is the most common refractive error in this age group and can be corrected with eyeglasses. If an alignment problem or other eye health issues is suspected, the child should have a comprehensive exam by an ophthalmologist.

On the other end of the age spectrum, many older people often forgo routine eye exams and falsely believe that free vision screenings offer adequate monitoring and protection of their eyesight.

This is extremely dangerous, since the most common causes of blindness — glaucoma, diabetic retinopathy and macular degeneration — increase with age. Vision loss often can be preventedor reduced if these conditions are diagnosed and treated early. But the only way this can be done is to have routine comprehensive eye exams.

Dont take chances with your eyesight as you get older. It may be sufficient to have a comprehensive eye exam every two years in your early adult life. But if you are over 39, have an annual eye exam to preserve your vision and make sure you are seeing the world as clearly as possible.

Stages of Vision Screening:

• Pre-Vision testing-It involves all the preparatory including identification of the target population, permission from authorities, collecting information about students’ strength from each school, providing information about the Vision screening to the School-in-Charge, Formation of teams for different schools, training of members of the team, Appointing a in charge for instruments maintenance and assigning teams to school for vision testing.

• Vision testing- The initial test of visual acuity identifies children who are ‘abnormal’ and who need to be refracted and examined in more detail. Decisions need to be made whether to measure vision in each eye separately, or with both eyes open. The level of acuity that denotes ‘failure’ also has to be decided. If the level of acuity is too high (i.e., less than 6/9 in one or both eyes) a very high proportion of children will ‘fail’, many of whom would not need or benefit from glasses. If the level is set too low (i.e., <6/60 in the better eye) only those with severe visual impairment will be detected. In India, a cut off of < 6/9 in either eye is used to define abnormal vision. Children failing this test are referred to an ophthalmic assistant for refraction.

If the child already wears glasses, vision should be recorded with the spectacles. As children can memorize the Snellen chart quickly, a card with 4 E optotypes of the same size is preferable. Children should not stand too close together, as they also tend to ‘help’ each other.

• Post Vision testing- The team members document the name of the school, area along with the student’s name in an Excel Sheet. Data will be cross-checked with individual members and team leaders the subsequent day. All the students with refractive errors will be called again to collect their respective spectacles and once again visual acuity assessment is performed at the clinic. Children with other eye disorders will be referred to the eye hospital for further treatment.

• Follow-up: Once a child has been diagnosed, he/she should be re-examined at intervals of 1–2 years by the optometrist/ ophthalmologist. This is particularly important for myopic children, as their myopia might progress.

A Tele-ophthalmology team has been implemented at our hospital to create awareness to the public regarding Eye and its disorders.It campaigns to offer information regarding nutrition/diet, Awareness meeting and Counselling to the patients.

Keeping up with its mission of social responsibility, responsiveness and accountability BEH has planned to initiate a vision screening camp for many under-privileged school children.