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 MIEPDistribution by Diagnosis

Diagnosis Frequency %

Normal 21 17.9%

Refractive Error 30 25.6%

Corneal disease 15 12.8%

Lens related 15 12.8%

Retinal disease 13 11.1%

Albinism 19 16.2%

Other 4 3.4%

Total 117 100.0%

Comparison of Presenting and Corrected Distance Visual Acuities

• Presenting distance vision in the better eye

Log MAR • Corrected distance vision in the better eye

13 11.1% ≥ 1.4 8 6.8%

24 20.5% ≥ 1.1 - 1.3 5 4.3%

49 41.9% ≥ 0.6 - 1.0 34 29.1%

31 26.5% ≤ 0.5 70 59.8%

117 100.0% 117 100.0%

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

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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 needs What can be done in schools and at home Measure of success

Assessment and first aid kit

Eye health needs in children Teachers Curriculum Within primary schools Within secondary schools At home Who can help Indicator

0-5 yrs 6-10 yrs 11-15 ys    

Allergies; red eye etc ++ ++ ++ ++ Causes, treatment and what not to do Hand and face washing Hand and face washing Causes, treatment and 

what not to doLocal health facility to 

diagnose, treat and or refer   Tetracycline eye ointment

Injuries − ++ ++ − Prevention and treatment Safe environment Safe environment 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 

useLocal eye unit; PTA; community leaders  

Visual acuity screening chart: 6/12 level; 3m rope. N8 reading test

Trachoma (rural areas) ++++ ++ − − Prevention and 

treatmentWater supply and sanitation; 

face washing; leaky tin  Water supply and 

sanitation; face washing; leaky tin

Refer for confirmation; treat with tetracycline eye 

ointmentClean hands and 

faces; use of latrines Tetracycline in kit

Vitamin A deficiency (rural areas) ++++ + − − Prevention and 

treatmentNutrition; home gardening; 

hand washing and sanitation; deworming

 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

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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