Global Blindness course: Developments in school vision testing

Global Blindness course: Developments in school vision testing


The type of refractive error
and how common they are vary enormously from
region to region. The region with the
lowest proportion of children at school with
uncorrected refractive error is in Africa, where it’s
probably less than 2% of children have a
refractive error. This is very different to Asia. Countries such as China
and Singapore, up to 80% of children now have been
shown to have myopia. So there’s a big variation
in the proportion of children who have uncorrected
refractive error and therefore need services. The age at which refractive
errors develop also varies. So children who are
long-sighted tend to be younger and they grow
out of it as they grow up. So primary school children
may have hypermetropia but by the time
they’re nine or ten, that’s all got better on
its own and they no longer need spectacles. On the other hand,
short-sightedness, myopia, is very uncommon,
except in China. And it tends to develop
around the age of nine or ten. So most programmes for the
detection and treatment of refractive error outside
China focus on children aged ten years and above. Having said that, there is
a great need for services for refractive error to be
integrated into Ministry of Education and Ministry of
Health’s school programmes. These are now
expanding considerably, and are receiving
much more support, because it’s been realised that
children who are not healthy or who are hungry or who
are deficient in vitamins, or who’ve got worms,
don’t learn well. So there’s a big
initiative to try and cover many different conditions
in school-age children. And refractive
errors can be seen as being part of that service. And this means working with
Ministries of Education as well as Ministries of Health. OK. And if a team is
going into a school to deal with refractive
errors, then there are all sorts of other
things that they can and probably should be doing. The teachers are likely
to have presbyopia, which would make their job
difficult. And marking homework in a poorly
lit home environment is going to make that
task very difficult. They may have glaucoma. They may be diabetic and
have diabetic retinopathy. So addressing the
health needs of teachers is not only good to
improve their ability to be able to do their
job, but it’ll also raise their awareness of
eye health needs generally. Children also have
other eye conditions, like styes and
conjunctivitis, which need to be detected and treated. And they may have
younger siblings at home who have locally endemic
diseases such as trachoma and Vitamin A deficiency. And children can be used as
agents of change to take health messages home so that their
younger siblings can also receive some benefit
from the programme. So I think it’s
important to think more broadly than just narrowly
focusing on refractive errors. And this could be an
entry point into schools and into Ministries of
Education to highlight the needs for the eye health
needs of children generally.

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