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Year : 2018  |  Volume : 66  |  Issue : 8  |  Page : 1224

Commentary: Should we restrict vision screening in primary school children?

Allen Foster Community Eye Health Research Centre, Gullapalli Pratibha Rao International Centre for Advancement of Rural Eye care, L V Prasad Eye Institute; Brien Holden Eye Research Centre, L V Prasad Eye Institute, Banjara Hills, Hyderabad, Telangana, India

Date of Web Publication23-Jul-2018

Correspondence Address:
Rohit C Khanna
L V Prasad Eye Institute, Kallam Anji Reddy Campus, Banjara Hills, Hyderabad, Telangana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijo.IJO_1028_18

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How to cite this article:
Khanna RC. Commentary: Should we restrict vision screening in primary school children?. Indian J Ophthalmol 2018;66:1224

How to cite this URL:
Khanna RC. Commentary: Should we restrict vision screening in primary school children?. Indian J Ophthalmol [serial online] 2018 [cited 2020 May 26];66:1224. Available from: http://www.ijo.in/text.asp?2018/66/8/1224/237302


Childhood blindness is a major global public health problem, and of the 19 million blind children, 12 million is caused by uncorrected refractive error.[1] One of the most common strategies to identify children with refractive error is the screening of children in school. Since 1994, school screening is an integral part of the National Program for Control of Blindness (NPCB). However, initially the focus was on children from 5th to 10th standard.

In this study,[2] the authors looked at the yield of screening done on children in class 3rd to 5th in 23 government schools of New Delhi. Though teachers performed the screening, to avoid excess false positives, the visual acuity cut off was increased to 6/12 (from 6/9 in NPCB) and those identified having any visual problem, underwent cycloplegic refraction. Overall, the prevalence of myopia was 2.5%, hyperopia was 0.6%, and astigmatism was 1.3%. Though the sensitivity of screening was quite high (92.3%), the specificity was moderate (72.6%). Apart from this, the compliance was 36% at 6 months. Further, there were 56 children referred for higher treatment. Hence the author's feel that, since the yield is not optimum, they recommend an annual screening to be conducted primarily in secondary school, and based on the availability of resources, conduct screening in primary school in the government setting.

However, we feel that, based on one study in primary school, the screening should not be restricted at the primary school, as this primary school is not a representative sample for the entire country's primary school population. Apart from this, there were also 56 children identified with other problems. Had the screening not been done, these children would have been deprived of care and some of them could have become permanently visually impaired. If there is a limitation of resources or personnel, we need to find a different strategy for screening this group of children or different ways to find personnel or resources.

It is well known that the prevalence of hyperopia is higher in younger children and ranges from 8.4% at the age of 6 years to 2–3% at the ages of 9–14 years and approximately 1% at age of 15 years.[3] Refractive Error Study in Children (RECS) in India also showed the prevalence of hyperopia to be 7.4% in New Delhi (15.6% at the age of 5 years to 3.9% at the age of 15 years)[4] to 0.7% in Mahabubnagar (0.7% at 7 years to 1.1% at 15 years).[5] Similarly, a study from Hyderabad showed prevalence of hyperopia to be 3.3% in urban area to 3.1% in rural area (4.6% at 7 years to 0.4% at 15 years).[6] Apart from this, the global prevalence of myopia in South Asia ranges from 5.3% at age of 5 years to 13% at age of 15 years.[7] There are also projections that this is going to increase in future. Hence, restricting the screening to a given set of children should be refrained from. Rather, a strategy to screen all children from newborn to high school should be thought of to achieve our goal for eliminating avoidable blindness in children.

  References Top

Kong L, Fry M, Al-Samarraie M, Gilbert C, Steinkuller PG. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. J AAPOS 2012;16:501-7.  Back to cited text no. 1
Shukla P, Vashist P, Singh SS, Gupta V, Gupta N, Wadhwani M, et al. Assessing the inclusion of primary school children in vision screening for refractive error program of India. Indian J Ophthalmol 2018;66:935-9.   Back to cited text no. 2
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Castagno VD, Fassa AG, Carret ML, Vilela MA, Meucci RD. Hyperopia: A meta-analysis of prevalence and a review of associated factors among school-aged children. BMC Ophthalmol 2014;14:163.  Back to cited text no. 3
Murthy GV, Gupta SK, Ellwein LB, Muñoz SR, Pokharel GP, Sanga L, et al. Refractive error in children in an urban population in New Delhi. Invest Ophthalmol Vis Sci 2002;43:623-31.  Back to cited text no. 4
Dandona R, Dandona L, Srinivas M, Sahare P, Narsaiah S, Muñoz SR, et al. Refractive error in children in a rural population in India. Invest Ophthalmol Vis Sci 2002;43:615-22.  Back to cited text no. 5
Uzma N, Kumar BS, Khaja Mohinuddin Salar BM, Zafar MA, Reddy VD. A comparative clinical survey of the prevalence of refractive errors and eye diseases in urban and rural school children. Can J Ophthalmol 2009;44:328-33.  Back to cited text no. 6
Rudnicka AR, Kapetanakis VV, Wathern AK, Logan NS, Gilmartin B, Whincup PH, et al. Global variations and time trends in the prevalence of childhood myopia, a systematic review and quantitative meta-analysis: Implications for aetiology and early prevention. Br J Ophthalmol 2016;100:882-90.  Back to cited text no. 7


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