|
 |
| ORIGINAL ARTICLE |
|
| Year : 1989 | Volume
: 37
| Issue : 4 | Page : 173-175 |
|
School eye health appraisal
Sanjiv Desai, Rajiv Desai, NC Desai, Shobha Lohiya, G Bhargava, K Kumar
The Tarabai Rotary Eye Hospital, E-22, Shastri Nagar, Behind Sardarpura Head Post Offiice,Jodhpur342 001, India
Correspondence Address:
N C Desai
The Tarabai Rotary Eye Hospital, E-22, Shastri Nagar, Behind Sardarpura Head Post Offiice,Jodhpur342 001
India
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 2638304 
School children form an important large target group which must be screened adequately for early detection of eye diseases and prevention of blindness. A total approach in a school eye health programme must include teacher orientation and health education of children in addition to screening for eye diseases. The ocular morbidity pattern in 5135 school children of Jodhpur is discussed in this paper and it is hoped that it will be an indicator to all eye care agencies to help plan their priorities in the delivery of school based eye care.
How to cite this article:
Desai S, Desai R, Desai N C, Lohiya S, Bhargava G, Kumar K. School eye health appraisal. Indian J Ophthalmol 1989;37:173-5 |
| Introduction | |  |
Considering the fact that 30% of India's blind lose their sight before the age of 20 years and many of them are under five when they become blind, the importance of early detection and treatment of ocular diseases and visual impairment in young children is obvious. In fact an effective blindness prevention programme must have as a key component, the screening of children. School going children therefore form an important large target group which is easy to aproach and also adaptable tothe Health Education imparted.
Our school eye health appraisal programme was implemented in 1984 with the aim of prevention of blindness by early detection and treatment of visual defects and eye health problems in School going and anganwadi children with components of health education and teacher orientation. This paper describes the salient features of our programme and the results of our pilot study to determine the ocular morbidity pattern in school going children of Jodhpur.
| Material and methods | | |
School children from 11 schools with age ranging from 4 to 16 years were screened. Each child underwent a torch light examination of the eye and adnexa. A binocular 1.4 X magnification loupe was used to aid the examination. Visual acuity was determined separately for each eye with the Snellen's chart at standard distance or with the Arrow Test for children below.8 years. A visual acuity of 6/9 was considered normal for children upto 6 years of age and in those above this age an acuity of 6/9 in any one eye was taken as a sign of visual impairment. The Maddox wing was employed to detect phorias for near. A range from 0 to 6 was taken as normal. Deviations above this were taken as significant.
Colour vision defects were tested with the Ishihara's pseudoisochromatic plates in day light at the normal reading distance. Children below 6 years age were asked to trace lines on the plates rather than identify numerals due to obvious disadvantage in comprehension. All children with visual impairment eye disease were referred to our base institution for treatment and follow-up.
Teacher orientation to the importance of eye care and their role in simple eye care delivey was accomplished, during the entire span of the school eye clinic by demonstrating the signs and symptoms of common conditions like Trachoma, Xerophthalmia, and refractive errors in the school children. Vision testing with Snellen's chart was also taught to them as also the concept of prevention of eye injuries and first aid emergency care for eye injuries. Health Education of teachers and children dealt with prevention of common eye diseases, classroom illumination and role of nutrition in maintenance of life long good vision. Health education modalities include slide shows, health talks [Figure 1] and a modest eye care exhibition.
| Result | | |
A total of 5135 children [Table - 1] were studied out of which 3643 (71%) were male and 1492 (29%) female. [Table - 2] shows the visual acuity status of the screened children. Visual impairment as defined by criteria given earlier was present in 1073 (20.8%) children. [Table - 3] depicts the age wise distribution of muscle imbalance in the screened children. Esophoria of 5 and greater was found in 20 children (0.38%)and Exophoria of 6 and more in 270 children (5.2%). [Table - 4] shows the distribution of the two common eye diseases in children i.e. Trachoma and Xerophthalmia [Table - 5] discusses other eye diseases/defects present in the studied population of school children.
| Discussion | | |
If diminished visual acuity due to refractive error can be detected early in life then a great deal can be done to prevent the social and intellectual underdevelopment of the child and present the eye from becoming amblyopic. In our study the prevalence of defective vision was 20.8%. It was more among the males and the highest in the 4 to 6 years age group (25.6%). Agarwal [2]sub found refractive errors in 17.83% children whereas Pa1 [3] detected it in 12.70% in 1961-62. Since refraction was done at the base hospital after referral and not at the school, breakdown into the various types of refractive errors is beyond the scope of this presentation.
Trachoma was prevalent in 1467 (28%) of the screened children. The sex distribution was nearly equal and the highest prevalence occured in the age group of 4 to 6 years (38.3%), in families with income less than Rs.500/- per month (31.8%) and in Muslims (35.9%) Mathur [4] found trachoma in 44.2%, Mehta [5] in 41.03% and Desai et al [6] reporting from Jodhpur, in 68.77%. The present figures are lower than those of 9 years ago [5] This is probably due to improvement in ocular hygiene, better education and better availability of health services.
Vitamin A deficiency was found in.278 children (5.39%). The highest prevalence occured in the age group of 4 to 6 years and in families with income less than Rs.500/= per month (10.2%) and in Muslims (8.7%). Ghosh [7] quotes a prevalance of 8.7% and Trivedi [8]sub 8.4%, Night blindness was found in 280 (4.4%) children. Looking to the fact that conjunctival xerosis with bitot spots (XIB) and night blineness (XN) showed the highest prevalence in the population screened, we suggest that XIB and XN should be made mandatory screening criteria for Vitamin A deficiency in all school general health check-ups, in addition to the routine distance acuity screening..
In the present study conjunctivitis was deteted in 5.0%, blepharitis in 1.6%, Chalazion in 0.25%, stye in 0,21%, Congenital disorders in 0.29%, Corneal opacity in 0.03%, Ptosis in 0.09%, squint in 0.21% and miscellaneous eye disorders in 0.75% of school children.
Colour vision defects were found in 148 (2.88%). Lamba et a1 [9] reported a prevalance rate of 2.5%. Good colour vision is a prerequisite for many vocations notably the Armed forces, Railways, Roadlines etc. Identification of colour vision defects in school children with concurrent vocational counselling can save the child the frustration later on and help him to choose a suitable vocation.
Keeping in mind that an ounce of prevention is worth a pound of cure it should be the aim of all blindness control programmes to propagate awareness in the masses of the importance of eye care and to teach the essentials of ocular hygiene and eye health care. An ungainly aspect in the natural history of blinding diseases is that people generally tend to ignore their symptoms until it is too late. In the case of school children it is therefore important that the teachers are able to recognise changes in behaviour or appearance of a child rubbing of eyes frequently blinking excessively and holding books close to the face, might suggest underlying eye disease, and refer the child to the nearest ophthalmologist. Teacher orientation programmes in. our school eye clinics are held especially to equip teachers with these skills. In itself teacher orientation is no easy task but it is perhaps the most important. Our efforts are concentrated on teaching them about the cause, prevention and cure of refractive errors, xerophthalmia and trachoma, good classroom illumination and visual acuity screening by Snellen's charts. School kits to be used by teachers for vision screening of school children are also prepared and distributed by us.
| Summary | | |
School children form an important large target group which must be screened adequately for early detection of eye diseases and prevention of blindness. A total approach in a school eye health programme must include teacher orientation and health education of children in addition to screening for eye diseases. The ocular morbidity pattern in 5135 school children of Jodhpur is discussed in this paper and it is hoped that it will be an indicator to all eye care agencies to help plan their priorities in the delivery of school based eye care.
| Acknowledgement | | |
The authors wish to thank the following for their unflinching encouragement and support in their school eye health appraisal programme: UNICEF, Department of Social Welfare, Dr.L.S. Sisodia (C.M.& H.O.), Dr. R.N. Singh (Paediatrics), Dr, P.N. Sharma (P.S.M.), Dr. Raghuveer Singh (P.S.M.), Mr. Saxena (Inspector of Schools).
| References | | |
| 1. | Park J.E., Park K.; Test Book of Prevention and Social Medicine, Bhanot, 9th ed. page 415, 1983.  |
| 2. | Agarwal. L.P.;Orient. Arch. Ophth:4,1,1956. |
| 3. | Pal N.K.: Ind.J.Pub. Health :3,1966. |
| 4. | Mathur G.M., Sharma. R.;Ind. J. of Med. Res. :58, 1085,1970. |
| 5. | Mehta A.J.; Study of ocular morbidity in rural areas in Jamnagar, Disertation, Oct., 1983. |
| 6. | Desai N.C., Chauhan B.S., Qureshi M.S. and Sharma S.P. Ind. J. Ophthal.: 25, 1, II, 1977. |
| 7. | Ghosh B.N., Datta S.P.; Orient Arch of Ophthal.: 7,16, 1969. |
| 8. | Trivedi G.K., Falor A., Haricharan; Proc. Rai. Ophthal. Soc: Vol. VIII, 1983. |
| 9. | Lamba P.A.. Rao V.A., Pangarkae, A.V.; 21: Afro-Asian J. Ophthal.:ll June/21. |
[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]
| This article has been cited by | | 1 |
Effectiveness of using teachers to screen eyes of school-going children in Satna district of Madhya Pradesh, India |
|
| Sudhan, A., Pandey, A., Pandey, S., Srivastava, P., Pandey, K.P., Jain, B. | | Indian Journal of Ophthalmology. 2009; 57(6): 455-458 | | [Pubmed] | | | 2 |
Ocular morbidity prevalence among school children in Shimla, Himachal, North India |
|
| Gupta, M., Gupta, B.P., Chauhan, A., Bhardwaj, A. | | Indian Journal of Ophthalmology. 2009; 57(2): 133-138 | | [Pubmed] | | | 3 |
Ocular morbidity amongst primary school children in Delhi |
|
| Kumar, R., Dabas, P., Mehra, M., Ingle, G.K., Saha, R., Kamlesh | | Health and Population: Perspectives and Issues. 2007; 30(3): 222-229 | | [Pubmed] | | | 4 |
Present status of eye care in India |
|
| Thomas, R., Paul, P., Rao, G.N., Muliyil, J.P., Mathai, A. | | Survey of Ophthalmology. 2005; 50(1): 85-101 | | [Pubmed] | | | 5 |
A study of ocular infections amongst primary school children in Delhi |
|
| Kumar, R., Mehra, M., Dabas, P., Kamlesh, Raha, R. | | Journal of Communicable Diseases. 2004; 36(2): 121-126 | | [Pubmed] | | | 6 |
Pattern and distribution of ocular morbidity in primary school children of Rural Delhi |
|
| Chaturvedi, S., Aggarwal, O.P. | | Asia-Pacific Journal of Public Health. 1999; 11(1): 30-33 | | [Pubmed] | |
|
 |
|
|
|
Search Pubmed for