Home About us Editorial board Ahead of print Current issue Search Archives Submit article Instructions Subscribe Contacts Login 
  • Users Online: 45171
  • Home
  • Print this page
  • Email this page

   Table of Contents      
COMMENTARY
Year : 2020  |  Volume : 68  |  Issue : 10  |  Page : 2185

Commentary: Identifying barriers to referrals in preschool-age ocular screening in Southern India


Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Date of Web Publication23-Sep-2020

Correspondence Address:
Arvind K Morya
Department of Ophthalmology, All India Institute of Medical Sciences, Jodhpur, Rajasthan
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_436_20

Rights and Permissions

How to cite this article:
Morya AK, Sahu S, Shiromani S, Parashar N. Commentary: Identifying barriers to referrals in preschool-age ocular screening in Southern India. Indian J Ophthalmol 2020;68:2185

How to cite this URL:
Morya AK, Sahu S, Shiromani S, Parashar N. Commentary: Identifying barriers to referrals in preschool-age ocular screening in Southern India. Indian J Ophthalmol [serial online] 2020 [cited 2020 Oct 31];68:2185. Available from: https://www.ijo.in/text.asp?2020/68/10/2185/295741



Good visual acuity is very important for every child's developmental, emotional, and educational well-being. According to WHO estimation in all around the world, 6%–10% of children aged less than 5 years have significant refractive errors and 2%–5% have amblyopia. Amblyopia or lazy eye is defined as a decrease in visual acuity not attributed to any structural abnormality of the eye or visual pathway; it is the leading cause of visual impairment in children. Identifiable and treatable risk factors for amblyopia include squint, anisometropia, isometropia, refractive media opacities, and uncorrected refractive errors. Childhood glaucomas are also an important ocular pathology to look for having worldwide prevalence of 1%–3%.[1],[2]

Challenges in children's eye care screening clinics are as follows:

  1. Sometimes a child is unable to explain what they feel and how things look like
  2. Presence of parents also causes a problem as they may be apprehensive or reluctant
  3. Children can also become bored or hungry or upset straight away, then you cannot examine them easily
  4. Most professionals agree that seeing children may require multiple visits
  5. Some professionals also found the use of the eye drops problematic
  6. Lack of good communication.[1],[2],[3],[4]


Poor compliance with follow-up after visual acuity screening is a known hurdle in child eye care. Follow-up rates are as low as 30% as per reported by multiple studies of preschool children who failed visual acuity screenings. Yawn et al. observed that after a failed preschool visual acuity screening, visits to an ophthalmologist were delayed on an average of 0.8 year and up to 1.8 years for those seen by a pediatric optometrist.[3]

Common barriers to obtain preschool child eye care are as follows:

  1. Technical difficulty in planning and attending appointments with ophthalmologists
  2. Financial burden of costly eye care as most heads of treatment are not covered by health insurance and most of the parents in Second World and Third World countries do not have any insurance at all
  3. Negligence on parent's part to understand the importance of child eye care
  4. Lower socioeconomic background and ignorance regarding child eye care
  5. Prevalence of stigma in certain cultures that the children would become dependent on the glasses for lifelong and their eyes might get worse or they will be physical handicap.[1],[2],[3],[4]


How to overcome these barriers:

  1. Development of good communication skill to gain trust of parents and children for their better vision care.
  2. Make parents an integral part in providing eye care to kids, such as in regular glass wearing, patching, and putting drops.
  3. Always prefer lay terms and avoid heavy scientific definitions. Try to be little informal and funny for a healthy bond with the kids and their wards.
  4. Children are born curious so keep them interested for a consistency in the mode of treatment.
  5. Examination room should be children friendly. Glasses could be of Disney or colorful frame so that they can be worn regularly and with love.
  6. Involvement of NGOs for the financial support for the disbursement of child eye care.[1],[2],[3],[4]


Ravindran et al. have elaborated on the barriers to referrals in preschool-age ocular screening in Southern India.[5] A multidisciplinary approach and proper coordination between eye health-care providers, children, their parents, health insurers, and NGOs is the only way forward in keeping the impact of different barriers to a minimum level for achievement of better child eye care.



 
  References Top

1.
US Preventive Services Task Force. Screening for visual impairment in children younger than age 5 years: Recommendation statement. Ann Fam Med 2004;2:263-6.  Back to cited text no. 1
    
2.
Kemper AR, Uren RL, Clark SJ. Barriers to follow-up eye care after preschool vision screening in the primary care setting: Findings from a pilot study. J AAPOS 2006;10:476-8.  Back to cited text no. 2
    
3.
Yawn BP, Kurland M, Butterfield L, Johnson B. Barriers to seeking care following school vision screening in Rochester, Minnesota. J Sch Health 1998;68:319-24.  Back to cited text no. 3
    
4.
Su Z, Marvin EK, Wang BQ, van Zyl T, Elia MD, Garza EN, et al. Identifying barriers to follow-up eye care for children after failed vision screening in a primary care setting. J AAPOS 2013;17:385-90.  Back to cited text no. 4
    
5.
Ravindran M, Pawar N, Renagappa R, Ravilla T, Khadse R. Identifying barriers to referrals in preschool-age ocular screening in Southern India. Indian J Ophthalmol 2020;68:2179-84  Back to cited text no. 5
    




 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
References

 Article Access Statistics
    Viewed126    
    Printed1    
    Emailed0    
    PDF Downloaded35    
    Comments [Add]    

Recommend this journal