Children May Benefit From School-Based Eye Care Initiatives

A health program in India, Refractive Errors Among Children (REACH), has provided visual acuity (VA) screening for a high proportion of school-aged children and referred them for additional care when needed, according to findings published in Clinical and Experimental Optometry.

The REACH program involves training 1 teacher from each participating school during a 1-day session on how to assess VA among children. Children who have identifiable refractive errors are referred to a health center evaluated by an ophthalmic assistant who facilitates appropriate management and additional referrals. After providing the appropriate referrals, REACH monitors spectacle wear compliance and provides informational resources. The program has been implemented in partnership with 6 hospitals in 5 states in India.

A total of 2,024,053 children from 10,309 schools underwent primary screening.

Among these participants, 8.63% were referred for detailed evaluation due to self-reported blurred vision (32.3%), current spectacle wear (26.9%), inability to read 0.2 logarithm of the minimum angle of resolution (logMAR) letters unaided (28.5%) or using a +1.50 diopter (D) lens (0.7%), other ocular symptoms (17.5%), and headache (7.0%).

A total of 78.5% of children who were referred attended a detailed evaluation. These secondary evaluations resulted in a prescription for new spectacles (42.0%), continued use of current spectacles (15.9%), and referral to a partner hospital (20.1%). The false-positive rate of the preliminary teacher-led screening was 22%.

Children who were referred for detailed evaluation were more likely to attend private schools and schools in urban locations compared with government-funded or rural schools (both P <.001), and the proportion of children referred for evaluation differed significantly by state, according to the report.

“The REACH model for child eye health delivery aims to address challenges in the existing model of vision screening and eye health in school children, to provide evidence for future interventions, and to build and test an innovative program model,” according to the study authors. “Ongoing development will ensure that this program is sustainable and scalable.”

A major limitation of the REACH program is that it is resource intensive and likely will require additional external funding.