An eleven-year-old boy often made mistakes in copying the texts from the board at his school, which led his parents and teachers to conclude that he had no interest in reading or writing. But they were wrong. Actually, the child had a vision problem which was discovered during a vision screening test at his school. Had vision screening tests been mandatory for schools in Nepal, like in Western countries, the child’s problem would have been identified much earlier, sparing him the rebuke of his parents and teachers.
Poor school performance, reduced rates of learning and unusual behavior may be a result of visual problems. In many children, vision problems may not be easily discernible. Young children with vision problems often do not know that what they see does not appear the same to people with normal vision. Since they may not even realize that they cannot see well, they are less likely to complain of symptoms related to their eyes. School vision screening programs are designed to identify vision problems in young children and to take further steps to ensure that they are addressed in time. The advantage of regular vision screening of school children is timely intervention in case of problems that are amenable to treatment.
A school is an ideal place to monitor the health of children. Since students are under the constant observation of teachers in the classroom, teachers end up playing a key role in detecting possible visual problems. Watching TV from very near, complaining of headaches or tired eyes, avoiding activities for no apparent reason, rubbing eyes frequently, constantly squinting or tilting head to see, etc. can be the clues to possible vision problems. Conducting screenings at schools is desirable because first of all, a large number of children can be tested in a short period of time with relative ease at schools. Also, school screenings are far less expensive compared to the same service performed at hospitals or private clinics.
Screening is intended to facilitate early identification and diagnosis of diseases and functional disorders. Ocular and visual defects are among the most common reasons for school children being referred to hospitals. It has proved to be very helpful in the treatment of prevalent ocular morbidities. Timely intervention and management of significant refractive error with the help of appropriate glasses, contact lenses, and medicines for eye diseases can reduce the risk of long-term visual problems and disabilities. Early intervention helps in preventing ocular conditions like amblyopia (lazy eye) that will prove to be irreversible later. Meanwhile, ocular diseases can indicate the presence of more serious ailments including life threatening conditions. Finding these conditions through visual screening, therefore, could be a lifesaver.
Visual impairment in children is more common in poorer countries due to inadequate eye care professionals available to manage treatable causes of blindness like refractive error, cataract and glaucoma. Early visual impairment due to refractive errors is one of the most common problems among school-age children, and is the second leading cause of treatable blindness. According to Vision 2020 Action Plan 2006-2010 by WHO, about 40 percent of the causes of childhood blindness are preventable or treatable. The control of such childhood blindness is a priority of Vision 2020: The Right to Sight, a joint initiative of WHO and International Agency for the Prevention of Blindness (IAPB).
Visual problems can affect the child’s physical, intellectual, social and emotional development, as it is hard for families and even professionals to provide adequate care to children with visual problems. A child’s neurological development is also highly dependent on adequate vision, with compromised vision having serious implications on a child’s overall progress and quality of life. Since it potentially limits the range of experiences and information a child is exposed to, it profoundly influences a child’s prospects of employment, social life, and other opportunities throughout his/her life.
Laws are prevalent in many countries requiring all school children to receive a vision screening test at least once a year. Nepal has no laws requiring schools to provide such screenings. The government of Nepal should also formulate laws and policies to ensure that all new students are screened after enrollment. The concerned group must set standards for the screening, train and certify school teachers and employees to conduct screenings, and identify children who may need the services of eye care specialists (Optometrists and Ophthalmologists). Implementing vision screenings will help ensure that students’ visual issues are identified earlier, thereby helping the students to succeed academically, professionally and socially.
Vision screening is but one of many health-related school activities that are necessary to provide optimal health care for students. But it needs cooperation from school personnel, students, parents, and eye care practitioners. A school vision screening program consists of testing of visual acuity, refractive error, binocular coordination and ocular health. In addition to screening programs, related eye health education appropriate to the students’ grade level and maturity should be offered. It should emphasize the relationship between correct health practices and the prevention of eye diseases and injuries. It should also educate students on prompt medical treatment of correctable and/or reversible eye health conditions and environmental factors which are conducive to the maintenance of eye health and safety.
It is important that all children understand the purpose and importance of early vision screening and regular eye exams, and their own roles in such activities. If not, a child may have to bear the burden of visual impairment for years to come. Moreover, children are the future of a country who will contribute to its development. As we prepare our child for each new school year, we should not forget one of the most important school supplies: A good vision.
The author is an optometrist at BP Eye Foundation, Children’s Hospital for Eye Ear and Rehabilitation Services (CHEERS)