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 Table of Contents    
Year : 2015  |  Volume : 8  |  Issue : 1  |  Page : 28-32  

Role of optometry school in single day large scale school vision testing

1 Elite School of Optometry, Chennai, Tamil Nadu, India
2 Elite School of Optometry, Sastra University 8, GST Road, St. Thomas Mount, Chennai, Tamil Nadu, India

Date of Web Publication23-Jan-2015

Correspondence Address:
Krishnakumar Ramani
8, GST Road, St. Thomas Mount, Chennai, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0974-620X.149861

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Background: School vision testing aims at identification and management of refractive errors. Large-scale school vision testing using conventional methods is time-consuming and demands a lot of chair time from the eye care professionals. A new strategy involving a school of optometry in single day large scale school vision testing is discussed.
Aim: The aim was to describe a new approach of performing vision testing of school children on a large scale in a single day.
Materials and Methods: A single day vision testing strategy was implemented wherein 123 members (20 teams comprising optometry students and headed by optometrists) conducted vision testing for children in 51 schools. School vision testing included basic vision screening, refraction, frame measurements, frame choice and referrals for other ocular problems.
Results: A total of 12448 children were screened, among whom 420 (3.37%) were identified to have refractive errors. 28 (1.26%) children belonged to the primary, 163 to middle (9.80%), 129 (4.67%) to secondary and 100 (1.73%) to the higher secondary levels of education respectively. 265 (2.12%) children were referred for further evaluation.
Conclusion: Single day large scale school vision testing can be adopted by schools of optometry to reach a higher number of children within a short span.

Keywords: Large scale, school children, single day, vision testing

How to cite this article:
Anuradha N, Ramani K. Role of optometry school in single day large scale school vision testing. Oman J Ophthalmol 2015;8:28-32

How to cite this URL:
Anuradha N, Ramani K. Role of optometry school in single day large scale school vision testing. Oman J Ophthalmol [serial online] 2015 [cited 2023 Mar 25];8:28-32. Available from: https://www.ojoonline.org/text.asp?2015/8/1/28/149861

   Introduction Top

Refractive errors are the main causative factor for visual impairment among children. [1],[2],[3],[4] This issue is tackled extensively by vision screening camps for school children aiming at identification of refractive errors and dispensing free spectacles. [5] According to the 2011 census, 363, 610, 812 children in India belong to the age group of 0-14 years. [6] With a huge number of children remaining to be screened, various methods have been discussed in the literature [7] such as training of teachers, volunteers and health workers.

Elite school of optometry (ESO) is an educational institution in India that runs a 4-year Bachelor's degree program in Optometry apart from offering post-graduate and doctorate programs. ESO is involved in school eye screening programs under the National Program for Control of Blindness. As part of its initiative to screen maximum number of school going children, ESO involved its optometry students in an attempt to perform school vision testing on a large scale. This paper presents the methodology adopted by ESO.

   Materials and Methods Top

Single day vision testing is a means to screen school children in large numbers and identify those with vision impairment. Taking into account, shortage of manpower, infra-structure and time, such single day large-scale screening aims at optimal utilization of resources.

Elite school of optometry was assigned two zones (7 - Central Chennai and 10 - South Chennai) of Chennai to do vision testing by the Chennai Corporation. Totally 51 schools in both zones, including primary (I-V), middle (VI-VIII), high (IX-X) and higher secondary (XI-XII) according to the levels of education were covered on a single day using this method.

For effective planning, the stages of single day vision testing were divided into pre vision testing, vision testing and post vision testing.

In the prevision testing stage , the preparatory work before the vision testing was done. It included identification of the target population, permission from authorities, collecting information about students' strength from each school, providing information about the school vision testing to the school in-charge, formation of teams for different schools, training of the members of the teams, identifying one in-charge for instrument maintenance, and assigning teams to schools for vision testing.

Permission was obtained from the Education and Health Departments of the Tamil Nadu Government for screening on a single day. All the school authorities were informed through the Zonal Assistant Educational Officer and Zonal Assistant Health Officers about the single day vision testing on October 8, 2010 between 8.30 am and 4.30 pm. Our social worker visited the respective heads of each school, submitted the government order and informed them about the vision testing.

An overall coordinator and two zonal coordinators ensured smooth running of the screening. Twenty teams were formed based on the data from schools. Each team had a team leader (Optometrist), team members (Optometry students), a volunteer coordinator and social worker. The team leader reported to the zone coordinators or overall coordinator for any modification in the execution of the screening. Social workers took care of the mobilization of the team members to their allocated schools.

All the members underwent training on performing the procedures in a standardized format and documenting the data. Student members practiced the basic vision screening among them. Mock sessions of basic vision screening were executed for the optometry students. Training was also given for documentation of the results in a standardized manner.

Each team member including the team leader carried a phase I kit (ESO Pocket Vision screener, +2.00 DS lens, Torchlight, Note Book, Pen and 3 meter thread) and every team had one Phase II kit (Refraction unit, Model frames, and PD ruler). The instrument in-charge person of each team scrutinized all the instruments according to the checklist 2 days in advance and kept things ready in working condition.

In addition to the above, the following aspects were taken care of:

  • Copies of the permission letter from authorities, contact number of team members, social workers, volunteers, zonal and overall coordinator were circulated
  • Information about the location of the schools, nearest landmarks and route map were provided to the teams to avoid wasting time in locating the schools. All the team leaders confirmed their allocated school's locations with the social workers 1 day in advance
  • Team leaders were asked to contact the social workers or the zone coordinators for extra hands required for completion of their allocated schools. Teams that completed their allocated vision testing helped teams that were lagging if they were located closer
  • The order in which the schools were to be screened were determined in advance as primary schools worked only during the forenoon
  • Every team had a vehicle of their own and as a school was completed the team moved to the next. The team even split themselves according to the strength of the school and completed the phases
  • Each school had a different population-strength and, therefore, the number of children screened by each team was not equal.

The second stage was vision testing, and it was conducted using a three phased the protocol [Figure 1].
Figure 1: Schematic representation of the three phases of the single day vision testing

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Phase I constituted basic vision screening: History taking, distance visual acuity assessed using ESO Pocket vision screener (The ESO Pocket Vision screener is a distance visual acuity screening chart that contains letters of 0.2 logMAR acuity size arranged in 3 lines with 7 letters per line. It has a sensitivity of 81%, specificity of 94%, and it's positive and negative predictive values are 91% and 87% respectively [Figure 2]), +2.00 DS lens test, external eye examination, and pupillary reaction by torch light. This was done for all the children in their respective classrooms. Children who failed any of the components of this phase were sent to phase II after informing their teachers.
Figure 2: Image of Elite School of Optometry pocket vision screener with the middle five letters highlighted

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Phase II included the refraction, inter pupillary distance measurement, extra ocular motility and cover test. For children who were found to have refractive error, glass prescriptions were generated. School children were given the option of selecting their own frames to increase the compliance of glass wear. This phase was performed in a pre-determined location in the school. Average time taken for phase I screening was approximately 2 min/child. Average time taken for phase II screening was 10 ± 5 min. Time taken for screening was minimized because of the involvement of a bigger team.

Children whose vision did not improve with glasses and those with binocular vision problems were referred to the third phase. Abnormal findings (like cataract, squint etc.) using torch light examination were noted, and those children were referred to the base hospital for further management.

At the end of the stage, all the data were documented in the respective team member's notebooks. The team leader had to ensure completion of work in each school. At the end of the day, the team leader submitted data regarding the total number screened in each school, number of glass prescriptions generated and number of referrals for other reasons. The overall coordinator consolidated all the data on the same day.

In the post vision testing stage, all the team members documented the name of the school and the area it belonged to along with their names in their notebooks. Data were crosschecked with individual members and the team leaders the subsequent day. Collected information was entered in a Microsoft Excel data sheet, which was again rechecked by another person.

   Results Top

The project covered 17 primary schools, 21 middle schools, 5 high schools and 8 higher secondary schools in Zone 7 and 10 of Chennai. In the two zones, a total of 12,448 children (age group-5-19 years mean ± standard deviation: 13.7 ± 2.2 years) were screened. Of these, 2216 students belonged to primary school, 1662 students to middle school, 2760 students to high school and 5780 students to the higher secondary level of education.

On the day of a large-scale vision testing, 420 (3.37%) students, 260 female and 160 male were found to have refractive error. 28 (1.26%) students belonged to the primary class, 163 to middle (9.80%), 129 (4.67%) to high and 100 (1.73%) belonged to the higher secondary classes respectively. The detailed distribution of refractive errors is listed in [Table 1]. These students were either not using their previously prescribed glasses or were identified to have refractive errors for the first time. 72 children were found to be using glasses already. 281 (2.26%) children were referred for other ocular problems listed in [Table 2].
Table 1: Distribution of the refractive errors

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Table 2: Reasons for phase III referrals

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There were 11 special children who were referred for detailed evaluation. Two children were found to have unilateral blindness. Twenty-four children who showed signs of conjunctivitis were referred for the ocular management.

   Discussion Top

To the best of our knowledge, this was the first time such a large scale single day vision testing was done anywhere in India. This approach was able to identify 3.37% with refractive errors and 2.26% of children with other ocular ailments.

One hundred and fifty million people, including 13 million children, are blind or visually impaired simply due to the lack of an eye examination and appropriate pair of glasses (uncorrected refractive error). [8] Such huge numbers indicate the necessity of strategies to screen children in large numbers. Our new approach targeted this population and benefited 12448 students.

There were benefits observed through this new approach to the children, school and eye care professionals. Basic vision screening was done in the respective classrooms not disturbing the children/school in their routine work. Co-operation from the school authorities was better because it involved only 1 day. Schools with less strength would not have been screened in conventional screening as the costs involved in transportation, food and time of a person would outweigh the benefit provided to less number of children. Schools that were located in remote areas and with lesser strength were included in a single day large scale vision testing.

Screening many schools in a short span of time was possible with single day strategy that would otherwise take months to complete using the conventional approach. Screening 51 schools with 12,448 children might have taken at least 2 months, if it had been done on a daily basis. In the conventional method, if a trained person assessed 100 children per day, the number of persons required testing 12,448 would be 124. These 12,448 children are in 51 different schools with a small number of students in each school in various locations. A single volunteer who would have to travel to each school would take more time to finish the screening. With almost the same number of team members, 12,448 children were seen with a single day approach.

In the case of teachers being involved in screening, there is a non-availability of eye care professionals to clarify issues regarding the procedure/referrals. Practicing optometrists, who led the teams, were available on the same day of screening to provide guidance to the optometry students and thereby enhance the quality of screening in the new strategy. In addition, optometry students also gained the benefits of teamwork, management and understanding various approaches to referral.

The chances of missing children requiring further evaluation by eye care professionals are common in regular vision screening. However, in this approach, the professionals involved in the second phase immediately attended to those who failed in the first phase. Therefore, there was no discontinuity in the services being offered, and the chances of missing out people for further testing were minimized. Thus, single day screening helped in effective utilization of manpower and reduced wastage of time.

If the screening were done at the start of the academic year, the provision of glasses and tertiary eye care facilities could be planned well, and these children could also be followed up during the same academic year. This would help in tracking the students easily.

Expenses involved in testing 12,448 children through the single day vision-testing approach were INR 63,000. The conventional method would have cost approximately INR 110,300. Therefore, the single day approach was cost-effective.

Cost calculated for expenses include only recurrent costs. The cost of instrumentation was not considered in both the approaches. ESO utilized instruments that are regularly used by the institution for screening and teaching. Since the school is attached to Sankara Nethralaya, a tertiary eye care hospital, additional instruments needed for a single day approach were sourced from the hospital .

In a single day approach, children who are absent from school, lose the opportunity of availing the primary eye care service. This could be overcome by proper documentation of absentees so that they can be provided with an eye care service at a later date. The screening also needs to be planned in such a way that it does not fall on festivals, rainy days or during school exams.

   Conclusion Top

Maximizing the utilization of available resources with adequate planning have demonstrated the possibility of ensuring vision testing for 12,448 school children on a single day. The authors recommend the model to be adopted by schools of optometry in their school vision testing initiative. A consolidated effort of the schools of optometry in India will be a great contribution towards eradicating needless blindness in this country.

Optometry colleges with a 4 year-program are approximately 100 in number in India. Assuming 80 students in each college, 8,000 members can screen eight lakh children in a day. This will help to complete the screening of 400 million children within 2 years with proper planning and implementation. Vision screening on such a massive scale can reduce the burden of the prevailing refractive errors if optometrists are involved in this cause in large numbers. With so many optometry colleges coming up in the country, such initiatives can be well planned and replicated in different parts of the country.

   References Top

Kalikivayi V, Naduvilath TJ, Bansal AK, Dandona L. Visual impairment in school children in southern India. Indian J Ophthalmol 1997;45:129-34.  Back to cited text no. 1
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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. 2
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. 3
Chaturvedi S, Aggarwal OP. Pattern and distribution of ocular morbidity in primary school children of rural Delhi. Asia Pac J Public Health 1999;11:30-3.  Back to cited text no. 4
Jose R, Sachdeva S. School eye screening and the National program for control of blindness. Indian Pediatr 2009;46:205-8.  Back to cited text no. 5
Available from: http://www.censusindia.gov.in/census_And_You/age_structure_and_marital_status.aspx. [Last accessed on 2013 Apr 09].  Back to cited text no. 6
Sudhan A, Pandey A, Pandey S, Srivastava P, Pandey KP, Jain BK. Effectiveness of using teachers to screen eyes of school-going children in Satna district of Madhya Pradesh, India. Indian J Ophthalmol 2009;57:455-8.  Back to cited text no. 7
[PUBMED]  Medknow Journal  
Available from: http://www.who.int/mediacentre/news/releases/2006/pr55/en/. [Last accessed on 2014 May 27].  Back to cited text no. 8


  [Figure 1], [Figure 2]

  [Table 1], [Table 2]

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