Commentary

Pediatric eye screening - Reaching the unreached

Childhood blindness is second only to adult cataract in terms of the number of blind person years or lived and the consequent overall economic impact on the society.[¹] About half of the causes of blindness, and visual impairment are potentially preventable or treatable.[¹] The old adage of “an ounce of prevention is worth a pound of cure” rings true, especially with children's eye health. Therefore early detection, diagnosis and management of various types of eye problems in children from birth are essential with continuation of timely and periodic screening.

Vision screening is important to achieve full academic potential of children. Preschool and school vision screening is part of government health programs in many countries but referral criteria may somewhat vary.[²³] While some countries and organizations have mandated screening at birth and thereafter periodically at every pre-scheduled point of contact with the pediatrician,[³⁴⁵⁶] recent recommendations by the United States Preventive Services Task Force (USPSTF) limit screening of children aged 3–5 years to detect amblyopia or its risk factors.[⁷] The USPSTF advises that the current evidence is insufficient to recommend vision screening in children <3 years of age.[⁷] With changing trend in lifestyle and increase in incidence of refractive errors, it might be logical to screen preschool children, both rural (anganwadis), and urban schools (play schools).[⁸]

Neonatal screening - is it a must? Primary care providers (pediatricians) should perform a basic eye screening of newborns.[⁹¹⁰] Risk-based screening for retinopathy of prematurity, congenital anomalies, and retinoblastoma in the immediate post-natal period should be conducted by an ophthalmologist.[⁹¹⁰]

The various people in Indian scenario who can be sensitized to detect eye problems are the ones who come in contact with children. They are obstetricians, pediatricians, preschool teachers (private play schools, anganwadis), school teachers, ASHA (Accredited Social Health Activist) workers, para medical ophthalmic assistants (PMOAs), refractionists. The authors in one of their school screening projects have tried training ASHAs (involved in women and child welfare) in vision testing and detecting common eye problems in children in their villages, in two of the larger districts of southern India (Karnataka). The authors, although feel that school teachers are a better point of contact, the ASHAs may be an additional source of motivation of village women in getting their children screened for eye problems. This screening should be undertaken by government and private hospitals, non-governmental organizations and other health care providers at regular intervals along with delivering frequent awareness programs about the importance of eye health in children; thereby a holistic approach is achieved towards the endeavor “eye health for all children”.

To conclude, government health programs for vision screening are essential for all children regardless of socioeconomic status and rural or urban schools.[⁸]

Vision screening can be incorporated in our Universal Immunization Program and annual school health check up for early detection and intervention of eye problems. Although there are no formal national guidelines in India for eye screening in children, they continue to evolve as regards to timing and methodology of screening.[⁵]

We could adopt current guidelines, which are based on the available evidence and preferred practice recommendations of expert committees[⁹¹⁰] and modify to suit our Indian scenario and requirements. However, due to diverse culture in India, it can be difficult to implement standard universal guidelines throughout the country and to ensure 100% coverage and follow up. Smartphone assisted screening programs which are a simple and effective way to help achieve total coverage can be adopted and implemented.