Distribution of Astigmatism among School Children Who Fail Vision Screening in South India.

PURPOSE: The purpose of this study is to report the distribution of astigmatism among school children in South India. METHODS: The study was conducted as part of a national school eye screening project named 'Refractive Error Among Children' (REACH) between 6 and 17 years of age. Children underwent presenting visual acuity screening, external eye examination, screening for color vision deficiency, and non-strabismic binocular vision anomalies. Those who failed screening underwent, objective and subjective refraction, and identification of other ocular conditions. Astigmatism was defined as cylindrical power greater than 0.50D. Refractive errors were classified into myopia (≤0.50D), hyperopia (≥0.75D), and other refractive errors (between -0.50D and +0.75D). The data on astigmatism were analyzed and were deduced into its vector components (M, J0 and J45). Descriptive statistics and regression analysis were performed. RESULTS: Data of 245,565 children from 1047 schools were taken for analysis. The average age was 11.63 ± 3.32 (range:6-17) years. After screening, refractive errors and astigmatism was found to be 6.57% (n = 16157) and 3.69% (n = 9064), respectively. Astigmatism among children aged 6 to 10 years was 1.37%. The mean cylindrical power, J0, and J45 was found to be 1.93 ± 1.06D, 0.06 ± 0.59D, and 0.43 ± 0.81D, respectively. Linear regression showed a decreasing trend in the cylindrical component (p < .001) and shift towards less positive J0 values (p < .001). Higher proportions of astigmatism more than 1.50 D (1.83%,n = 4578) and unilateral astigmatism (1.20%,n = 2952) are evident among refractive errors. CONCLUSION: More than 50% of children who failed vision screening with refractive errors presented with astigmatism. Prevalence was higher among primary school children. Presence of higher magnitude and unilateral astigmatism is amblyogenic and needs early intervention.

Cost Analysis of a Comprehensive School Eye Screening Model from India.

PURPOSE: School eye screening is a crucial strategy in the elimination of childhood blindness because of its ability to reach out to children who are otherwise inaccessible to eye care needs. Comprehensive screening programs are recommended and are beneficial, but the economic aspects of such models remain to be understood. This study aimed to analyse the cost of a comprehensive school eye screening model while utilizing optometrists and optometry students. METHODS: This cross-sectional study was conducted for 295 schools screened in the academic year 2018-2019. The analysis was performed from the service provider's perspective including only the direct costs. Financial records were used for cost estimates. The outcome measures were cost per school and child, predictors for the cost, DALYs averted, cost of childhood blindness, and Benefit-Cost Ratio. RESULTS: A total of 65 094 children underwent screening from 295 schools. The median (IQR) cost per school and child for screening was $29.65 (29.65-44.34) and $0.66 (0.32-1.13). The regression model predicted that the cost of screening was dependent on school strength, number of screening personnel, distance of the schools, and deliverables. With the interventions to improve compliance, 14686.30 DALYs have been averted. Loss of productivity due to childhood blindness was estimated to be $339070.83. Screening for colour vision also had a Benefit-Cost ratio of greater than one. CONCLUSION: Cost of screening was low and the benefits were high while utilising optometrist and optometry students along with a comprehensive screening protocol.

Profile of ocular conditions from school eye screening in Southern India.

Purpose: To profile the presentation of ocular conditions among school children aged 6 to 17 years from the south Indian state of Tamil Nadu. Methods: The study was conducted as part of a school eye health program in Kanchipuram district, Tamil Nadu that aimed to address the refractive needs of children (6-17 years) between July 2016 and June 2019. The study followed a three-phase protocol, which included visual acuity test, modified clinical test, color vision test, binocular vision assessment, objective and subjective refraction, dispensing spectacles, posterior segment evaluation using direct ophthalmoscopy, and referral to the base hospital. The demographics, clinical details, and ocular conditions (classified under 16 categories) were analyzed. Profiling and association of ocular conditions among different locations, types of schools, class grades, and gender were presented. Results: Data of 2,45,565 children were analyzed from 1,047 schools, of which 4,816 (1.96%) children were identified with ocular conditions other than refractive errors. The common reasons for referral were high myopia 901 (0.37%), strabismus 819 (0.33%), and amblyopia 691 (0.28%). Retinal problems (odds ratio [OR]: 1.65, 95% confidence interval [CI]: 1.22-2.22, P = 0.001) and strabismus (OR: 1.41, 95% CI: 1.21-1.65, P < 0.001) were the conditions prevalent in the rural location. Cataract and related conditions (OR: 5.73, 95% CI: 4.10-8.01, P < 0.001) and retinal problems (OR: 4.76, 95% CI: 3.37-6.72, P < 0.001) were common in children studying in public schools. Of the 16 categories, 13 conditions were seen among primary school children. Vernal keratoconjunctivitis (OR: 3.64 95% CI: 2.12-6.23 P < 0.001) was common among males. Conclusion: The study profiled ocular conditions among school children. Most ocular conditions warrant prolonged care and specialty eye care services. Ensuring the availability of such services and follow-up after school eye screening would safeguard the visual development of these children.