Orbis brings school-based eye health intervention to children in India

The Refractive Error Among Children programme has been instrumental in improving the lives of over five million children across India, according to Orbis International. (Image credit ©StockImageFactory / stock.adobe.com)

A pair of glasses can provide so much more than clarity of vision. It can dramatically change someone’s life, especially for children. Visual impairment often leads to poor academic performance, missed opportunities, and social exclusion. Refractive error is one of the most common causes of visual impairment among children aged 5 to 15 years. It is responsible for up to 77% of blindness and severe visual impairment globally.¹

India has nearly 680,000 blind children, the highest of any country in the world. About one-third of these children have uncorrected refractive error (URE).² The good news is that the financial, economic and social burden of refractive error can be prevented and mitigated with regular eye check-ups and timely interventions.

Dr Rishi Raj Borah

School-based eye health interventions have the potential to provide high-quality and cost-effective services to a vast cohort of school-aged children. They allow for early detection, prevention and appropriate management of visual impairment.

Orbis International, a global nonprofit fighting avoidable vision loss, is working with its partners to combat this issue for school children in India.

The Refractive Error Among Children (REACH) programme aims to reduce visual impairment due to URE among school-going children³ and has been instrumental in improving the lives of over five million children across the country.

REACH operates with three objectives:

• to eliminate barriers to eye health for school children;
• to improve the quality of school eye health services; and
• to create a positive, sustainable environment at schools where eye health services are provided, ensuring children feel comfortable to access these services.

Orbis, along with its partners, deploys teams of eye care professionals to schools to perform vision screenings. During these screenings, teams prescribe and provide glasses as well as refer children with eye conditions requiring surgery to local Orbis partner hospitals for further examination and treatment.

To increase uptake of services and encourage children to wear their prescribed glasses, children can bring their friends to help them choose their favourite frames. REACH also monitors children’s adherence with wearing their glasses and increases awareness of eye health. Children identified as requiring further examination or intervention are referred to the nearest vision centre.

Engaging students and teachers

REACH engages students to further the success of the programme. Select students are identified as Vision Ambassadors and are encouraged to help identify children with refractive error, advocate for the use of glasses among their peers and help overcome the stigma attached to wearing glasses, such as being teased for looking different or being called names.

Schoolteachers are also engaged in the programme and provide key support. They help facilitate the school screening events, relay relevant information about children’s eye health to the students and their families and participate in counseling parents about the importance of wearing glasses.

Positive messaging on eye health and eye conditions is also disseminated among the communities through information, education and communication materials with catchy and relatable messages and characters. These were developed based on the findings of a study that looked at the knowledge, attitudes and practices that cause barriers to school-based eye care. This instills a sense of responsibility and ownership among the communities.

Technology and innovation in REACH

A major driving factor of this intervention is its robust data management at every step of the way. Towards this, Orbis has developed REACHSoft, a dedicated software solution for holistic support towards planning, implementation and management of the programme. REACHSoft helps Orbis teams schedule and plan programme activities, collect data at the individual student level and monitor their progress. In addition, the software aggregates data from all participating schools and helps Orbis to better understand the current state of refractive error among children in India.

During the pandemic, when conducting school screening was not possible, Orbis quickly adapted the REACH programme with a door-to-door approach to screen children at their homes. This also led to the development of the Door-2-Door app, an innovative tool for efficient door-to-door eye screening data management. Bringing eye health services to families in their homes not only helps screen and identify children who would have missed out on school screening, but also presents a unique opportunity to interact directly with parents and create one-on-one awareness of the importance of eye health. Orbis continues to implement the door-to-door approach in addition to school screenings.

REACH’s impact

The programme has been implemented across 13 locations in India. The programme has reached nearly 22,000 schools, provided more than 172,000 prescriptions, dispensed more than 116,000 pairs of glasses, and referred more than 2,000 surgical cases.

Vision and learning are closely related. Children with poor vision face critical setbacks in their education that can last a lifetime. Orbis continues its mission to provide children with an early, good quality eye examination; care; and support to fulfill their fundamental right to education. Early detection of visual impairment and access to quality eye health services can open a child’s eyes to a world of possibilities. These children further become the ambassadors of change and bring awareness to and conversations around eye health that percolate through and enable empowered communities.

Dr Rishi Raj Borah

Dr Rishi Raj Borah is country director – India, Orbis. He has no financial interests relevant to the subject.

References

1. Naidoo KS, Jaggernath J. Uncorrected refractive errors. Indian J Ophthalmol. 2012;60(5):432-437. doi:10.4103/0301-4738.100543

2. Dandona R, Dandona L, Srinivas M, et al. Refractive error in children in a rural population in India. Invest Ophthalmol Vis Sci. 2002;43(3):615-622.

3. Sil A, Aggarwal P, Sil S, Mitra A, Jain E, Sheeladevi S, Murthy GVS, et al. Design and delivery of the Refractive Errors Among Children (REACH) school-based eye health programme in India. Clin Exp Optom. 2022;1-10.
   doi:10.1080/08164622.2022.2125793