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Design and delivery of the Refractive Errors Among Children (REACH) school-based eye health programme in India
Asim Sil1, Prachi Aggarwal2, Subhra Sil1
1Community Eye Care, Vivekananda Mission Ashram Netra Nirmay Niketan, West Bengal, India.
Insights
The Refractive Errors Among Children (REACH) program screened over 2 million Indian school children for vision problems. It successfully identified and referred many for further eye care, improving visual outcomes.
Area of Science:
- Ophthalmology
- Public Health
- Pediatric Optometry
Background:
- School-based vision screening programs are crucial for early detection of refractive errors in children.
- The Refractive Errors Among Children (REACH) program in India aims to enhance school vision screening effectiveness through hospital collaboration and continuous eye care monitoring.
Purpose of the Study:
- To evaluate the implementation and outcomes of the REACH school vision screening program across India.
- To identify factors influencing referral rates for detailed eye examinations among school children.
Main Methods:
- The REACH program conducted vision screening using pocket screeners in numerous schools across five Indian states.
- Children failing initial screening were referred for comprehensive evaluation, including cycloplegic refraction when necessary, with data recorded electronically.
- Follow-up included spectacle dispensing and compliance assessment.
Main Results:
- Over 2 million children aged 5-18 years were screened.
- 8.6% of screened children required detailed evaluation, with higher referral rates in urban/private schools (11.8%, 10.4%) compared to rural/government schools (5.9%, 7.2%).
- Referral proportions varied significantly by state, ranging from 4.0% to 14.4%.
Conclusions:
- The REACH program successfully screened a large cohort of school children, demonstrating the potential for optimized vision screening programs.
- The initiative provided essential follow-up care, contributing to improved visual health outcomes for participating children.
Clinical Relevance:
Optimisation of vision screening programmes can result the detection of refractive anomalies in a high proportion of school children.
Background:
The Refractive Errors Among Children (REACH) programme aims to optimise outcomes of school-based vision screening in India by collaborating with hospitals and monitoring eye care throughout school attendance.
Methods:
REACH delivers school vision screening using pocket vision screeners (cards presenting rows of seven 0.2 logMAR Sloan letters at a 3 m viewing distance) in five states across India. Children who fail screening are referred for detailed evaluation including refraction, those requiring cycloplegic refraction are referred to partner hospitals. Spectacles are dispensed as needed and compliance is assessed. All data are recorded electronically.
Results:
Out of 2,240,805 children aged 5 to 18 (mean 11.5; SD ±3.3) years, 2,024,053 have undergone REACH screening in 10,309 schools predominantly in rural locations (78.7%) and government-funded (76%). Of those screened, 174,706 (8.6%) underwent detailed evaluation. A higher proportion of children in private or urban schools (11.8% and 10.4% respectively) were referred for detailed evaluation than those in government-funded or rural schools (5.9% and 7.2%, respectively; p < 0.001). The proportion referred for detailed evaluation differed by state (p < 0.001), from 4.0% in West Bengal to 14.4% in Kerala.
Conclusion:
The REACH programme screened a high proportion of school children, providing further care and follow-up to optimise visual outcomes.
