Blog: School Screening in Nepal
I would like to take this opportunity to thank Jon Wild from Keeler for firstly exhibiting at our event and secondly making a donation of a Keeler Ophthalmoscope / Retinoscope Set to Ms Junu Shrestha who is an Optometrist working in Kathmandu. Ms Shrestha attended the conference and told me that she had limited access to equipment and resources which severely restricted her ability to screen young school children for uncorrected refractive error.
Read Junu’s account of her first screening programme using the donated equipment from Keeler.
Photo from L-R – Jon Wild (Keeler), Junu Shrestha (HEPA), MahadevDhuri (Keeler) and Philip Hoare (IAPB).
Health and Education for Poverty Alleviation, (in Nepali “Garibi Niwaran ka lagi Swasthya ra Sikchhya“) was founded by a team of optometrists, medical doctors, engineers and public health researchers on 2011 with the aim to empower people ultimately to rise up from the poverty. This organisation has worked in fields of health care, health promotion, education (teacher’s training) and is on the way to extending its functions deeper into those arenas.
As children are the main hope of tomorrow, prerequisites of their development should be ensured with good quality. They should not leave their school or should not be deprived of education due to any avoidable barrier in their eyes. A larger group of optometrists involving in HEPA, as a supporting factor too, led our interest in school screening.
What we did
The Lotus Innovative School, Bode, Madhyapur Thimi, is a lower secondary school with a history of 10 years. Lotus never conducted eye screening till date. The school principal was very enthusiastic when I proposed we do free eye school screening. She also said that she was indeed waiting for such programme, because she had referred a student to an eye hospital, and he was found to have -2.00 refractive error–how were her other wards faring?
On 11th and 12th October 2017, two optometrists (Junu Shrestha and Manisha Dahal) and three volunteers (Amrita,Subhadra,Sunita) measured vision (see figure 1) using Snellens Visual Acuity charts and an occluder with pinhole and where indicated used a retinoscope and trial set to measure refractive error. We used an ophthalmoscope and torchlight to examine the inside and outside of the eyes. We did ophthalmoscopy and retinoscopy on the nursery students.
93 of the students had normal and near normal visual acuity, 8 of them had visual impairment which could be corrected to normal visual acuity. We could not measure visual acuity in 13 of the preschoolers because of lack of proper visual acuity charts.
We also referred one student who needed cyclorefraction to an eye hospital. The student was diagnosed bilateral meridional amblyopia and was advised for follow up in 1 month to plan for occlusion therapy.
What went well
Eye examination was not easy in children, fluctuating power due to improper fixation, less cooperation, but with the help of motivated volunteers, we were able to screen the children. We were very grateful for the Keeler retinoscope and Keeler Ophthalmoscope which was donated. With the brightest illumination, obviously not hurting the eyes and making us able to visualise clearly. On Day 2, we examined the students who were absent the day before and also examined some parents who were willing to wear glasses or had worn glasses previously.
We were able to track whether our referred children had proper eye examination or not. This is in comparison with our previous school screening camps where we just prescribed the power and referred some of them. At this time, we called the guardian of referred child and also looked for the prescription sheet from eye hospital. The programme was systematic this time and every child underwent comprehensive eye examination. The power prescription was more accurate this time.
One of the children with refractive error was referred to eye hospital. The guardians of remaining 3 children with refractive error did not come to school. So, we requested the school principal to contact them and counsel them to have spectacles from anywhere as soon as possible. We provided glasses to 6 students at minimum costs with the help of two opticians who provided some discount. On 15th October, we distributed glasses to the students and captured their smiles.
We expressed our sincere gratitude to the school administration for providing us the opportunity to serve the children and help us eliminate avoidable blindness in their community. May we also thank KEELER LTD for their generous donation of a brand new Ophthalmoscope and Retinoscope Set, which was presented to Junu Shrestha at the IAPB Council of Members Conference In Kathmandu in September 2017.