The KwaZulu-Natal Child Eye Care Programme: Delivering refractive error services to primary school learners

Abstract

Globally, over 300 million people are estimated to be visually impaired. Uncorrected refractive error is the primary cause of almost half of all visual impairment, resulting in the global economy losing $269 billion in productivity annually. There is a definitive level of urgency in the treatment of refractive error in children as uncorrected refractive error results in the failure of normal visual maturation, termed amblyopia, which cannot be corrected in adult life. In South Africa, the lack of appropriate child eye care strategies has posed a serious problem to the visual health of children. In 2006, the International Centre for Eye Care Education (ICEE) conducted a situational analysis of child eye care services in the province of KwaZulu-Natal (KZN). The findings of this analysis indicated a dire need for comprehensive services in the province. Stakeholders (the KwaZulu-Natal Department of Healthand the KwaZulu-Natal Department of Education) were advised on the value of a short-term strategy as the underpinning of a long-term sustainable approach. This resulted in the formation of a trialliance to implement the KZN Child Eye Care Programme. Eighty (80) individuals who were previously volunteers for the KZN Department of Health were trained in vision screening. These vi- sion screeners screened 239 606 primary school children from February 2007 to May 2008. Seven percent (15 944) of the children failed the vision screening and were referred for optometric assessments. Of the 15 944 children that failed the vision screening, 10 707 children were examined by optometrists and 1083 were found to have a refractive error and were therefore supplied with spectacles. The study indicates that a short-term programme to address a backlog of services can reach many underserved children. This programme identified many challenges of implementing a vision screening programme such as poor uptake of refractive services by learners in the absence of an appropriate referral system and high attrition of trained vision screeners. (S Afr Optom 2011 70(2) 61-68