Schoolbased vision screening program in Oaxaca, Mexico

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School-based vision screening program in Oaxaca,
Mexico

• Nita Patel, OD, MPH (npatel_at_hki.org)
• Helen Keller International
• World Congress on Refractive Error
• March 15, 2007

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Objective

• To describe the strategies and approaches of a
  school-based refractive error program in Oaxaca,
  Mexico

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Considerations

• Pre-implementation
• Background
• Project site
• Funding
• Program model
• VA screening
• Refractions
• Eyeglasses
• Referrals
• Protocol

• Monitoring and evaluation
• Retention
• Post-implementation
• Lessons learned
• Challenges/barriers
• Sustainability

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Background

• Ver Bien Para Aprender Mejor (See Well to Learn
  Better)
• National program operated in 22 of 31 states
• Provide vision screenings, refraction, eyeglasses
  to schoolchildren

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Project site

• State of Oaxaca
• 3.4 million inhabitants
• Indigenous population
• Mountainous terrain
• Target age group 6-14
• Primary and secondary students
• 7,860 schools
• 800,000 students
• 92.2 school enrollment in primary school
• Baseline data from Ver Bien National
• 12.7 of children enrolled need eyeglasses in
  Mexico

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VA screening

• Teachers conduct the initial visual acuity
  screening
• Some teachers are trained
• Others receive the visual acuity chart and
  instructions
• Distance visual acuity 6/12 in either
  eye referred for refraction

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Refractions

• Ver Bien team travel to schools/communities to
  refract
• Team consists of
• Optometrist
• Support staff paperwork, eyeglass assembly
• Non-cycloplegic retinoscopy performed
• Eyeglasses prescribed

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Eyeglasses

• Students provided eyeglasses
• Voucher
• On-site
• Round glasses
• Correct for astigmatism
• Acceptance test
• Provided by
• Government of Oaxaca
• Donations from HKI

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Referrals

• Students referred
• City of Oaxaca
• Pediatric ophthalmologist
• La Hospital Niñez Oaxaquena
• Referrals for
• Cataract, strabismus, glaucoma, etc

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Protocol
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ME

• In 5 years
• Screened almost 700,000 students
• Eyeglasses provided to about 65,000
• Approximately 1,800 referral examinations
• Over 600 referral treatments
• Over 100 surgeries provided

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Retention

• Unannounced eyeglass follow-up visits
• 493 children who received eyeglasses
• Average 12 months
• Determined by direct examination
• Wear vs. Non-wear
• Results
• Wearing eyeglasses - 13 (66)
• Had eyeglasses at school - 34 (169)

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Retention

• Reasons for non-compliance
• Left at home 17
• Appearance/teased 16
• Only wears occasionally 14
• Broken/lost 14
• Dont need 9
• No/other reason 9
• Headache 6
• Parents object 2

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Retention

• More likely to wear their spectacles
• Younger
• Rural areas
• Myopic -1.25 D or hyperopic 0.5 D
• Concerns about appearance and fear of being
  teased
• Older
• Urban/suburban
• Risk for visual disability from myopia

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Retention

• Increase in myopia protocol
• From -0.75D to -1.00D
• Change in eyeglass style
• From round frame to a choice of stylish oval
  frame
• Two methods
• Use precut lenses for left and right eye
• Sphere prescriptions provided on site
• Astigmatism cannot be corrected on site
• Procure from optical shop
• Wider choices of eyeglass frames
• Astigmatism can be corrected
• Increase turnaround time

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Lessons learned

• Motivation for teachers by providing screening
  and eyeglasses
• Retention results can vary
• Urban, rural, indigenous, age group
• Program needs to educate teachers and parents
• Advocates for eyeglass wear and eye health
• Every program not the same
• Adapt a base model
• Local resources, practices, attitudes and beliefs

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Challenges/Barriers

• Screening conducted by teachers
• Retention rates
• Eyeglass distribution
• Referral for further care
• Political problems
• Sustainability

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Sustainability

• Difficult because eyeglasses are expensive and
  make program costly
• Possible with government involvement and
  sufficient human resources for the program
• HKI has successfully transitioned out of the Ver
  Bien program

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Thank you