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Pre/School Vision Screening in Nicaragua

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El Salvador, Guatemala, Nicaragua. UNESCO Chair in Visual Health and ... Planning meeting in El Salvador September 2005. Role of Volunteer Optometric ... – PowerPoint PPT presentation

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Title: Pre/School Vision Screening in Nicaragua


1
Pre/School Vision Screening in Nicaragua
  • A Pilot Project
  • in cooperation with the
  • UNESCO Chair in Visual Health and Development
  • VERAS
  • (Vision, Education, Achievement, Learning, and
    Sustainability) project.

Drs. Patti Fuhr, Wendy Marsh-Tootle, Marcela
Frazier of VOSH Int and the VERAS Working Group
2
International Participants El Salvador,
Guatemala, Nicaragua
  • UNESCO Chair in Visual Health and Development
  • Opt. Anna Rius
  • Lic. Astrid Villalobos
  • Janet Leasher, OD
  • Maria Cilleros
  • VOSH/UAB, NECO/UES/U. GALILEO/ MINSA/MECD
  • Wendy Marsh-Tootle, OD
  • Marcela Frazier, OD
  • Patti Fuhr, OD, PhD
  • Bruce Moore, OD
  • Erik Weissberg, OD
  • Lic. Natalia Colome
  • Nelson Rivera, OD
  • John Gehrig, JD
  • Miguel Silva, OD
  • Ing. Sergio Romero
  • Elise Harb,OD
  • Kayla Smith
  • Kimberly ChanKate Moore
  • Marsha Feist-Moore
  • Carolina Toledo
  • Jose Salinas A.
  • Vilma Chavez de Pop, MD
  • Milago del C. Meduia
  • Rosa Elana Alfaro
  • Samuel Alanso, OD
  • Jose Salinas Andreade
  • Juan Carlos Aresti, OD
  • Rommel Izaquirre, MD
  • Milton Eugarrios Najlis, MD
  • Jacqueline Castellon R, MD
  • Johanna Ramirez Villalobo, MD

3
Central America
  • Belize
  • Guatemala
  • Honduras
  • El Salvador
  • Nicaragua
  • Costa Rica
  • Panama

4
Central America lt 2/Day
  • Belize -
  • Guatemala -37.4
  • Honduras 44.4
  • El Salvador 45
  • Costa Rica 14.3
  • Panama 17.9
  • Nicaragua 94.5 lt 2/Day
  • 33 lt 1/Day

5
Nicaragua
  • Nicaragua (and Haiti)
  • poorest nations in Western Hemisphere
  • Population 5 million
  • 1 million in Managua
  • Literacy rate 66
  • 800,000 without access to health services
  • Human Poverty Index - ¼ are fully deprived of
    decent standard of living (drinkable water, etc)

6
Nicaragua Visual Health
  • Opticians or optometrists without specialized
    training 35 (CR50)
  • Opticians or optometrists with university
    training 15 (CR350)
  • Ophthalmologists with university training 55,
    CR 100
  • No optometry school
  • Optometry laws exist only in Panama, Guatemala
    and Costa Rica
  • UNESCO CHAIR IN VISUAL HEALTH AND DEVELOPMENT
  • REPORT ON VISUAL HEALTH IN CENTRAL AMERICA

7
VERAS Vision Education Achievement Learning
Sustainability Vision, Educacion, Rendimiento,
Aprendizaje y Sostenibilidad
  • Cooperative project
  • UNESCO Chair in Visual Health and Development
  • VOSH
  • MINSA and MECD
  • Guatemala, El Salvador, Nicaragua
  • Universities in Spain, El Salvador, Guatemala,
    US
  • NGO - FOR Nicaraguan Health
  • Planning meeting in El Salvador September 2005

8
Role of Volunteer Optometric Service to Humanity
(VOSH)
  • Enlist support of Nicaraguan Minister of Health
    and Minister of Education
  • Expert advisors to help develop vision screening
    and examination protocols
  • Help to train local persons to follow the
    protocol
  • Ministers identify screeners
  • Examine and treat the children in Nicaragua

9
VERAS
  • September 2005
  • Planning Meeting
  • Protocols developed
  • January 2006 Summit
  • Introduced protocols
  • Trained and certified
  • participants from
  • El Salvador
  • Guatemala
  • Nicaragua
  • superscreeners

10
(No Transcript)
11
VERAS in Central America
  • Goals
  • Detect, diagnose and treat vision problems in
    preschool and first grade children
  • Increase awareness of children's vision problems
    among health care providers, teachers and parents
  • Design a feasible system that is culturally
    appropriate and sustainable in the local
    community

12
VERAS Pilot Project in Nica
  • Goals
  • Test the screening and examination protocols
  • Training screeners / super-screeners
  • Initial training of supervisors
  • Follow-up training
  • MECD 20 volunteer teachers
  • MINSA 5 volunteer nurses
  • On site observation of initial screenings (1000)

13
School-based screening
14
VERAS
  • Screening protocol
  • Target population preschool and first grade
  • VERAS visual acuity test 20/40 targets
  • Screening acuity at 5 feet

15
VERAS
  • Standardization of Vision Screening
  • Present cards 1-12 at 5 ft
  • both eyes together (cards 1-4)
  • right eye alone (cards 5-8)
  • left eye alone (cards 9-12)
  • Communication
  • teach child to name or match symbols
  • do not answer for child
  • Test conditions
  • ambient lighting
  • hold test straight
  • keep 5 foot string tight

16
Screening Form
17
VERAS
  • Screening criteria
  • Fail at least 2 symbols in any condition
  • (eyes together, right eye alone or left eye
    alone)
  • Protocol testing
  • All children failing and equal number who passed
    to be examined

18
VERAS
  • Examination Acuities
  • Test targets from 20/100 to 20/20 size
  • Monocular
  • 10 feet

Acuity tests donated by GoodLite
19
Examination Acuity Form
20
Pilot Project
  • Goal of Examiner training
  • Standardized form
  • Standardization of Methods
  • Cycloplegic
  • Standardized approach to correction of refractive
    errors in children

21
Examination
  • Cover test
  • detect strabismus
  • detects latent strabismus
  • with prism measure

22
Examination
  • External inspection
  • determine safety for dilation
  • detect external eye disease
  • detect media opacification

23
Examination
  • Cycloplegia
  • proparacaine
  • 2 drops 1 cyclopentolate
  • 1 drop 1 Tropicamide
  • 45 minute wait

24
Internal Examination
25
Retinoscopy and Rx
26
Treatment Plan
  • Spectacle Treatment
  • Exact prescription
  • Retinoscopy
  • New frames
  • New lenses
  • Fabricated in Nicaragua

Frames donated by AA Optical, Texas
27
Treatment Plan
  • Surgical Evaluations
  • Corneal specialist
  • EOM surgeon
  • Low vision care not available in community
  • Coordination of care with local MDs

Frames donated by AA Optical, Texas
28
Pilot Study Results
  • 5673 Children Screened!
  • 350 Failed the screening (6 referral rate)
  • Examination
  • 365 Children in protocol examined
  • 211 who had passed the screening
  • 154 who had failed the screening
  • Masked to examiners

29
Pilot Study Results
  • True Positives
  • Failed the screening and needed glasses 53
  • False Positives
  • Failed the screening and did not need glasses
    101
  • True Negatives
  • Passed the screening and did not need glasses
    195
  • False Negatives
  • Passed the screening and did need glasses 16

30
Pilot Study Results
Sensitivity 0.77 Specificity 0.66
31
Efforts to Decrease False Positive Rate
  • High false positive rate can destroy a screening
    program
  • Increase cost
  • Decrease confidence in screening program

32
Efforts to Decrease False Positive Rate
  • What can we do?
  • Require re-screening by a supervisor of those who
    failed screening initially
  • Or increase training of first screeners
  • Continue monitoring program for outcome until
    improvements are documented

33
Pilot Study Results
  • Quality control
  • Track and compare results per individual screener
  • Individuals beliefs about medical care may
    influence referral rates
  • Teachers appeared more committed to finding
    children with vision problems
  • They see the day-to-day problems
  • Some individuals get better cooperation from
    pre-schoolers

34
Pilot Study Results
  • Lessons Learned
  • Our test is inexpensive and well accepted in the
    community
  • Process is labor intensive requiring training
  • Tracking of results
  • Re-training
  • Re-testing before examination
  • Lay people can be excellent screeners

35
Pilot Study Results
  • Parents were very interested
  • Teachers are the key
  • Sustainability occurs when local providers can
    continue the protocols and the care

36
Vision Screening in Nicaragua Acknowledgements
  • First VOSH cooperative project with UNESCO Chair
    in Visual Health and Development
  • Very productive partnership
  • Pilot phase completed in 8 months!
  • Grant from VOSH International
  • UAB School of Optometry
  • Department of Veterans Affairs
  • GoodLite
  • AA Optical of Texas
  • All planning, implementation, and evaluation
    participants

37
Its the glasses!
38
Its the vision!
39
Its the children!
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