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Uncorrected refractive error (URE) is the second-largest cause of treatable blindness after cataracts in India and globally.1 URE can hinder performance at school, hamper childhood learning and development goals, and reduce future employability and productivity.2 Mission for Vision’s (MFV) Mission Roshni programme implemented in collaboration with Cognizant Foundation in the Nashik district of Maharashtra from 2018-2020 focuses on delivering quality eye care among school children in government and government-aided schools.3 Through this programme, MFV conducts eye screening camps, provides corrective spectacles at no cost to children with refractive error (RE), enables treatment and raises awareness on the issue. During the programme assessment, MFV studied spectacle usage and its impact on the Quality of Life (QoL) of children.
As part of this programme, 51,673 children were screened covering 99 schools. Most of these schools are based in rural regions and the children hail from socio-economically challenged backgrounds. While analysing the impact, we noticed that the prevalence of any RE in the worst eye was 2.7% (95% CI 2.6% – 2.8%). All children diagnosed with RE were provided spectacles at no cost. As part of this evaluation, a total of 96 children aged between 10 and 16 years were interviewed before and after three months of provision of spectacles, of which 59.4% (n=57) were girls. The median ages of boys and girls were 12 and 13 years respectively. About 70% (n=67) were in their secondary schooling. Majority (87.5%) had mild or no visual impairment (VI) in the worst eye, followed by 9.4% with moderate VI and 3.1% with severe VI in the baseline.
However, post-correction, about 99% of children had mild or no VI. The overall mean Vision Function Related Quality of Life (VFQoL) score was 21 (SD 11.2) and 4 (SD 4.8) in the baseline and follow-up respectively, indicating a five-fold reduction in the level of difficulty in performing tasks, suggesting a significant improvement in VFQoL post-spectacle usage. The post-correction mean QoL scores declined with increasing age, suggesting that the impacts on QoL were comparatively more profound in the older children. In addition, 91% of the children reported that they can see better with spectacles and 54% reported that they look better after wearing spectacles.
In our experience, the main cause of visual impairment was URE. To address this issue, the Mission Roshni programme offered a pair of child-friendly glasses and colourful frames that ensure greater uptake and regular use of these spectacles. The Mission Roshni initiative also focused on generating greater awareness among key stakeholders. The initiative trained parents and teachers on eye health-related matters, spectacle usage, and compliance, thereby addressing the issue holistically.
The programme is also an incredible example of collaborative action where MFV joins hands with funding organisations and other eye health partners to deliver quality eye care for children.
Among all UREs, Myopia impacts millions of children every year. Before the onset of the COVID-19 pandemic, data from the East and Southeast Asian regions show that 80-90% of high school children were presenting with myopia. The pandemic accelerated this situation, owing to the increase in digital learning/screen time, lack of outdoor activities and exposure to sunlight. As per the World Health Organization, the myopia prevalence will reach 3.3 billion people by 2030.4 A vast majority of myopia and other forms of vision loss can be alleviated by way of cost-effective solutions such as spectacles.
With the alarming statistics in terms of eye health issues among children, there is a need to replicate and expand programmes such as Mission Roshni, so that more children can benefit and continue with their education without any difficulty. This will help reduce inequalities and provide an impetus to future livelihood and social opportunities.
Image on top: A school boy gets his eyes screened/Shrikant Ayyangar, Mission for Vision
As part of Focus on Child Eye Health, a piece by Mission for Vision on their Mission Roshni programme. Focus on Child Eye Health engages some of the world’s best and brightest thought leaders throughout the year to share knowledge, inspire action, discuss ideas and push Child Eye Health to the forefront of pressing development issues. It is supported by CooperVision.