title: Vision Screening of School Children by Teachers as a Community Based Strategy to Address the Challenges of Childhood Blindness.
abstract: BACKGROUND
  Early detection and treatment of vision problems in children is imperative to meet the challenges of childhood blindness. Considering the problems of inequitable distribution of trained manpower and limited access of quality eye care services to majority of our population, innovative community based strategies like 'Teachers training in vision screening' need to be developed for effective utilization of the available human resources.
  
  
  OBJECTIVE
  To evaluate the effectiveness of introducing teachers as the first level vision screeners.
  
  
  METHODS
  Teacher training programs were conducted for school teachers to educate them about childhood ocular disorders and the importance of their early detection. Teachers from government and semi-government schools located in Ludhiana were given training in vision screening. These teachers then conducted vision screening of children in their schools. Subsequently an ophthalmology team visited these schools for re-evaluation of children identified with low vision. Refraction was performed for all children identified with refractive errors and spectacles were prescribed. Children requiring further evaluation were referred to the base hospital. The project was done in two phases. True positives, false positives, true negatives and false negatives were calculated for evaluation.
  
  
  RESULTS
  In phase 1, teachers from 166 schools underwent training in vision screening. The teachers screened 30,205 children and reported eye problems in 4523 (14.97%) children. Subsequently, the ophthalmology team examined 4150 children and confirmed eye problems in 2137 children. Thus, the teachers were able to correctly identify eye problems (true positives) in 47.25% children. Also, only 13.69% children had to be examined by the ophthalmology team, thus reducing their work load. Similarly, in phase 2, 46.22% children were correctly identified to have eye problems (true positives) by the teachers. By random sampling, 95.65% children were correctly identified as normal (true negatives) by the teachers.
  
  
  CONCLUSIONS
  Considering the high true negative rates and reasonably good true positive rates and the wider coverage provided by the program, vision screening in schools by teachers is an effective method of identifying children with low vision. This strategy is also valuable in reducing the workload of the eye care staff.
authors.affiliation: Associate Professor, Department of Ophthalmology, Christian Medical College , Ludhiana, Punjab, India .
authors.forename: Gurvinder
authors.initials: G
authors.lastname: Kaur
authors.affiliation: Associate Professor, Department of Ophthalmology, Christian Medical College , Ludhiana, Punjab, India .
authors.forename: Jacob
authors.initials: J
authors.lastname: Koshy
authors.affiliation: Professor, Department of Ophthalmology, Christian Medical College , Ludhiana, Punjab, India .
authors.forename: Satish
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Head, Department of Ophthalmology, Max Multispeciality Hospital , Mohali, India .
authors.forename: Harpreet
authors.initials: H
authors.lastname: Kapoor
authors.affiliation: Student, Department of Ophthalmology, Christian Medical College , Ludhiana, Punjab, India .
authors.forename: Jiju George
authors.initials: JG
authors.lastname: Zachariah
authors.affiliation: Post Graduate Resident, Department of Ophthalmology, Christian Medical College , Ludhiana, Punjab, India .
authors.forename: Sahiba
authors.initials: S
authors.lastname: Bedi
keywords: National Program for Control of Blindness; Negative predictive value; Positive predictive value; Refractive errors; Visual acuity