Glasses: a simple way to make learning easier for many children

In August 2016, 11-year-old Pouk Sreyneth was given a pair of glasses at the Wat Run primary school in Siem Reap, Cambodia.

Many children struggle to learn at school because of poor vision, so Sightsavers has worked alongside her government to provide screening for schoolchildren and distribute glasses to every child who needs them.

I started wearing glasses when I was 10. I remember having difficulty seeing things at distance, including the blackboard in class. I also used to have difficulty recognising people across the room, and watching TV. Thirty years on I often reflect on how my life would be different if my vision was not corrected. Given that 80 per cent of learning is visual, being unable to see at distance would no doubt have affected my educational performance.

My experience is not unique. According to a report by the Education Commission, up to 10 per cent of children in developing countries may suffer from poor vision. Approximately nine in 10 of these cases are because of uncorrected refractive error (URE), a condition in which the eye does not focus correctly when looking at distance or close-up, resulting in blurred vision. URE can be addressed through an eye examination, which includes a ‘refraction’ (measuring the power of the eye), and can be corrected with glasses.

I was lucky to grow up in a wealthy community where I was able to get comprehensive eye care. This early exposure may have shaped my own decision to become an optometrist specialising in public health.

URE is the leading cause of global visual impairment. According to a recent article in medical journal The Lancet, there are 124 million people unable to see clearly at distance, 19 million of whom are children. Yet the solution to URE ­– an eye test and a pair of glasses – is straightforward and cost-effective.

Despite this, there are several challenges: in particular, a lack of trained professionals to carry out eye examinations, and the absence of good-quality, affordable glasses. Two-thirds of ophthalmologists and optometrists in sub-Saharan Africa are located in capital cities. There are issues with demand, meaning children, parents, and teachers are sometimes unaware of the benefits of wearing glasses, in some cases believing they actually weaken the eye.

There is also stigma. In India, girls can feel pressure not to wear glasses for fear of it affecting their chance of getting married. Cost can also be a barrier: eye care and eyeglasses are often expensive. It can be prohibitively costly for a parent to travel to a clinic for screening and treatment, and then to pay for glasses.

School vision screening programmes have been developed to address many of these issues. But sometimes interventions are uncoordinated, ad hoc, non-standardised and unsustainable. The lack of coordination occurs between organisations carrying out the screening and the ministries of health and education.

What’s more, screening is often a one-time activity, based on external funding. There is a lack of standardisation in terms of what age ranges should be screened, by whom, how often, and the point at which a child be given a pair of glasses. There is also the issue of ensuring a child wears glasses in the classroom.

To address these issues, Sightsavers worked with Partnership for Child Development (PCD) and the World Bank to implement the School Health Integrated Programme (SHIP) project, supported by a grant from GPE. SHIP’s objectives were to raise awareness and build the capacity of governments to implement school health initiatives, and to demonstrate how schools can help to carry out eye screening and deworming.

Doing this in schools enabled us to reach more children and it was less disruptive to their education as they didn’t have to travel to a clinic. The intervention was piloted in four focus countries: Cambodia, Ethiopia, Ghana and Senegal.

The project was implemented in phases:

1. Joint planning between ministries of education and health to build capacity and prioritise school health and nutrition, while identifying locations and schools for screening.
2. Next, a cascading programme of training aimed to spread expertise among teachers in schools. Teachers were also given resources to carry out screening, including manuals and a simplified vision screener.
3. Once screened, students who failed the test were referred to a mobile refraction unit, under the ministry of health, providing glasses at no cost. Students who required further examination were referred to the closest eye unit. Teachers who took part in the screening were also screened and given glasses as needed.

The project used a standardised system of guidelines developed in collaboration between Sightsavers, Brien Holden Vision Institute, and the International Centre for Eye Health at the London School of Hygiene and Tropical Medicine. These guidelines outline the use of teachers to screen, simplified vision screening and prescribing protocols.

The project trained 476 teachers in 158 schools; reached 57,434 children with vision screening; de-wormed 47,106 children; and dispensed 1,017 pairs of glasses.

Imran Khan
Imran is Chief Global Technical Lead at Sightsavers.
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