MOST VISUAL IMPAIRMENT IS AVOIDABLE
Findings
POPULATION OF THE WORLD - 8.062 BIILION
239,000,000
children live with poor vision​
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1,400,000
children are blind from disease​
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2,000,000
children are blind due to uncorrected refractive error
VIDEO: What is a vision screening?
OBSERVATIONS OF NOTE
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Median Age 12mo (IQR 6-36)
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12.4% referral amblyogenic risk factors
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25 total, all with refractive error
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Median time for photo screener 8sec (IQR 5-14)
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Median time added per visit 4min (IQR 2.5-6)
Suriname Test of Concept
December 2019
Pediatric glaucoma, cataract, and retinoblastoma are uncommon but potentially devastating diseases. Early recognition is key to successful treatment. Timely intervention will prevent permanent vision loss, or in the case of retinoblastoma, disfigurement or loss of life. ​Amblyopia occurs frequently. Undiagnosed refractive error profoundly affects school performance and learning. This unnecessary limitation for the child and burden on the school system is avoidable.
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The goal is to create a sustainable model of early vision screening driven and owned by local providers that integrates into existing healthcare frameworks and can be performed by non-ophthalmic professionals.
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Newborn vaccine protocols are widely available around the world in free polyclinic healthcare settings. These encounters are predictable and well attended. Our screening strategy ‘seamlessly incorporates’ onto an established and accepted vaccine schedule. This allows for up to 7 screening opportunities before the child begins school.
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When time burden added was evaluated, start to finish (informational video, consent for care and screening) added less than 4 minutes to the well child vaccine visit.
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Over the course of five days, a team of two project managers visited 4 clinics in Paramaribo and screened 208 children (2% of Suriname’s infant pop.) yielding a 12.5% referral rate for follow up care.
Barbados Screenings
March 2023
During the winter months of 2023 The PPB Team worked with members of Barbados’ Ministry of Health and Wellness (MOH) and the island’s only pediatric ophthalmologist, Mr. David Callender, to lay out plans, responsibilities and logistics, and to recruit key opinion leaders within the clinics. Crucial to the success of this project was the support of the MOH’s Chief Medical Officer, The Right Honorable Dr. Kenneth George, the Chief and Deputy Chief Public Health Nurses, Norma Bynoe, and Larone Hyland.​
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In March the team hit the ground running and performed screenings of 130 children in 7 of the island's 9 polyclinics over five days where most of the island’s childhood vaccinations are administered. This represented approximately 5% of the infant population on the island. Photo screeners were used to detect refractive errors and malalignment and to asses the fundus reflex for amblyogenic causes of vision impairment. This small cross-section of the population, provided a referral rate of 7.5% for refractive error.​
VIDEO: Why vision screening?
OBSERVATIONS OF NOTE
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Median Age 19mo (IQR 6-76)
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7.5% referral amblyogenic risk factors
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25 total, all with refractive error
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7 out of 10 Spot readings was successful in first attempt
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Family ocular history revealed that 92% wear glasses, 22% has/had cataracts, and 16% has/had glaucoma
The Burden of Pediatric Visual Impairment (VI) and Ocular Diagnoses in Barbados
Groundbreaking Study
K. Da Silva, M. Dowell, EJ Savatovsky, D. Grosvenor, D. Callender, MH Campbell, I. Hambleton, EA Vanner, AL Grajewski and TC Chang​
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This is the first study investigating the causes of pediatric VI and eye diseases in Barbados. It addresses the need for epidemiological data on pediatric VI by revealing the common ocular diseases and causes of VI in Barbadian children as well as the need for an optimized health medical information system. This study complements the previous work undertaken by the Barbados Eye Study in the adult population.
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This cross-sectional review of patient records determined the patterns of pediatric eye diseases and VI. 3,278 patient records with a mean age at the first visit of 7.8 ± 3.9 years. There were 80 (2.4%) children with VI, 62.5% of which were attributed to amblyopia. A total of 94% of VI was preventable or treatable. The most common diagnoses were refractive error (87.5%), strabismus (27.5%), and allergic eye disease (20.0%). Amblyopia is the major cause of pediatric VI in Barbados and is largely avoidable.
