1 Prof Clare Gilbert_Comprehensive school Eye Health

Comprehensive school eye
health programmes
Child Eye Health course: IAPB General Assembly
Clare Gilbert, ICEH, LSHTM
School eye health programme
 School eye programmes often focus on refractive
errors alone, are vertical, bypass the education
and health system, and are not sustainable
 They are rarely monitored or evaluated
• ? what difference are they making
• ? are they cost effective/a good use of resources?
 Programmes need to be
integrated within school health programmes
monitored and evaluated
cost effective
Components of comprehensive school
eye health programme
Identify children with significant refractive errors and
supply spectacles
1. Education about eye conditions and eye health
2. Primary eye care for children
3. Eye care for teachers (e.g. presbyopia)
4. Health promoting school environment
5. Child-to-Child approach
6. Links to control programmes for local endemic
Education about eye conditions and
eye health
 Engage with Ministries of Education and Health
 What is taught depends on local epidemiology:
Keeping their eyes healthy (diet; avoid trauma)
Common conditions affecting their age group
Common conditions affecting younger age group
Common conditions affecting the elderly
Promote positive attitudes towards blindness and how to
interact with someone who is blind
Eye health
embedded in
Education about eye conditions and
eye health
Educational materials for children
Manuals for teachers
Primary eye care for children
 Primary eye care:
- identify and treat /refer simple eye complaints
- identify children with locally endemic eye conditions
(e.g. trachoma; vitamin A deficiency) and taking
action necessary
- identify and refer children with non-RE causes of
visual impairment
Primary eye care for children
 Developing curriculum for school nurses:
 Task analysis – what they should be able to do
after training
 Drives content of training
 Drives what they will need to do the job
• medication / supplies
• visual acuity charts
Primary eye care for children
 Focus on common eye problems affecting
conjunctivitis (viral/bacterial)
styes/chalazions etc
foreign bodies and trauma
refractive errors
 Rare but more serious problems
Primary eye care for children
 Supplies of topical medication e.g. tetracycline
eye ointment
Supplies of eye pads, eye shield etc
Know where the nearest eye unit is
Communication with parents
Record keeping
Eye care for teachers
 Spectacles for uncorrected presbyopia
 Cup:disc ratio assessment for glaucoma
 Counsel diabetics to have regular retinal
Health promoting school
 Physical:
water for face and hand washing
appropriate sanitation for boys and girls
water collection
kitchen gardens...how to grow (and cook) nutritious
 Attitudinal
• disability and inclusion
Child-to-Child: children as agents of
 Developed in 1978 by a paediatrician and health educator
 Builds on natural care-giving and relationships of children
 Entails a 6 step process
• links learning, using fun activities with action at home and in
the community.
• participatory learning involving discussion, action and
evaluation e.g. carrots in Mongolia
 Programmes in many countries for nutrition; HIV etc but
none for eyecare or ear care. Unpublished pilot studies in
India and Nigeria
 Peer education is inherently sustainable
Link to programmes for control of
locally endemic conditions
Primary school
vitamin a deficiency
measles infection
All ages
MDA for trachoma
Work with Ministries of health / education so that
eye health is part of broader school and child health
schools are safe and healthy places
children learn about eye health
school nurses can deliver primary eyecare
Should not be a stand alone, vertical program
that only deals with refractive error