EARLY IDENTIFICATION AND INTERVENTION OF THE STRABISMIC CHILDREN AMONG PREPRIMARY SCHOOLS FOR MAINSTREAM EDUCATION

INTRODUCTION:

             Twenty Four percent of persons at birth go un-noticed for a long time until the person acquires vision problems in one eye than the other. Squint affects 2% to 4% of the population and can result in Amblyopia, which is often not discovered in time to initiate effective treatment (National Screening Committee (NSC) -2005).  Early detection and prompt intervention in terms of treatment of ocular disorders in children is important to avoid lifelong visual impairment. 

NEED AND IMPORTANCE OF THE STUDY:

• Nearly 80% of preschool age children never get an eye examination. The prevalence of undetected vision problems among preschool age children is estimated to be 5% to 10%. Failure to detect visual impairment early may have a permanent effect on long term vision outcomes, education achievement, and self esteem reported by The University of Texas, USA, (2006).
• Parents think that nothing can be done to improve vision in the Amblyopic eye, but this can be prevented to a great extent in majority of cases, if it is detected around the age of 3-4 yrs (Maglia and his co-workers, 2008).
• Medline (2009) reported that, the prevalence of squint in children of 5 years and younger is between 7% and 8%. Three percent of children have amblyopia. Treating children younger than 8 years who have cataracts or squint with vision therapies may prevent the development of amblyopia.
• The parents of children with late diagnoses expressed less concern over the seriousness of amblyopia but were more likely to report that their children had suffered of some adverse consequences of amblyopia, (Children's National Medical Center, Washington, 2009).

Hence there is a great need for orienting the parents on the following aspects:

• a positive family approach for squint,
• greater parental support,
• an increased chance for early and frequent diagnosis,
• Concern to promote education in inclusive schools.

            In India, ophthalmologist population ratio counts 1: 25,000. Hence this issue is neglected due to treatment back lock in cataract and major eye diseases.  Hence this situation necessitated and urges the education and rehabilitation professionals to identify the children with squint and children at risk for squint at earlier stage persay and assist them with the intervention such as standardized vision therapy exercises. Hence the research study on “Early identification and intervention of the strabismic children among preprimary schools for mainstream education” is planned in the educational setting using indigenous techniques and devices.

             This study carried out the screening procedures among 800 preprimary children of south zone from Coimbatore district. The objectives and the methodology followed are presented below:

OBJECTIVES OF THE STUDY:

The objectives of the study are to:

• Survey the existing Anganwadi programme, at south zone of Coimbatore district.
• Screen children with squint in the educational setting using indigenous devices and techniques with the help of teachers, parents and caretakers.
• Detect children with squint and atrisk for squint.
• Refer children with squint and children atrisk for squint at risk subjects for comprehensive clinical evaluation.
• Facilitate intervention in terms of vision therapy and refractive correction thereby preventing squint.

METHODOLOGY:

The investigator explored the children enrolled in Anganwadi schools situated at 3 types of corporation schools at south zone of Coimbatore district, hence descriptive survey method is followed.

SAMPLE SELECTED FOR THE STUDY:

The south zone of Coimbatore city was selected for the study. There were about 77 Anganwadi schools with 800 children enrolled. The investigator interviewed the teachers, parents and caretakers for identification of children with squint and atrisk for squint. There were 193 children referred for further detection of vision problems.

VARIABLES:

        The independent variables such as Gender, Age group, Parent education, Occupation and Income were selected for the study.

        The Dependent variables of the study consisted of intervention approaches to identify squint condition with the use of indigenous devices and techniques and vision therapies adapted from Dr.Gala’s Vision training programme (2008) which is an individualized supervised program designed to correct visual-motor and/or perceptual-cognitive deficiencies.

TOOL:

1) Personal Data Bank:

        Personal data bank was used to collect personal information such as age, gender, parent occupation, income and locality of the selected sample.

 2) Vision Screening Schedule:

        The WHO checklist was adapted (1993) by the investigator. It consisted of three areas such as: i) appearance of the eye, ii) behaviour of the children and iii) complaints due to vision.

Identification of Squint Children:

          The investigator used indigenous devices like Ophthalmoscope, Torch light and techniques and out of 193 children 27 children were identified and referred as atrisk for squint. Subsequently 27 children were referred to comprehensive eye examination at Aravind Eye hospital - Coimbatore, which is a leading eye hospital in the country. The clinical examination revealed that there were 7 children with squint (6 boys and one girl).

              The flowchart present an overview on the strategies adopted to identify squint. Among 800 children, in each stage, children were eliminated and finally seven children were identified with squint and they are trained with Vision therapy exercises adopted from Dr.Gala’s Vision training programme (2008).

Vision therapy

The investigator adapted the Vision Therapy exercises from DR.Gala’s Vision training programme (2008) which is an individualized supervised program designed to correct visual-motor and/or perceptual-cognitive deficiencies. It is evident that vision therapy exercises enhances the squint children to develop appropriate eye functions such as eye alignment, eye teaming, eye focusing abilities and eye movements and/or visual processing.

The vision therapy exercises consisted of 5 types which are used as the rehabilitation therapies with the assistance from the parents, teachers and care takers for the squint children and they are,

·         Eye Pressing - Contracting firmly the eye muscles around the eyes to create pressure on the eye balls which increases the blood circulation in both the eyes.

·         Neck Exercises – Bending the head forward, backward, left and right as much as possible which promotes the arteries to supply nourishment to the eyes lie between the muscles of the neck

·         Thumb Pursuits – The child should steadily look at the thumb which was moved in different directions which decreases the eye strain arising out of an imbalance because of squint in muscles is relieved.

·         Eye Tracking - The child should steadily look at the pen tip which was moved in different directions which helps to develop the ability of the eyes to follow a fast moving object smoothly and uninterruptedly which promotes tracking skill.

·         Dodge Ball – When the ball is released to swing towards the chest of the child, without moving the feet from its position they should try to move out of the ball’s way where the  co-ordination between the eyes and the body develops.

The data after collection was processed and analyzed in accordance with the outline laid down for the purpose at the time of developing research plan and depicted as follows:

1. Appearance of the Eye

S. no	Appearance of the eye	No of children	Percentage
1	Redness of the eyes	14	41
2	Watery eyes	10	29
3	Jerky eyes	13	38
4	Have squint in one eye	2	6
5	Have squint in both eyes	4	12

From the table it was found that redness of the eyes was exhibited by 41% of the children, jerky eyes 38%, watery eyes 29%, having squint in both the eyes 12% and having squint in one eye is only 6% respectively.

                                       

       2. Complaints reported by the Children

S. no	Complaints	No of children	Percentage
1	Headache	4	12
2	Burning eyes	8	24
3	Rubbing the eyes frequently	19	56
4	Double vision	2	6
5	Sensitivity to light	8	24

           

It was found that 56% of children exhibited rubbing their eyes frequently. Twenty four percent of students showed sensitivity to light and 24% complained of having burning eyes. Headache and double vision was reported by 12% and 6% of the children respectively.

3. Behaviour of the Children

S. No	Behaviour	No of Children	Percentage
1	Blinking excessively	5	15
2	Frequently inattentive	19	56
3	Hesitate in moving	9	26
4	Maintain eye contact	11	32
5	Lack of interest in out door activities	16	47
6	Taking objects nearer to the eye	11	32

           

It was found that the highest percent (56%) of children were inattentive in the class due to their eye defect which made them disinterested in participating outdoor activities.

RESULTS AND DISCUSSION:

1. Among the 800 children screened 7 children were identified with squint and clinically proved.

2. The strategies adopted were found effective for early identification of squint in educational setting.

3. The prevalence of squint among boys is more than girls.

4. The highest percentage of the squint found in the age group of more than 2 years.

5. It was found that 80% of the children were enrolled in Anganwadi schools of urban area and the remaining 20% of them were enrolled in rural area. The enrolment of children in urban area was more than the children in the rural area.

6. It was found that the highest percentage (41%) of children exhibited redness of the eyes, 11% of the children had squint in both the eyes and where as only 5% of them had squint in one eye only.

7. Rubbing the eyes frequently was found to be the most common complaint encountered by 56% of children.

8. Hereditary was the major cause of squint reported by 50% of the children.

9. From the t test it was found that, the intervention in terms of Vision therapy exercises helped in acquiring the ability of functional vision skills such as visual fixation, tracking, discrimination and motor co-ordination skill by the squint children.

10. From the t test it was revealed that, the intervention in terms of Vision therapy exercises helped in overcoming the vision problems such as appearance of the eye, complaints reported and behavior exhibited.