IDENTIFICATION AND PROVIDING REHABILITATION THERAPIES FOR THE STRABISMIC CHILDREN AMONG PREPARATORY SCHOOLS

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. Strabismus 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 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 strabismus 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 strabismus,
• 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 strabismus and children at risk for strabismus at earlier stage persay and assist them with the standardized vision therapy exercises. Hence the research study on “Identification and providing rehabilitation therapies for the strabismic children among preparatory schools” is planned in the educational setting using indigenous techniques and devices.

             This study carried out the screening procedures among 1,100 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 Strabismus in the educational setting using indigenous devices and techniques with the help of teachers, parents and caretakers.
• Detect children with strabismus and atrisk for strabismus.
• Refer children with strabismus and children atrisk for strabismus at risk subjects for comprehensive clinical evaluation.
• Facilitate treatment in terms of vision therapy and refractive correction thereby preventing strabismus.

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 70 Anganwadi schools with 1,100 children enrolled. The investigator interviewed the teachers, parents and caretakers for identification of children with strabismus and atrisk for strabismus. There were 185 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 strabismic 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 185 children 17 children were identified and referred as atrisk for strabismus. Subsequently 17 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 5 children with strabismus (4 boys and one girl).