Identification of children with Strabismus using simple techniques at classroom

Introduction

“Vision looks inward and becomes duty. Vision looks outward and becomes aspiration.      Vision looks upward and becomes faith.”

-          Stephen S.Wise (2004)

            The human vision system at birth is under primitive development but rapidly it becomes the remarkable combination of nerve tissues, muscles and optical lenses that provide us with the sense of vision. It is the organ which gives us the sense of sight, allowing us to observe and learn more about the surrounding world than we do with any of the other four senses.  We use our eyes in almost every activity we perform, whether reading, working, watching television, writing a letter, driving a car, and in countless other ways. 

The misalignment of one eye from another is known as squint and it is a fairly common visual problem in young children. It is a crossed eye condition resulting from an eye muscle irregularities making one of the eyes farsighted than the other. This imbalance forces the normal eye to work hard to cope with the functions of farsighted eye, which if left untreated leads to its loss of vision reported by Toronto (1969). The strabismus is prevalent among children in the age group of 5 years or younger which is roughly between 7-8%, whereas 3% of children were affected by amblyopia. Development of cataracts or strabismus into amblyopia can be prevented through early treatment of children (MEDLINE 1999).

In India, ophthalmologist population ratio counts 1: 10,000. 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. Hence a study is planned in the educational setting using indigenous techniques and devices. The present research study encompasses primarily to study the incidence and prevalence of Strabismic children in preparatory schools, importance of early vision screening and how these children can be identified using simple techniques in the classroom setup.

Statement of the problem and Operational definitions

            The problem of the current research study is stated as “Identification of children with Strabismus using simple techniques at classroom”.

Operational definitions

Eye defects : Errors in vision of the eye are called as eye defects. (WHO, 2001). The children with strabismus are the sample for the study.

Strabismus : It is a term used to describe the uncorrectable loss of vision in an eye that appears to be normal. Commonly referred to as ‘LAZYEYE’. (Larry Bickford, O.D., 1999) 

The common types of strabismus are,

Esotropia : One eye is turned inwards. Commonly called as Crossed Eye.

Exotropia : One eye is turned outwards. Commonly called as Wall Eye.

Hypotropia : One eye is directed downwards.

Hypertropia : One eye is directed upwards.

Objectives of the Study

The objectives of the study are to:

• to study the incidence and prevalence of Strabismic children in preparatory schools.
• to study the importance of early vision screening.

·         Screen children using simple techniques in the classroom setup

·         Identify children with strabismus

·         Identify children atrisk for strabismus enrolled in anganwadi programme.

Methodology

            The researcher adopted survey method of study to identify children with strabismus and to identify children atrisk for strabismus enrolled in anganwadi programme.

           

Hirschberg method

            The child is made to sit comfortably in front of the investigator. Using a small torch, the investigator lit it and lighted it up on the child’s nasal point just below the pituitary gland. If the light falls at the centre of both the eyeballs, then the child has no strabismus but if the light does not fall in any one or both the eyes at the centre of eyeball, then the child can be suspected to have strabismic condition. This test can be done by the teacher at the normal classroom setup itself.

Site description

The present study was conducted in Anganwadi schools situated at Coimbatore district covering Singanallur block including both urban and rural areas. The Strabismic children were identified from 45 Anganwadi schools.

Sample selected for the study

The investigator used Purposive Sampling technique to select the sample for this study. The sample chosen for the present study consisted of 1,350 preprimary children age group between 2 – 5 years. The investigator gathered information from the teachers and parents with regard to the eye problems encountered by the anganwadi children. Based on the information, the investigator used Hirschberg method and identified 31 children having Strabismic condition. They were once again screened with the help of adapted checklist from WHO (1993) to find out if there are any problems such as appearance of the eyes, complaints and behaviour of the child.

Tools used for the study

Based on the objectives of the study, the investigator selected suitable tool such as

 i) Personal data bank to collect the information about the subjects such as name, age, gender, date of birth, order of child, any visual problems in family, qualification, occupation and income of parents.

ii) Vision screening checklist developed by WHO (1993) which consisted of 50 items listed under 3 areas, such as Appearance of the eye, Complaints encountered by the children and Behaviour of the children. The purpose of the checklist was to screen the strabismic condition associated with any other visual defects.

Findings of the study

The major findings are summarized as follows:

      31 children were identified having strabismic eyes. Out of which 17 were boys and the remaining 14 were girls i.e., the prevalence of strabismus among boys is more than girls.

      The highest percentage of the strabismic children fall under the age group of more than 3½ years.

      While analyzing the type of strabismus 73% of them having Esotropia and the remaining 27% of them represented Exotropia. It was noted that none of the children had Hypotropic and Hypertropic strabismic.

    The teachers, parents and caretakers were promoted with better understanding of the problems of strabismic children and the identifying strategies of strabismic condition.

Conclusion

            Early identification and intervention is the best means to minimize the eye defects associated with strabismus. Despite enormous challenges encountered by the strabismic children in day to day activities they can also achieve great deals in their life through proper training and follow up of remedial programmes. The early identification enhance equal opportunity and exposure in education and employment in the right time for the strabismic children. Thus the research carried out currently leads us to more hope in the search for the causes for strabismus. Awareness among the parents of anganwadi children enhanced them to know about the child’s eye condition. So that every child enrolled in anganwadi schools will be benefited.

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