Simple Technique in Identification of Children with Strabismus

Introduction

“Vision without action is a daydream.

Action without vision is a nightmare”

-          Stephen S.Wise (2004)

            Human eye 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. 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. 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).

The University of Texas, USA (2006) reported that only 21% of preschool children received eye examination and when it comes to a comprehensive eye examination the percentage dropped further. It was estimated that 5 to 10% preschool children suffer undetected vision problems as they never got an eye examination. As a result, long term vision outcomes, education achievements and self esteem of these children will be permanently affected owing to failure of early detection of visual impairments. Therefore, many professional organizations including American Academy of Pediatrics (AAP), stress the necessity for detecting vision problems at preschool levels and treating the same before they enter school. 

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. Hence a study is planned in the educational setting using indigenous techniques and devices.

The present research study entitled encompasses primarily to study the importance of early vision screening and how these children can be identified using simple techniques in the classroom setup and correcting the strabismic children with glasses, patches and exercises.

Statement of the problem and Operational definitions

            The problem of the current research study is stated as “Simple Technique in Identification of Children with Strabismus”.

Operational definitions

The operational definitions of the terms used in the study are as follows

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.

            In this study the samples were having only the esotropic and exotropic strabismus whereas the hypertropic and hypotropic types were not found among the samples.

Pseudostrabismus : It is a false appearance of Strabismus. Strabismus is usually falsely anticipated when the patient has a flat, wide bridge of the nose and a fold of skin in the corner of the eye that makes the eye appear to be turned inward. Pseudostrabismus is typically found in infants and children. (Strabismus.com)

Anganwadi : The children between 2-5 years are enrolled and their growth, supplementary feeding, immunization, distribution of vitamin A, Iron and Folic acid supplements, treating minor ailments, referring medical services were monitored (ICDS -International Child Development Services., 1995).

 In this study the strabismic children were identified from 50 Anganwadi schools representing the North, and South block of Coimbatore district.

Objectives of the Study

The objectives of the study are to:

·         Screen children using indigenous devices and techniques

·         Identify children with strabismus and atrisk for strabismus enrolled in anganwadi programme.

·         To inculcate the knowledge about the importance of early vision screening.

·         To give remedial programmes on how these children can be identified using simple techniques in the classroom and home setup itself.

·         Create awareness to teachers, parents and caretakers on the effect of strabismus and the benefits of vision therapy and visual efficiency training activities to overcome strabismic problem.

Methodology

The researcher adopted Quasi – experimental study to screen and Identify children with strabismus and at risk for strabismus enrolled in anganwadi programme.

            The investigator also used Case study approach for careful and critical investigation of the individual’s sensory skills particularly vision skills with the support of parents and teachers. The study was designed on the basis of Pretest and Posttest without control group Design.

Site description

The present study was conducted in Anganwadi schools situated at Coimbatore district covering North block and South block including both urban and rural areas. The Strabismic children were identified from 50 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 1,500 preprimary children age group between 2 – 5 years. These children were enrolled in 50 Anganwadi schools, registered under ICDS project of Coimbatore District.

The investigator gathered information from the teachers and parents with regard to the problems encountered by the anganwadi children. Based on the information, the investigator used Hirschberg method and identified 31 children having strabismic and at risk for 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 with 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.

      It was found that cent percentage of the children were congenitally strabismic.

      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.

      It was found that, the remedial programmes on identifying strabismic condition at classroom or home itself was very valuable.

      It was revealed that, the remedial programmes and awareness programmes helped in overcoming the vision problems such as appearance of the eye, complaints reported and behavior exhibited by the children.

      The teachers, parents and caretakers told that the remedial programme and awareness programmes promoted better understanding of the problems of strabismic children.

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 and awareness  programmes. The early identification and intervention 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 and intervention for strabismus. Awareness among the parents of anganwadi children enhanced them to undertake the identification process, to know about the childs eye condition. So that every child enrolled in anganwadi schools will be benefited.

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