Door-to-door Screening as a New Model Augmenting School Eye Screening: Reaching Out to School Age Children in the Midst of a Pandemic

Barriers to compliance with the use of free-of-cost spectacles prescribed through door-to-door screening of children in urban slums of Delhi

PURPOSE

Compliance with spectacles provided during school eye-screening programs has been low. The aim of this study was to assess compliance to free-spectacles provided to children via a door-to-door screening model and to ascertain the reasons for non-compliance.

METHODS

A cross-sectional study was conducted, including children aged 5-18 years, 3-6 months after spectacle prescription; vision screeners assessed compliance during unannounced visits via direct observation and parental enquiry. Full compliance was defined when a child was wearing spectacle at the time of visit, taking spectacles to school, and using them for ≥4 hours/day at home. Qualified compliance was considered if two of the above criteria were met, and non-compliance as one or no criteria met. Parents' and children's reasons for non-compliance were recorded using a mixed-type questionnaire, and spectacle quality was assessed. The association of compliance with age, gender, spectacle quality, parental education and occupation, parents' or siblings' use of spectacles, uncorrected visual acuity (UCVA), best corrected visual acuity, improvement of VA, and magnitude and type of refractive error was analyzed.

RESULTS

A total of 436 children, including 189 (43.3%) males, were included in the study. Full compliance, qualified compliance, and non-compliance were observed in 297 (68.1%), 34 (7.8%), and 105 (24.1%) children, respectively. Common reasons for non-compliance were unsatisfactory vision with the spectacles, dislike for the frames, watering eyes, and headache. Factors affecting compliance included spectacle quality, distance UCVA in the worse eye, father's education, and mothers' occupation.

CONCLUSION

Compliance to spectacles in a door-to-door screening model was 76%. Quality of the spectacles was the most important determinant of compliance.

Approaches for delivery of refractive and optical care services in community and primary care settings

BACKGROUND

Uncorrected refractive error is a leading cause of vision impairment which, in most cases, can be managed with the appropriate spectacle correction. In 2021, the World Health Assembly endorsed a global target of a 40-percentage-point increase in effective coverage of refractive error by 2030. To achieve this global target, equitable access to refractive and optical services within community and primary care settings needs to be strengthened. This review will inform the development of technical guidance to support improvements in the testing and correction of refractive error among World Health Organization (WHO) member states.

OBJECTIVES

To determine the range of approaches for delivery of refractive and optical care services in community and primary care settings, and the methods employed for their evaluation.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase and Global Health databases, grey literature, and annual reports and websites of relevant organizations involved in eye-care delivery from January 2002 to November 2022 to identify approaches for refractive and optical service delivery.

SELECTION CRITERIA

We included observational and interventional studies, reviews, and reports from relevant organizations related to delivering refractive services and optical services for preschool and school-aged children and adults in community and primary care settings published between January 2002 and November 2022. We searched for studies and reports published within the last 20 years because vision impairment due to uncorrected refractive error has only recently become a public health and eye health priority, therefore we did not expect to find much relevant literature until after 2002.

DATA COLLECTION AND ANALYSIS

Two review authors screened titles, abstracts and full texts, and extracted data. We resolved any discrepancies through discussion. We synthesized data, and presented results as tables, figures, and case studies. This project was led by the World Health Organization (WHO) Vision and Eye Care Programme.

MAIN RESULTS

We identified 175 studies from searches of databases and grey literature, 146 records from company reports, and 81 records from website searches of relevant organizations that matched our inclusion criteria. Delivery approaches for refractive and optical services in community care included school-based, pharmacy, and outreach models, whereas primary care approaches comprised vision centre, health centre, and a combination of vision or health centre and door-to-door delivery. In community care, school-based and outreach approaches were predominant, while in primary care, a vision-centre approach was mainly used. In the WHO African region, the school-based and outreach approaches were mainly reported while, in the Americas, the outreach approach was mostly used. Very few approaches for service delivery were reported in the WHO Eastern Mediterranean region. Prominent gaps exist in the evaluation of the approaches, and few studies attempted to evaluate the approaches for delivery of refractive and optical care services.

AUTHORS' CONCLUSIONS

We comprehensively describe a range of approaches for delivery of refractive and optical services in community and primary care. Further evaluation of their effectiveness will better inform the application of these service-delivery approaches. The study outcomes will help guide WHO member states in strengthening refractive and optical services at community and primary care levels.

FUNDING

This scoping review was supported by the Vision and Eye care Programme, World Health Organization and ATscale Global Partnership.

REGISTRATION

The protocol of this scoping review was published in the Open Source Framework.