Introduction
Established in 2004, Nepalese Association of Optometrist (NAO) is a not for profit national non-government and professional organization working to uplift eye care services in Nepal. The association is formally registered to the chief district office of the government of Nepal. With over 300 members optometrist registered, the association has been working in the areas of primary eye health care, health promotion and rehabilitation from its beginning. Special focus has been given to people who have poor access to eye health services. Regular conduct of school screening camps and community eye camps by the association has served thousands of people restore their eye health. While health promotion activities have made another thousands of people in the rural communities aware of the health conditions that can disrupt from seeing well. The association has a wide network throughout the country through its regional representatives. Coordination and partnership with stakeholders from central to grass root level has remained the major thrust for success in projects carried out by the association so far.
NAO provides platform for professional development for Optometrist so that common Nepali people will get quality eye service with licensed and skilled Optometrist. NAO has been helping rural and unreached population with Ocular screening from 2004 since our establishment. NAO has taken lead in for eye care service to the needy affected during Earthquake 2015.It has always advocated in the favor of government owned eye care policy and service in Nepal.
Ocular Morbidity is increasing in school children with increase in near work and digital gadget use. In elderly population there is a huge chunk of presbyopia and other ocular pathology like Cataract, Glaucoma, Diabetic Retinopathy etc. In the recent Report on Vision by WHO 2019, 50% of the world population will be myopic by 2050. The number of people with myopia will increase from 1.95 billion in 2010 to 3.36 billion in 2030. The number of people with high myopia, often associated with severe complications, is projected to increase from 277.2 million in 2010 to 516.7 million in 2030. Three Asian regions alone (representing 51% of the world’s population) account for 62% of the estimated 216.6 million people in the world with moderate and severe bilateral presenting distance vision impairment: South Asia (61.2 million); East Asia (52.9 million); and South-East Asia (20.8 million). The prevalence of bilateral blindness in low- and middle-income regions of western and eastern sub-Saharan Africa (5.1%) and South Asia (4.0%) are reported to be eight times higher than in all high-income countries (<0.5%). It is expected that average ocular morbidity of Nepal is 20% and 10% of school children need spectacle corrections.
Eye care is not adequately integrated in basic health service by GON that’s why all the eye service is delivered by NGO i.e., NNJS, Tilganga, Bp eye foundation, Reiyekai and few private hospital and eye center. The burden of increased myopia if not addressed on time will have devastating effect on the overall performance of the child. People are scared of screening their eyes as they have fear of wearing Spectacle. If not screened and treated on time they may increase comorbidity associated and decrease the quality of life of the people.
Rationale
Visual Acuity less that 20/20 in children can be an indication of Ocular morbidity associated with refractive error like myopia, hypermetropia, astigmatism, and amblyopia, which has significant affect in children learning abilities and intellectual development. In adult it can be indicative of refractive error, ocular pathology associated with cataract, glaucoma, retinopathy and many more. Less than N6 in near vision is indicative of Presbyopia which can have significant effect on the quality of life of general people.
As refractive error is increasing day to day in children and they are more involved in household games which has increased the risk of amblyopia, if not treated on time, it can have significant effect on the ocular health, it can promote deviation of eye and may be unilateral or bilateral blindness and can affect the overall performance of the children. In Adult near and distance visual acuity can have significant effect on the quality of life of adult. Maximum people are unaware about the ocular problem they have because they are afraid of ocular checkup and fear of Spectacle wear. Ocular health screening can be the first tool to diagnose some of the Non communicable disease like hypertensive and diabetic cases. There is the need of awareness about vision screening among common people so that regular vision screening will help them to combat ocular as well as some of the systemic comorbidity.
Objective
General Objective
To Screen Visual Acuity of child from Age 5 to Adult of all the age group.
Specific Objective
Method
Sampling Technique
Non-random, opportunistic
Sample size
Approximately 100,000 population
Number of participants and Justification:
This is a non-random sampling unit based on our previous vision screening experiences.
Criteria for sample selection
Child from Age 5 to Adult of all the age group.
Data Collection Technique
Interview and Vision Screening
Description of research design
This will be a cross-sectional study to create awareness of Vision screening. The collected data will be used to estimate the proportion of Vision Morbidity of Patients.
Process
Following steps will be followed:-
Tool
Vision Screening will be one by Snellen Vision Acuity Chart. The questionnaire will be asked to collect information from an interview.
The questionnaire is developed by Nepalese Association of Optometrist will be validated by pre-testing.
Plan for supervision and monitoring
An advisory board and organizing board will be established under the leadership of principal investigator for proper supervision and monitoring.
Plan for data management and analysis
Data will be collected using pen and paper method. The collected data will be transported to our field office in Maharajgunj then, data’s collected will be entered in our database. The data will be utilized to prepare a separate paper and to prepare a global paper.
Ethical Approval
Budget
| Human Resource Cost: | Rs 5,00,000 |
| Field cost: | Rs 5,00,000 |
| Vision Chart and Tool printing | Rs 3,00,000 |
| Data management cost: | Rs 50,000 |
| Report writing and dissemination Cost: | Rs 1,00,000 |
| Logistic cost: | Rs 2,00,000 |
| Monitoring and evaluation Cost: | Rs 50,000 |
| Leaflet + Miscellaneous cost: | Rs 2,50,000 |
| Ethical Approval Cost: | Rs 10,000 |
| Total budget of research: | Rs 15,10,000.00 |
| Is this research funded? | Yes |
Expected Outcome
The project will create awareness about the Vision Screening in general public, especially in schools where they should screen their children vision before taking admissions and regularly in three months’ time. Our Volunteer will teach two students and two teachers how they can carry out vision screening in their own school themself and send the suspected students to hospital for further evaluation. It will provide data to estimate the proportion of vision morbidity.