Universal Vision Screening for School Children in Bangladesh: Evidence on Need, Feasibility, and Public Health Implications
Abstract
Uncorrected refractive error (URE), meaning an error in the eye that impacts how clearly an object appears, is the leading cause of visual disability among children around the world. URE disproportionately affects children living in low and middle-income countries, such as Bangladesh. While there is a large burden of URE and it can be treated easily, there are very few systematic school-based initiatives for screening children for vision problems. This study investigated how much demand there is for school-based vision screening and the feasibility of implementing such screening programs in Bangladesh using secondary data from an NGO-led screening program. A retrospective cross-sectional study of 320 primary school students (640 eyes) who screened for vision using autorefractors under standard settings was completed in Dhaka, Barisal, and Chandpur during 2015. Refractive errors were found in at least 91.6% to 94.8% of screened eyes. Myopia accounted for at least 30% to 42% of the detected refractive errors. The child-level prevalence of refractive error was estimated at 93.5% (95% CI: 90.8%- 96.2%). The reported incidence of refractive error in this study, while much higher than the population-based prevalence, is likely due to selection bias (screening was conducted among people with current symptoms) rather than reflecting true national prevalence. However, the data support that there is a large burden of previously undiagnosed visual impairment in this population and support the idea that school-based vision screening should serve as an effective tool for the early identification of visual impairment and for the timely provision of treatment. Without the rapid implementation of systematic nationwide screening programs, a large proportion of preventable blindness and visual impairment in Bangladeshi children would stay undiscovered and would have a severe impact on their scholastic performance and the development of human capital in the long run.