Detecting Childhood Blindness using Innovative, Low-Cost Screening Methods: Find the Blind

Visual screening for school children is effective in detecting and treating visual defects at an early stage. Unfortunately, many Indian children with visual disabilities do not attend schools, leaving them to be raised at home. There are many hurdles in detecting, diagnosing and treating such children. We intend on bridging the gap by ensuring that all children with visual disabilities are detected, and provided access to proper ophthalmology support to treat and rehabilitate them.

Narayana Nethralaya has developed many creative new strategies to detect children with vision and life threatening eye conditions. The group of strategies has been called ‘Find the Blind’, which was conceived by Dr. Ashwin Mallipatna, a pediatric ophthalmologist who leads this group of pediatric community ophthalmology projects.

Photo Red Eye Diagnosis (Photo-RED)

Figure 1: Representative Pictures obtained using the PhotoRED strategy

Representative Pictures obtained using the PhotoRED strategy

Red reflex screening is a standard prescribed method to detect very young (pre-verbal) children with visually threatening eye defects. A policy from the American Academy of Pediatrics suggests that all infants and children be screened by a pediatrician or personnel specifically trained in screening for these defects. When the red-reflex is altered (either absent, or looking white or looks unequal in the two eyes) the child would warrant a full eye examination. In resource-poor countries like India, this procedure is not carried out as a routine. The test involves the use of an instrument called an ophthalmoscope to check the eyes for the red reflection which is not unlike the “annoying” red reflexes in flash photographs.

At the Hospital for Sick Children in Toronto, Dr. Ashwin Mallipatna developed a scientifically sound strategy to consistently induce the appearance of a red-eye in digital flash photographs of children. The strategy uses an inexpensive digital camera set with the right parameters and using the proper subject conditions to ensure that a red-reflex be obtained in all normal children.
We pilot tested this strategy and found that it was effective in detection of vision and life threatening eye conditions in very young children, including a pediatric eye cancer called retinoblastoma. An appropriately trained red-reflex screener would take digital photographs in the prescribed way and send suspicious photographs to a pediatric ophthalmologist. The obtained photographs are read by a pediatric ophthalmologist for possible abnormalities and the results sent back to the red-reflex screener.
The utilisation of this technology has won the Humanitarian Award from Technology Review (India), which is a publication affiliated to Massachusetts Institute of Technology in the United States.

Child to Child Strategy

Home screening of a visually disabled child detected using the child-to-child strategy.

Home screening of a visually disabled child detected using the child-to-child strategy.

A key-informant is a person who is responsible for bringing a medical condition to the notice of the medical authorities. In this project our objective was to effectively train village citizens to be key-informants and identify obvious eye abnormalities and visually-impairment in the children of their community. We trained community health workers, non-health workers and school children with the knowledge required to find young children who may be facing a lifetime of blindness within their community.

The development and implementation of a pilot project was carried out by Narayana Nethralaya. After an hour of a lecture, the key-informants would go out into the community and report cases of childhood blindness from their neighbourhoods. Through this pilot project, we were about to find children with blindness up to 16 kilometers away from where the teaching was conducted within a week of our teaching. Our key informants were able to identify about 50 children with possible eye problems. On a follow-up screening of the children identified, we were able to find about 25 children with blindness. The children with untreatable blindness were put on rehabilitation programs.
This program is unique and novel in its ability to rapidly screen rural communities for children with treatable and untreatable blindness, and bring them to proper care. This strategy has proven to be more efficient in the detection of severe blindness when compared to house-to-house screening, vision screening in schools or eye camp related activities. In the coming years, we plan to expand our area of coverage. This strategy has the potential to find children with physical and intellectual deficits as well.

Found for life project: Smartphones for Health Workers

Smartphone enabled location tagging of the house of the visually disabled child.

Smartphone enabled location tagging of the house of the visually disabled child.

Armed with a GPS enabled smart phone, an ophthalmic assistant will visit the home of each child with a visual deficit. These children will be briefly examined by the ophthalmic assistant and photos will be obtained and documented in a database. The parents will be advised about where and how they can seek help, and the location of the house will be recorded using the GPS. The progress of the child will be periodically monitored by health workers, using these GPS co-ordinates to find the house and child. Systematic registering of every child with a visual disability will help us keep track of their progress.

For further details contact us

Sowmya Raghavan (Project Co-ordinator)