Vision screening of kinder pupils aims to detect errors of refraction, lazy eye

The Philippine Eye Research Institute (PERI) of the UP Manila National Institutes of Health (UPM-NIH) marked its 50th founding anniversary through a media presentation of its “National Vision Screening Program (NVSP) for kindergarten pupils held recently at the UP Manila Museum of a History of Ideas.

The NVSP aims to screen all kindergarten pupils entering the Filipino school system at age 5 or 6 in order to detect errors of refraction and amblyopia (lazy eye condition). Both conditions were proven to be quite common in young pupils nationwide. According to PERI Director and Project Leader Dr. Leo Cubillan, the vision screening program aims to detect the “lazy eye” amblyopia. At birth, a person is not born with a 20/20 vision; sight is developed afterwards at growth and development. In some children during development, a child may have one of the eyes develop a different area of refraction. One eye will have a higher refraction than the other, thus one eye will be clearer than the other.

This condition is treatable but it has to be detected and treated before seven years of age. Kindergarten age starts at 6-7 years old. Dr. Cubillan explained that PERI is supportive of the K-12 program because children who will enter kindergarten will be five years of age. Asked why the Lea Chart was used in screening the pupils, he said that the common Snellen Chart would be difficult to use for children who are just beginning to read. The way to detect this problem is to use another test that uses symbols instead of letters which are used by the Lea chart. After two years of extensive research, PERI developed the vision screening kit for Filipino pupils that includes, apart from the LEA symbols chart, a transparent response key, eye occluders, and training manual.

The program intends to train one teacher per district, who will then train all kindergarten teachers of the district, for them to be able to do this screening every year. The DOH is pushing this screening activity to do at least once a year, during the August 'Sight Saving Month.'

Vision screening for children is a cost-effective way of identifying those with visual impairment, especially amblyopia or lazy eye. Permanent blindness can be avoided if lazy eye is diagnosed and treated before age seven. One out of 20 preschoolers and one out of every four school pupils in the Philippines has an eye problem. For early-age children, the condition often goes unnoticed. This makes vision screening an important tool to prevent and treat visual impairment for this age group.

The program was pilot-tested at the Aurora Quezon Elementary School on November 25, 2013 and at the Justo Lukban Elementary School on November 28, 2013, both in the City of Manila. The pilot tests were successful that the researchers were able to train teachers while students understood easily the screening test. The teachers that conducted the screening were impressed with the tools used, including the LEA Symbols chart.

Currently, a bill promoting the said program is awaiting passage in Congress. House Bill No. 5190 or “An Act Establishing a National Vision Screening Program for Kindergarten Pupils and Appropriating Funds Therefor” is principally authored by Rep. Kimi S. Cojuangco and is being sponsored by Sen. Pia Cayetano.

Vision screening is one of two visual health projects being spearheaded by PERI. The other is Retinopathy of Prematurity (ROP) screening that enabled Filipino ophthalmologists to develop guidelines for the Philippine setting.

Blindness from ROP and amblyopia are part of the causes of blindness of an estimated 480,000 Filipinos of which a significant number are preventable and treatable with timely screening and appropriate interventions. Figures from the situational study done by PERI and the World Health Organization showed that of 237,070 premature births per year in the Philippines, 34,510 are at high risk for developing ROP.

Formerly known as the Institute of Ophthalmology, PERI is dedicated to the advancement of ophthalmology in the country through basic, clinical, epidemiological, and translational research.

(Written by Fedelynn M. Jemena and Cynthia Villamor)