Effectiveness of vision screening program to reduce visual impariment among preschool children in Malaysia

Abstract

Visual impairment is a serious problem among children. Eighty seven percent of the amblyopic cases found in school children age between 7 to 15 years old in Malaysia were due to uncorrected refractive errors. If untreated the children will not be able to perform well in school due to blurred vision. Therefore early detection is recommended by conducting vision screening at the preschool level. This study was conducted to determine the effectiveness of vision screening conducted by preschool teachers in Malaysia. The challenges in developing this program included convincing KEMAS to participate in this project and to identify the teachers who are committed to complete the training and conduct the program at their workplaces. A vision screening module was developed consisting of a vision screening kit and a vision screening manual that is to be used by preschool teachers. 60 preschool teachers from Tabika KEMAS Wilayah Persekutuan Kuala Lumpur and Taska KEMAS Negeri Selangor were chosen randomly. The teachers were divided into two groups with thirty teachers in each group. All of the teachers were given a written test on their knowledge of vision impairment and vision screening before and after training. The subject group was given theory and practical training on how to conduct vision screening using the kit and manual. The control group was only given a brief instruction on how to use the kit. Each teacher was asked to conduct vision screening on 15 children aged 4 to 6 years old at their preschool premises. The tests involved external inspection of the eye, visual acuity testing and the Hirschberg's test. The vision screening was then repeated by trained optometrists on the same children. Children who failed the vision screening tests were referred to the UKM Optometry Clinic for further examination and treatment. A total of 703 preschool children were screened. Forty eight of them failed the vision screening tests and were referred for further examination. The sensitivity and specificity of the referrals was 63% and 92% respectively. The level of agreement between the preschool teachers and optometrists for the visual acuity test was 0.89 and for the Hirschberg's test was 0.95. There was a significant difference between the test results of the teachers before and after training with p<0.05. These findings suggest that with proper training, the preschool teacher's awareness and knowledge on vision impairment in preschool children can be improved. The preschool teachers are able to conduct vision screening effectively which will facilitate early detection of vision impairment. Therefore the module developed can be suggested to be incorporated as part of the preschool teacher's curriculum.