Hyperopia, a Catalyst to School Dropouts – Can we do Better?

Hyperopia, commonly referred to as long sightedness, is an academic refractive error in children where distant objects can be seen clearly but there are difficulties with near vision. Symptoms include eye strain, headaches, accommodation, difficulty in reading at a near distance, difficulty in concentrating squinting, less eye movements in reading and distorted vision. The refractive system of the eye that include the cornea and the lens doesn’t refract properly, so nearby objects are blurry. Hyperopia is also caused due to the eyeballs being too short and this is called axial hyperopia. Vision in hyperopia is reliant on the tiny ciliary muscles within the eye which continually contract and relax, altering the shape of the lens and bringing the object into focus. This is the source of all the above symptoms.

Link with dropping out from schools

Many practitioners overlook hyperopia due to its self-limiting nature. Hyperopia of anything above +1.00 at age 14 and above may mean permanent hyperopia. Many studies have associated hyperopia with poor scores in class and hence school dropout. More evidence was gathered through an academic study conducted by George Moyo and Sanchia Jogessar at Mzuzu University in 2012, where 100 learners of ages 13 – 15 attending primary school were recruited. The results were that 26% of the learners were hyperopic (plus lens test).

This is an academically critical average age group and any disturbance during this age group may lead to failure to compete with their peers.  Ammetropia may still happen even later than this age group. All of this leads to lost opportunities.

Diagnosing and correcting hyperopia at this age group may initiate a competition for places in the Public sector. This is a never picked upon condition during the screening programmes in schools as the usual target in School Screening is myopia and some higher astigmatism detected using a snellen chat with a cut off of 6/12. This means anybody who has a vision of 6/12 and above is considered having normal vision and nothing is done to this group! This is a higher form of health inequity. For Malawi, this is the age group that needs to score highly in their final exam in order to enter High School, otherwise, learners have to repeat and repeat and finally drop out at this level. Failure to find a place in public high schools leads to higher dropouts.

I therefore feel we need to include full refraction or plus lens test to be included during School Screenings to capture the hyperopes who need to get a simple correction if children are to compete equally in schools. This will reduce the school dropouts as hyperopia correction is believed to increase the love of reading and hence the love of school.