Addressing Childhood Blindness in South Sulawesi

Satyaprabha Kotha and Gwyneth Cotes on addressing Childhood Blindness in South Sulawesi…
The Global Burden of Disease Study estimates that in 2010 there were more than 100 million cases of moderate and severe visual impairment (MSVI) around the world. In addition, 6.8 million cases of blindness occurred due to uncorrected refractive error (URE)[1].

Integrating vision screening into school health programmes is one of the most effective way to identify children with URE, but when screening is provided, treatment must also be made available and accessible. The essential parameter for success is therefore the provision and use of eyeglasses.

Helen Keller International, with funding from the Seeing is Believing programme, is currently implementing the programme Addressing Childhood Blindness in South Sulawesi. Through this we ensure early detection of common eye conditions, improve service delivery, improve the accessibility and affordability of services, improve awareness of URE, and advocate for changes in national and provincial policies and guidelines.

There are many challenges to providing refraction and optical services at the district level in Indonesia, including:

1. Local governments and private providers are not aware of the regulations for service providers and opticians, refractionist opticians face long waits for renewal of licenses, and there is little oversight of optical shops.
2. There are few refraction opticians and optical shops in remote areas, making access difficult for many.
3. National policies require an ophthalmologist’s prescription in order for the cost of eyeglasses to be covered by insurance. Due to this policy patients must go to the hospital to visit an ophthalmologist.

HKI and its partners have adopted the following approaches to address these challenges:

1. Establish partnerships:

We sensitize and coordinate with district health and education offices to arrange services, and we involve the professional association of ophthalmologists and ROs to provide additional resources for refraction services.

1. Training GPs in refraction services:

In partnership with the refraction academy (LEPRINDO), HKI has trained three general practitioners in each district to carry out refraction for children with the power of -3.0 dioptres to +3.0 dioptres. According to national policy, this is within GP’s competency to refract.

• Carrying out refraction services in districts:

Since 2017, HKI has screened 161,502 children and referred 28,124 students from 24 districts in South Sulawesi. In partnership with the professional association of ROs and ophthalmologists, 2,035 students have been provided with eyeglasses so far.

1. Providing optical services:

Once refracted, the child selects the frame of his/her choice. HKI then dispenses ready-made spectacles to children who fulfil the criteria for their use, and will provide custom-made eyeglasses for the others that need them. The child may be referred to the ophthalmologist for further examination if required.

In districts where the resources for provision of refraction and optical services is very low, establishing partnerships with ophthalmologists and ROs and organizing refraction events in coordination with the district health and education offices may be the only way to ensure that all students with URE get services.

[1] Lou L, Yao C, Jin Y, Perez V, Ye J. Global patterns in health burden of uncorrected refractive error. Invest Ophthalmol Vis Sci. 2016;57:6271– 6277. DOI:10.1167/iovs.16-20242

Image on top: ROs refracting students at the Refraction stations set up for the activity in one of the districts in South Sulawesi