National Vision Screening Program

1. Screening Program
for Refractive Errors
in Kindergarten
Children in The State
of KuwaitDr. Khalid Al Anezi
MRCGP (int.)
Head of Jahra School Health Division
State of Kuwait

2. Introduction
• The National Screening Program for Refractive
Errors in Kindergarten Children in The State of
Kuwait is initiated by both school health
administration and the Ophthalmology
departments Counsel , Kuwait MOH.
• This program aims for the Early Detection of RE
in KG children & Prevention of visual disability.

3. Introduction
• These conditions could hinder the child ‘s
academic performance , social interaction , and
cognitive functioning.
• Prevalence in school age children : 12%
• Joint Responsibility. (SH – School – Family)
• Cost-Effective.
• EBM.

4. Refractive errors
• Refractive errors are abnormalities in the way light
from a distant object is focused - via convergence of
rays at the convex cornea and lens - onto the retina.
• Common at any stage of childhood.
• Treatment of refractive errors is with spectacles , to
improve visual acuity and prevent blindness.
• Commonest cause of blindness in childhood &
Adolescence.

5. Goals
• Early Detection of Refractive errors.
• Prevention of complications & Visual Disability.
• Estimation of possible Risk factors for RE &
Visual Health.

6. Methodology
• An estimation of the Total Population of KG1 Children with RE
in all schools (Governmental & Private) in the State of Kuwait.
• Our target Age group is : 4-5 years old.

7. Methodology
Timeline :
Preparation : March 2013 – August 2013
EBM
Joint meetings with ophthalmology Dept.,
Development of Clinical practice protocols
Staff training
Population estimation
Mass Media (Audiovisual , Printed , social M.)

8. Methodology
Starting Date : Sept 2013
Finishing Date : Jan 2014

9. Methodology
Governorate No. of KG
School
(Gov.)
No. of KG
School
(Private)
No. of KG 1
Students
No. of
Nursing
Staff
No. of School
Health
Physicians
Ahmadi 39 18 8462 39 6
Jahra 31 5 3991 31 5
Hawalli 27 52 6241 27 7
Capital 28 4 3000 28 4
Farwania 39 27 10630 39 5
Mubarak K. 34 - 2000 34 4
Total 198 106 34324 198 31

10. Methodology
School Health Nurse
School Health Doctor
Optician & Ophthalmologist

11. Methodology
Examination Technique :
Snellen chart was used in a distance of 6 m. and 1.5-2 m. height ,
pointers were used.
Room with adequate natural and artificial lightening with no
reflective surfaces.
Quiet Environment.
Adequate explanation for school staff , toys .
Disposable Eye pad. (right then left).
Standing sign.
Repetition of the exam by the school nurse in case of uncooperative
child or positive result.
Children with glasses were included.

12. Methodology
Examination Technique :
Recording of result was done in the Student Health File & The
Screening Program Registry.
Follow up examination after 1 month for positive cases , and after 6
months for negative cases.

13. Tools
1- Guardian Consent Form and Risk factors Questionnaire:
A medico legal consent form is distributed to the
guardians of the child to allow the visual assessment by
the nurse , if the guardian agrees , a questionnaire
contains the following :
possible Risk factors to visual acuity.
Whether the Child weirs spectacles or not
Whether previous ophthalmological procedure was
done for the child or not.
The Academic Qualifications for both parents /Guardians
:
(University/College , High school , below High School)

14. Tools
possible Risk factors to visual acuity include :
No. of Hours per day of :
Reading
Writing
Drawing
Using Devices with Screens (Computers , Tablets , Smart
phones , Video Games).

15. Tools
2-TheSchoolClinicRegistry:
Student
Name
Civil ID
Number
Contact
Tel.
The Result Referral Feedback
Report
Recommen
dations
With
Glasses
W/O
Glasses
Rt. Lt. Rt. Lt.

16. Tools
3-ReferralLetterFromSchoolHealthPhysician
:

17. Tools
4-FeedbackLetter fromtheophthalmologist:

18. Results
Province Total NO.
of Children
NO. of
Children
examined
No. of
Children
referred
Absentees &
Refusal
% of
Examined
Ahmadi 8462 4997 88 3465 59%
Jahra 3991 3281 67 710 82%
Hawalli 6241 5492 113 749 88%
Capital 3000 2480 136 520 83%
Farwani
a
10630 5422 106 5208 51%
Mubara
k
K.
2000 1440 102 560 72%
Total 34324 23112 612 11212 67%

19. Barriers
• Shortage of staff
• Constant absence of children
• Refusal (Children / Parents)
• Lack of feedback.
• Overcrowded 2ry point of care.

20. The End