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Programmes that provide protective eyewear to agricultural workers in developing countries can significantly reduce the risk of eye injuries, said Samrat Chatterjee MD, MGM Eye Institute, Raipur, Chhattisgarh, India, who received the Orbis Medal for his presentation at the Orbis free paper session at the XXXII Congress of the ESCRS in London.

“Agricultural workers in developing countries are prone to eye injury. Such injuries if severe can lead to penetrating eye injuries, or if trivial can lead to corneal abrasions. Corneal abrasions can get secondarily infected and cause corneal ulcers, bacterial or fungal, which is a significant cause of blindness in developing countries,” Dr Chatterjee said.

Dr Chatterjee presented the results of a prospective randomised interventional study, in which 575 agriculture workers in central India received clear plastic goggles with side covers for the purpose of eye protection while engaged in harvesting activities. Another 575 workers served as controls. Those in the safety-goggles group also received counselling on eye protection in one-to-one meetings and group discussions with community health workers.

A survey carried out immediately after the harvesting season showed that the frequency of eye injury was significantly lower among those in the eye-goggles group than it was in the control group (0.73 per cent vs 11.30 per cent, p< 0.0001). However, the survey also showed that the goggles were not universally accepted by the workers.

That is, 76 per cent said they wore the goggles most or all the time during work, nine per cent used them half the time, 13 per cent used them some of the time and two per cent did not use them at all. The reasons cited for poor acceptance of the protective eyewear included clouding of vision, discomfort, slowing down of the pace of work, breakages, an awkward appearance particularly amongst the female workers, forgetfulness and the perception that they provided no real benefit.

“This primary intervention was well accepted by the majority, although there were certain issues in the design and usage of the safety eyewear which need to be addressed to make this measure of prevention gain a still wider acceptance,” Dr Chatterjee concluded.


Preschool Vision Screening

A related presentation demonstrated how enlisting the aid of community health workers for the screening of preschool children’s vision could contribute to earlier, sight-preserving interventions in cases of high refractive errors or eye disease.

The retrospective community-based study was a part of Ramakrishna Mission Hospital-Orbis International, Country Office India Childhood Blindness Project conducted in Papumpare District, Arunachal Pradesh, India from 2008-2010, said Lobsang Tsetim MD, Ramakrishna Mission Hospital, Itanagar, Arunachal Pradesh, India.

Dr Tsetim and associates recruited 93 community health workers, known as Anganwadi workers, from 53 community/Anganwadi centres and trained them in screening preschool children for eye problems, who in turn screened all of the preschool children in their centres and villages. Those with eye problems were then further examined by orthoptists and/or ophthalmologists.

“Anganwadi workers are female health workers chosen from the community and given training in health, nutrition and childcare. They are well aware of the ways of the people, are comfortable with the language and know the rural folk personally. They were chosen to participate due to the shortage of trained ophthalmic manpower,” Dr Tsetim said.

The Anganwadi workers screened a total of 3,563 children. Of those, 624 (17.5 per cent) children were referred to the eye screening camp for further assessment. Some 63 per cent of these required more than one examination by the orthopist and 28 per cent were subsequently referred to an ophthalmologist for further assessment.

Dr Tsetim and his associates found that 178 required spectacle correction and received free glasses, and 58 children had significant refractive errors. They detected amblyopia in four children, five had squints without amblyopia, four children had Vitamin A deficiency, three patients had corneal opacity and one had ptosis.

“Vision screening for preschool children by health visitors is an effective alternative to primary screening by orthoptists. The findings suggest that using health visitors to screen vision in preschool children makes efficient use of existing routine checks,” Dr Tsetim concluded.


Samrat Chatterjee:

Lobsang Tsetim:

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