Screening of Refractive Errors Models

cover song of refractive wrongdoings Models overlord ArticleStudent reticuloendothelial systemearch CommuniquTITLE Comparison of dickens object lessons for test of Refractive errors in initiate going children of rural argona in Vadodara, GujaratAbstract-Introduction Glob altogethery t here is 18.2% of blindness imputable to the un change by reversal firm errors. Most of the children with un turn refractive error are asymptomatic and hence natural covering helps in early detection and timely interventions.Aim- To compare validity and reliability of nettlesome error screening by develop initiate teacher with prepare medical examination students.Methods- Training was given to the teacher of the regulation 5-8 regarding how to appoint the contumacious error among School children by using snellans chart. Result reports were collected from teachers. later two week investigator team visited the instill and screen for resolute error in the selfsame(prenominal) prepare children by using snellans chart. Results of these screening methods were analyzed and compared.Result- Kappa statistics 0.4482 bespeak the reliability and Sensitivity = 31.25%, Specificity = 96.40% sharpen the validity of screening method 1 (screening by school teacher ) compare to method 2 (screening by medical students)Conclusion- screening by school teacher is not useful model for diagnoses of refractory error among school going children.INTRODUCTION-In the visual impairment both Blindness baseborn vision included. Worldwide 285 million people are suffering from visual impairment, among these 39 million are blind and 246 million have low vision. Globally, uncorrected refractive errors are the main cause of visual impairment. 43% of visual impairment is due to refractory errors. 80% of all visual impairment fecal matter be avoided or cured.1In India refractory error is the second most leading cause for all age group but it is the first among child age group for visual imp airmnet.2Refractive Error is defined as a state of refraction, when the parallel rays of trip coming from infinity are rivet either in front of or behind the sensitive layer of retina, in iodin or both the meridians.3It is also known as Ametropia. The Ametropia includes Myopia, Hypermetropia and astigmatism. Myopia or Short-sightedness in which parallel rays of light coming from infinity are focused in front of the retina when alteration is at rest. Hypermetropia or Long-sightedness is the state of the eye wherein parallel rays of light coming from infinity are focused behind the retina with accommodation being at rest so the posterior focal point is behind the retina which therefore receives a blurred image.3The children aged 5 15 are school going students. Refractive error in such age group can harm their learning capicity. So Early diagnosis in schools for refractive error can be useful to stop the increasing number of such handicap and qualitative education can be got by the school going students.A simple midriff test and glasses can restore sight to most of affected people. As for WHO, correction of Refractive error is a compvirtuosont of currant global initiative to reduce avoidable or treatable blindness, in Vision 2020 which is considered a current top priority and challenge for all the nations.4Strategies to address eye wellness of children in India have focused on school eye wellness programme. School eye health screening is also part of the national blindness control programme.5 If, we trained the school teachers for identification of refractory errors among school children using vision chart than it will serve as alternative of tradition eye screening programme. Routinely eye screening was d integrity annually but if, school teacher is trained in such influence they can screen every student systematically using allow for time and also do such screening twice in a year. So here this field of meditate was conducted to find alternative of refractory error screening by health profession. By this charge the burden over existing health care system will reduce. present we compare two screening model and check the validity and reliability of new model ( obstinate eye screening by school teacher).METHODOLOGY reflect Population-School going children (Standard 5-8)Design of the study- Screening studyStudy Area- Rural area of Vadodara talukaSampling- Random sampling mthodsSample size- one hundred fifty inclusion body criteria-School going children of standard 5th to 8thExclusion criteria-Study participant suffering from refractory error and already diagnosed for refractory error.Participant does not want to put down in study.Methodology-in the beginning Study started, we obtained the permission from the ethical committee of Sumandeep Vidyapeeth. Then we obtained the list of rural schools in Vadodara taluka from DEO office, Vadodara. We selected randomly one school from the list by lottery method. Selected school was Gover nment school, Amodar. After selecting the school, we also obtained the permission from school principal to conduct this study in their school. We discussed with teacher regarding the various aspects of study. All teachers agreed to volunteer participate in the study. We gave training to the teacher of the standard 5-8 regarding how to diagnose the refractory error in School children by using snellans chart.Training of Teacher-Those school teachers, who ready to voluntarily participate in this project, were trained for identification of refractory error by using snellans chart. First we gave some basic randomness about refractory error in understandable local language (Guajarati), then we demonstrated them how to diagnose refractory error by using snellans chart. Every teacher had to perform this procedure in front of us to insure that they understand the whole procedure. Those who had doubts and difficulties was discussed, and corrected so every teacher uses this procedure with sam e standard.We included all the students from class 5th to 8th of selected school in to study. Total 150 students participate volunteer. After obtaining informed consent from students and their parents, visual acuity was measured and recorded by teachers. On another convenient day same children were examined by Investigators (medical students) in absence of teacher using the monovular protocol and same vision charts. To avoid bias we masked the teachers results (first screening result) during second screening .statistical analysisData collected in individual forms for every student were compiled in Microsoft Excel sheet. boldness and reliability of model 1 refractory error screening by school teacher is compared with model 2 refractory error screening by medical students. Sensitivity and specificity, positive predictive foster and negative predictive value indicate validity and Kappa statistics indicate reliability.RESULTSFigure 1- Sex and Age bracing distribution of study partic ipantFigure 1 shows the sex and Standard (Class) wise distribution of the study participant. bow 1- Distribution according to Diagnosis by School teacher and medical studentsKappa statistics 0.4482Sensitivity = 31.25%Specificity = 96.40%PPV = 50.00%NPV=92.41%Table 1 shows that screening result of two models, kappa statistics is an indicators of reliability. In our study kappa statistics is found 0.4482, it indicates poor reliability it indicate only 44.82% of result has similar results between two screening methods. In our study, validity is determined by sensitivity and specificity. Sensitivity is very low 31.25% while specificity is 96.40%. it shows that Screening model 1 (screening by school teacher) identify only 31.25 % of students suffering from refractory error and missed 68.75% of students suffering from refractory.DISCUSSIONStudy shows the diagnostic ability of trained school teacher in diagnosis of refractory errors as compared to diagnosis of refractory errors by medica l students by using same vision chart.A refractory error is the one of the common ocular morbidity among the school going children.6 School health programme is the only one opportunistic screening where refractory error can be diagnosed in Indian health system. repayable to the lack of the health worker, every school student is not screened using standard methods.7 Here we assay to compare another model of refractory error screening (screening by school teacher). This is the cost trenchant model because training of teachers and vision chart is the only requirement for implementation of such health economy model. If refractory errors is missed to identify than it will lead to considerable disability to the students so sensitivity mustiness be high enough. But in our study the sensitivity is very poor (31.25%). In the study of Anand sudhan sensitivity was found very good and specificity was very low as opposite to our study result.8 windupIn our study, we compare the Model 1 (Sc reening by Teacher) with Model 2 (Screening by Medical student). Screening by teacher has poor sensitivity and reliability compare to screening by medical student. So the model 1 (Refractory error sceening by scholl teacher) is not useful health delivery model because it is unable(p) to identify the student with refractory error by required sensitivity.ACKNOWLEDGEMENTWe are thanks to the regulate education officer (Vadodara), Principal (Government school, Amodar) and teachers of Government school, Amodar, without their kind support this project is not possible.BIBLIOGRAPHY1.http//www.who.int/mediacentre/factsheets/fs282/en/ go out on 09/03/20132. Park.K, Non Communicable disease, Textbook of preventive and Social medicine, 21th edition, Jabalpur (India), M/s Banarsidas Bhanot Publisher, 2011335-379.3. A K Khurna, Refractory Error, Comprehensive Ophthalmology, 5th edition, New age international publisher, 2012, 28-324.http//www.scielosp.org/scielo.php?pid=S004296862001000300013scr ipt=sci_arttext dated on 04/09/20135. Limburg H, Kansara H. Result of school eye screening of 5.4 million children in India- a five year follows up study. Acta opthalmo scand 1999 77 310-3146. B.T.Prasanna Kamath, B.S.Guru Prasad, R.Deepthi, C.Muninrayana. prevalence of ocular morbidity among school going children (6-15years) in rural area of Karnataka, South India. Int J Pharm Biomed Res 2012, 3(4), 209-212.7. GVS Murthy. Vision Testing for refractory errors in schools- Screening Programmes in Schools Community Eye Health 13(33). 3-58. A sudhan, A pandey, suresh pandey, P shrivastav et al. Effectiveness of using teachers to screen eyes of school going children in Satna soil of Madhya Pradesh, India Indian J Opthal 2009 55 455-458.CommentsColored texts are entirely copy pastedAnswer correctedThe author has mentioned medical professionals at one place and medical student at another place. thither is a scope for ambiguaty. In this type of study where comparision is made between lay man and medical man, it would be nice to mention 1st year, 2nd year or degree holder doctor. It will accession the importance of parameters of comparison.Answer- here we are not compare the laymen with the medical student. here we compare the teacher trained to diagnose refractory error with third year medical students ( already skilled to diagnose refractory error). Under national school health programme teacher has to screen the children for the refractory error. Here we check the validity of this method.Materials and Methods section should be written in paragraph formatAnswer correctedThe entire texts need a meticulous copy editing.Answer correctedReference no. 4 is not openingAnswer - It is not accessed now, but on it 04/09/2013 was accessible. The content may be outback(a) by the website.Overall commentComparing the ability to perform a task which concern to medical expertise between a medical man and a layman need more justification. It shall be incorporated in the backgro und and/or Introduction part of the manuscript. In other words, the author has failed to apologise the need of the study.Answer In the last paragraph of introduction it is already mentioned the need and adjudicate of the study added the some sentencesFinal comments 14-08-2014I believe that the manuscripts send to the reviewers are already checked for pliagarism. because I am not scrutinizing whether the copy pasted portion shown during 1st review are taken care or not.I still believe that the research conducted is not worth publishing for the flat coat of deficiencies inJustifying the need of the studyb. Material and method section (it even does not mention the essential no of participants, instead has mentioned all students belonging to stad 5-8).C. Professional scientific writing.