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In rural China, there is only one eye doctor per 400,000 people, and that doctor is almost always located in the county seat. In order to seek vision treatment in the county seat, 7 out of 10 rural residents must travel several hours by public transportation. Because of limited access to vision care, only one out of every six or seven children with poor vision has eyeglasses.
During the 2012-2013 Seeing is Learning project, REAP worked with local optometrists to deliver glasses to rural children. We found that eyeglasses significantly improve a child’s school performance, but this distribution model was too expensive to implement on a larger scale.
To build a scalable model, we decided to use a resource already available in schools: teachers. We developed the Vision Ambassador project, where teachers in rural schools learn how to screen their students for visual acuity.
We invited vision ambassadors from 120 schools -- that is, one teacher from each school -- to receive training from our partners at the Zhongshan Ophthalmic Center (ZOC). 100 percent of the invited teachers participated in the training, which focused on two areas: how to conduct visual acuity screening, and how to teach others to conduct visual acuity screening. At the conclusion of the training, the teachers received equipment and training materials for their schools. Back at their schools, the vision ambassadors screened their classes and taught other teachers to screen their own classes. The teachers contacted the parents of students who failed their visual acuity tests and encouraged them to seek further examination. We will measure the accuracy of the teachers’ screenings and the outcomes of the referrals.
38 percent of the students in the sample schools failed their screenings and were referred to receive further examinations. These examinations found that 25 percent of students had poor vision that could be corrected by glasses, 10 percent had vision that was not poor enough to require glasses, and 3 percent had a vision disorder that was uncorrectable with glasses.
But can teachers take on the burden of screening? Our data say yes—the vision ambassadors’ screenings were highly accurate. Less than five percent of the referrals were false positives. Even more encouraging, less than 10 percent of kids with vision problems were overlooked.
In our future projects, we will continue to use teachers to conduct vision screenings. We will also follow up with the 3 percent of children who have vision disorders uncorrectable with glasses.
