Closing the gaps in early childhood eye care

Why in the News

Many Indian children lose sight not because care is out of reach, but because the health contacts they already have fail to check their eyes. Untreated early eye disease can cause permanent loss of vision, because vision develops during a critical early period. The proposed remedy is to build eye checks into existing child health services rather than create a new system.

Why must a child’s eyes be checked early?

1. How vision develops: A baby’s visual system is immature at birth. Vision develops as the eye and the developing brain interact, and clear images must reach the brain during this critical period.
2. Amblyopia: Without clear images in this period, the brain never learns to use the eye. The loss, called amblyopia (lazy eye), cannot be fully reversed afterwards.
3. A missed case: A five year old girl arrived with dense bilateral cataracts (clouding of the lens in both eyes) and nystagmus (involuntary eye movement).
4. Too late for surgery: Nystagmus showed the impairment dated from infancy, so surgery could no longer restore her full sight.
5. The takeaway: An eye problem missed in the first years can become permanent, and nearly half of childhood blindness in India is preventable or treatable if caught in time.

Is lack of access the only reason children lose sight?

1. Inside the system: Access is still a major barrier, yet this girl’s vaccinations were up to date and she had seven documented health contacts by age five. None detected her impairment.
2. Waiting for cooperation: Her parents, raising twins, had waited until she could “cooperate” in an eye examination.
3. Poor integration: Vision screening is poorly linked to the vaccination schedule and to general paediatric screening, so routine visits include no eye check.
4. Pieces not connected: India already has frontline health workers, immunisation services and school health programmes. The task is to connect them.

What do the screening programme and Karnataka’s data show?

1. Child health programme: The Rashtriya Bal Swasthya Karyakram (RBSK), a national screening programme, aims to identify and manage health conditions in children from birth to 18 years.
2. Spectacle gap: Only 1.9 per cent of Karnataka’s screened school children received spectacles, though local studies put refractive errors (focusing faults that glasses correct) as high as 8 per cent.
3. Referral drop: A study of RBSK coverage gaps found that only 47.4 per cent of children detected with problems received further care.
4. Field evaluations: Independent evaluations in Tumkur found problems in handling younger children and in follow up care, citing parental non cooperation and logistical barriers.

Challenges

1. Untrained front line: Accredited Social Health Activist (ASHA) workers, village level health volunteers, in Tumkur said they lack the training to detect eye disease in children.
2. Thin specialist access: Without training, ASHAs act only when parents complain, and then refer them to a paediatrician who visits the taluk hospital once a week.
3. Referral and supply losses: Children drop out between the tiers of the referral system and spectacles arrive late, so screening does not end in glasses.
4. Young children: Infants and toddlers cannot read a chart or respond reliably to conventional vision tests, so standard screening misses them.

Way Forward

1. Red reflex test: Add this under 30 second eye check, which needs no cooperation from the child, to the immunisation schedule. It finds cataract, retinoblastoma (eye cancer) and high refractive error.
2. Train the front line: Train RBSK mobile health teams, primary health centre nurses, paediatric residents and ASHA workers to perform the test, so it becomes as routine as weighing a child, and to observe infants’ visual behaviour.
3. Monitored referral: Set clear referral pathways, with digital links from frontline screening to appointments at district and tertiary eye care facilities.
4. Tele-ophthalmology: Connect peripheral health workers with eye specialists remotely to cut the logistical barriers that make families drop out of care.

Conclusion

Child eye care in India fails at detection and follow through inside services children already use, not only at access. The test is whether every routine contact, from immunisation to school screening, ends in a recorded referral that is followed to treatment.

Key numbers

1. Visually impaired children worldwide (World Health Organization): About 19 million, of whom 1.4 million are blind.
2. Blind children in India: About 3 lakh.
3. Karnataka school screening, 2023 to 2024: 62,45,424 children aged 6 to 16 screened; about 1.2 lakh received spectacles.

Matching Previous Year Question

“[2024, GS2, 15 marks] In a crucial domain like the public healthcare system, the Indian State should play a vital role to contain the adverse impact of marketisation of the system. Suggest some measures through which the State can enhance the reach of public healthcare at the grassroots level.”