Commentary: Identifying barriers to referrals in preschool-age ocular screening in Southern India.

Good visual acuity is very important for every child's developmental, emotional, and educational well-being. According to WHO estimation in all around the world, 6%–10% of children aged less than 5 years have significant refractive errors and 2%–5% have amblyopia. Amblyopia or lazy eye is defined as a decrease in visual acuity not attributed to any structural abnormality of the eye or visual pathway; it is the leading cause of visual impairment in children. Identifiable and treatable risk factors for amblyopia include squint, anisometropia, isometropia, refractive media opacities, and uncorrected refractive errors. Childhood glaucomas are also an important ocular pathology to look for having worldwide prevalence of 1%–3%.[12]

Challenges in children's eye care screening clinics are as follows:

Sometimes a child is unable to explain what they feel and how things look like

Presence of parents also causes a problem as they may be apprehensive or reluctant

Children can also become bored or hungry or upset straight away, then you cannot examine them easily

Most professionals agree that seeing children may require multiple visits

Some professionals also found the use of the eye drops problematic

Lack of good communication.[1234]

Poor compliance with follow-up after visual acuity screening is a known hurdle in child eye care. Follow-up rates are as low as 30% as per reported by multiple studies of preschool children who failed visual acuity screenings. Yawn et al. observed that after a failed preschool visual acuity screening, visits to an ophthalmologist were delayed on an average of 0.8 year and up to 1.8 years for those seen by a pediatric optometrist.[3]

Common barriers to obtain preschool child eye care are as follows:

Technical difficulty in planning and attending appointments with ophthalmologists

Financial burden of costly eye care as most heads of treatment are not covered by health insurance and most of the parents in Second World and Third World countries do not have any insurance at all

Negligence on parent's part to understand the importance of child eye care

Lower socioeconomic background and ignorance regarding child eye care

Prevalence of stigma in certain cultures that the children would become dependent on the glasses for lifelong and their eyes might get worse or they will be physical handicap.[1234]

How to overcome these barriers:

Development of good communication skill to gain trust of parents and children for their better vision care.

Make parents an integral part in providing eye care to kids, such as in regular glass wearing, patching, and putting drops.

Always prefer lay terms and avoid heavy scientific definitions. Try to be little informal and funny for a healthy bond with the kids and their wards.

Children are born curious so keep them interested for a consistency in the mode of treatment.

Examination room should be children friendly. Glasses could be of Disney or colorful frame so that they can be worn regularly and with love.

Involvement of NGOs for the financial support for the disbursement of child eye care.[1234]

Ravindran et al. have elaborated on the barriers to referrals in preschool-age ocular screening in Southern India.[5] A multidisciplinary approach and proper coordination between eye health-care providers, children, their parents, health insurers, and NGOs is the only way forward in keeping the impact of different barriers to a minimum level for achievement of better child eye care.