Pediatric – Seva Foundation Technology Blog

It can be difficult to assess the visual acuity of young children – they don’t read typical eye charts and can become distracted or give unreliable results. But detecting and correcting visual problems before age 5 can make a huge difference for children in communities where eye screenings are uncommon.

“Correcting vision in children can increase their lifetime earnings by up to 78%, breaking the cycle of poverty.” (Seva & IAPB)

Bharatpur Eye Hospital (BEH)

BEH has operated since 1987 in the Chitwan District of southern central Nepal. Serving a catchment area of approximately 2 million people, BEH is comprised of the base hospital, 3 secondary hospitals and 18 Eye Care Centers.

Problem: In places like Nepal, standardized childhood vision screening interventions are often lacking or absent outside of school settings.

We aim to establish and evaluate an efficient vision screening program to detect preventable vision loss in school-aged children in Nepal.

A community-based program would have two main benefits: first, the capability to screen pre-school children (i.e., ages 3-5 years), and second, enhanced communication with parents.

Eye care often involves multiple steps for patients. Mapping their journey enables us to better understand challenges where technology may add value.

Staff members provide the critical connection between patients and technology. We’ve asked the team at BEH to share their learnings below.

Team Member	Success	Challenge	Potential Solution
Dr. Manisha Shreshtha, Pediatric Ophthalmologist	Early detection & treatment enable children to reach their full potential	Time management and workload given OPD flow	Economic study New economic study on childhood screening generating adult attendance
Gopal Bhandari, Optometrist	Managing wonderful project with various stakeholders; hiring and monitoring ophthalmic assistants	Convincing leaders of the impact to the community and hospital
Sadhan Bhandari, Bachelor in Public Health	Working with kids and guardians was a new experience	Some challenges keeping family interest during awareness campaign	Kids present information through art or videos Multiple stations to optimize efficiency
Devaki Acharya, Ophthalmic Assistant	Some parents couldn’t afford glasses; Others were happy they found out the child’s eyes could be treated in time	Some children didn’t cooperate well or lacked focus and may need multiple screening attempts	Prizes for screening – attempt other technology solutions that are easier for smaller children?
Deepak Yadav, Ophthalmic Assistant	School and tole personnel were supportive and positive; Door to door screening helped find children who did not attend events	Excluding kids at events who didn’t meet the study criteria; Some parents didn’t trust the study or indicated children had no disorders	Plan resources to add siblings, friends or others Get leader input before approaching community – educate and influence
Prakash Malla, Ophthalmic Assistant	Good coordination in study team; positive & helpful community and parents	Tracking children who moved; inability to travel safely during rainy season	Offer broad advertisements and community involvement

The Welch Allyn Spot Vision Screener was selected for BEH’s project based on colleagues’ recommendations.

Indications: Myopia, hyperopia, astigmatism, strabismus, anisocoria
Training: 30 minutes to learn; easy to teach new team members, including those without eye care backgrounds
Portability: Light-weight and easy to carry, making it available for a variety of screening settings
Power: Rechargable Lithium battery, expected lifetime 2.5 years
Results: Summary report in seconds
Engagement tools: Lights and sound
Data management: USB or Wifi export