Research Title: Implementation of a large scale school eye health program for Indian children
Background: Given increasing prevalence of refractive errors (RE) among school aged children, development of school based approaches to enhance the accessibility to refractive services is imperative. School eye health programs are promising in this regard. However, there are few reports of the implementation of these programs to understand the delivery in ‘real-world’ contexts. For example, little is known about the factors that influence a school eye health program or whether such programs can produce similar outcomes when delivered in medically underserved communities experiencing health disparities. The Refractive Errors Among CHildren (REACH) program, is a large scale, comprehensive school eye health program delivered during July 2016 to December 2018 in India targeting RE. This PhD project evaluates to implementation of this large scale program.
Aims: The primary aim of the thesis was to investigate implementation of a large scale school eye health program, the REACH program in different settings across India. The thesis has been informed by the systematic review of the prevalence of refractive errors in Indian children, and includes analysis of the program data and stakeholder consultation.
Methods: Systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guidelines. The quantitative data ascertained from program service delivery and administration informed estimates of prevalence of RE, causes of visual impairment in Indian children attending schools, factors influencing the compliance and proportion of prescriptions and cost across all ages. Qualitative data from the semi-structured interviews is triangulated with the quantitative data to understand what works best, for whom and why. The evaluation of the implementation contexts, mechanism and outcomes both the quantitative and qualitative was guided by the Reach, Effectiveness-Adoption, Implementation, Maintenance (RE-AIM) and realist frameworks.
Conclusions: RE in children is a major public health concern in India and a school based comprehensive eye health program such as the REACH program may be a promising tool to enhance the accessibility and coverage with moderate costs for implementation. This study helps to make informed decisions for the implementation of a school eye health in low and middle income settings.
Bharani Seelam is an international post-graduate research student with a focus on ‘paediatric refractive profiles’ for her doctoral dissertation. She is an optometrist by background, completed her educational training from Bausch & Lomb School of Optometry affiliated with LV Prasad Eye Institute, India and worked as low vision specialist at LV Prasad Eye Institute, India. Her research interests include person reported outcome measures and community-based management of eye diseases, predominantly refractive errors.
2016 - current Currently pursuing PhD from the School of Optometry and Vision Science, UNSW Sydney
2006 - 2010 Bachelor of Science in Optometry
Bausch and Lomb School of Optometry (affiliated to Birla Institute of Technology and Sciences, BITS, Pilani, Rajasthan, India), Hyderabad, India
- Sheeladevi S, Seelam B, Nukella PB, Borah RR, Ali R, Keay L. Prevalence of refractive errors, uncorrected refractive error, and presbyopia in adults in India: A systematic review. Indian J Ophthalmol. 2019 May;67(5):583-592. doi: 10.4103/ijo.IJO_1235_18.
- Gothwal VK, Seelam B, Mandal AK. Quality of life following surgery for congenital glaucoma: findings of the LVPEI congenital glaucoma registry. Eye (Lond). 2019 Apr;33(4):659-667. doi: 10.1038/s41433-018-0293-y. Epub 2018 Dec 5.
- Gothwal VK, Bharani S, Mandal AK. Parent-Child Agreement on Health-Related Quality of Life in Congenital Glaucoma.Transl Vis Sci Technol. 2018 Aug 24;7(4):15. doi: 10.1167/tvst.7.4.15. eCollection 2018 Aug.PMID:30159208
- Gothwal VK, Thomas R, Crossland M, Bharani S, Sharma S, Unwin H, Xing W, Khabra K, Dahlmann-Noor A. Randomized Trial of Tablet Computers for Education and Learning in Children and Young People with Low Vision.Optom Vis Sci. 2018 Sep;95(9):873-882. doi: 10.1097/OPX.0000000000001270.PMID:30153236
- Sheeladevi S, Seelam B, Nukella PB, Modi A, Ali R, Keay L. Prevalence of refractive errors in children in India: a systematic review. Clin Exp Optom. 2018 Jul;101(4):495-503. doi: 10.1111/cxo.12689. Epub 2018 Apr 22. Review.PMID:29682791
- Crossland MD, Thomas R, Unwin H, Bharani S, Gothwal VK, Quartilho A, Bunce C, Dahlmann-Noor A Tablet computers versus optical aids to support education and learning in children and young people with low vision: protocol for a pilot randomised controlled trial, CREATE (Children Reading with Electronic Assistance To Educate). BMJ Open. 2017 Jun 21;7(6) : e015939.
- Gothwal VK, Bharani S, Mandal AK. Impact of Surgery on the Quality of Life of Caregivers of Children with Congenital Glaucoma. Ophthalmology. 2016 May;123(5):1161-2. doi: 10.1016/j.ophtha.2015.11.013.
- Gothwal VK, Bharani S. Outcomes of Multidisciplinary Low Vision Rehabilitation in Adults. Invest Ophthalmol Vis Sci. 2015 Nov;56(12):7451-61. doi: 10.1167/iovs.15-16892.
- Gothwal VK, Bharani S, Kekunnaya R, Chhablani P, Sachdeva V, Pehere NK, Narasaiah A, Gunturu R. Measuring Health-Related Quality of Life in Strabismus: A Modification of the Adult Strabismus-20 (AS-20) Questionnaire Using Rasch Analysis. PLoS One. 2015.
- Gothwal VK, Sumalini R, Bharani S. Assessing the effectiveness of low vision rehabilitation in children: an observational study. Invest Ophthalmol Vis Sci. 2015; 56: 3355-60.
- Gothwal VK, Bharani S, Reddy SP. Measuring coping in parents of children with disabilities: a rasch model approach. PLoS One. 2015
- Gothwal VK, Bharani S, Mandal AK. Quality of life of caregivers of children with congenital glaucoma: development and validation of a novel questionnaire (CarCGQoL). Invest Ophthalmol Vis Sci. 2015; 56:770-7
- Gothwal VK, Bagga DK, Bharani S, Sumalini R, Reddy SP. The patient health questionnaire-9: validation among patients with glaucoma. PLoS One. 2014
- Gothwal VK, Bagga DK, Rao HL, Bharani S, Sumalini R, Garudadri CS, Senthil S, Reddy SP, Pathak-Ray V, Mandal AK. Is utility-based quality of life in adults affected by glaucoma? Invest Ophthalmol Vis Sci. 2014; 55:1361-9
- Gothwal VK, Sumalini R, Irfan SM, Giridhar A, Bharani S. Revised Olweus Bully/Victim Questionnaire: evaluation in visually impaired. Optom Vis Sci; 2013 90:828-35.
- Gothwal VK, Reddy SP, Fathima A, Bharani S, Sumalini R, Bagga DK, Sudharman PM. Assessment of the impact of keratoconus on vision-related quality of life. Invest Ophthalmol Vis Sci. 2013; 54:2902-10.
- Gothwal VK, Reddy SP, Bharani S, Bagga DK, Sumalini R, Garudadri CS, Rao HL, Senthil S, Pathak-Ray V, Mandal AK. Glaucoma symptom scale: is it a reliable measure of symptoms in glaucoma patients? Br J Ophthalmol. 2013; 97:379-80.
- Gothwal VK, Sumalini R, Bharani S, Reddy SP, Bagga DK. The second version of the L. V. Prasad-functional vision questionnaire. Optom Vis Sci. 2012; 89:1601-10.
- Gothwal VK, Reddy SP, Sumalini R, Bharani S, Bagga DK. National Eye Institute Visual Function Questionnaire or Indian Vision Function Questionnaire for visually impaired: a conundrum. Invest Ophthalmol Vis Sci. 2012 Jul 18;53(8):4730-8. doi: 10.1167/iovs.11-8776.
- Gothwal VK, Reddy SP, Bharani S, Bagga DK, Sumalini R, Garudadri CS, Rao HL, Senthil S, Pathak-Ray V, Mandal AK. Impact of glaucoma on visual functioning in Indians. Invest Ophthalmol Vis Sci. 2012; 53:6081-92
Best Poster at Asia ARVO Asia ARVO, 28-31 October 2013, New Delhi, India.
Best Poster (Co-author) at Indian Eye Research Group meeting, 28th and 29th July 2012, Hyderabad, India.
Best Poster (Co-author) at Indian Eye Research Group meeting, 30th and 31st July 2011, Hyderabad, India.
Best Paper (Co-author) at Indian Eye Research Group meeting, 30th and 31st July 2011, Hyderabad, India.
AFFILIATIONS AND MEMBERSHIPS
The George Institute for Global Health, New Delhi, India
University of New South Wales, Sydney, Australia
Orbis International, Gurgoan, India
Member of the Association for Research in Vision and Ophthalmology (ARVO)