Vision and hearing screening for school-age children -Implementation handbook
Background
Globally, 2.2 billion people suffer from vision impairment, while over 1.5 billion live with hearing loss (1, 2). The majority of those with sensory impairments live in low- and middle-income countries with limited access to required eye care and
hearing care (1, 2). This is mainly due to poor availability and disparate distribution of appropriately trained health-care personnel, infrastructure, and resources, and in some areas, the high costs associated with traditional eye care and hearing care (1, 2, 14–17).
Unaddressed sensory (vision and hearing) impairments have far-reaching impacts on the lives of those affected and their families. In children, sensory inputs from both their vision and hearing are important for their optimal developmental and learning outcomes (1–4). In adults, unaddressed sensory (vision and hearing) impairments are linked with poorer employment opportunities, social isolation, depression, and early cognitive decline; older adults are placed at a higher risk for developing dementia.
(1, 2). The impact can be even greater in those with dual sensory (vision and hearing) impairments. When compared to individuals with only one sensory impairment, those with dual sensory impairment are likely to experience a decreased quality of llife, an increased risk of falling, depression, and even mortality (18).
Population groups most likely to be affected by sensory (vision and hearing) impairments include newborns, preschool and school-age children, older adults and those exposed to harmful stimuli or substances. All these groups can benefit
from having access to services that ensure early identification of these impairments followed by prompt intervention. Important principles and considerations for vision and hearing screening at the above-mentioned life stages are outlined in WHO’s Vision and eye screening implementation handbook (19) and Hearing screening:
considerations for implementation (20).
This handbook focuses on the sensory (vision and hearing) needs of school-age children. In these age groups, it is not uncommon to find both vision impairment and hearing loss that is associated with ear diseases, such as otitis media.
Globally, most newborns are not screened for hearing loss, and even when they are, those with hearing loss that is progressive or develops later in childhood often remain unidentified and therefore untreated (1, 8). In addition, ear diseases, such as otitis media, are a common cause of hearing loss among children, and can be treated if
identified in a timely manner (1). Similar concerns arise with vision problems that are not identifiable at birth and that develop during childhood; these include uncorrected refractive errors, amblyopia and strabismus (21).
Uncorrected refractive errors (such as myopia, hyperopia, and astigmatism) are the leading cause of vision problems in2 Vision and hearing screening for school-age children Implementation handbook children aged 5–18 years; the global prevalence of myopia is projected to increase significantly in the future (5, 6).
To help slow the progression of myopia, or to prevent it in its earliest phases, particularly during the early school years, it is essential to
identify those children who are at a high risk of developing the condition (7).
The early identification of sensory (vision and hearing) impairments in children, and connecting these children to care, is critical to avoid the long-term impact on their language learning, cognition, educational attainment and social development (1, 2,9–11), and to improve their opportunities for employment later in life (1, 2, 11).
The key to effective management of sensory (vision and hearing) conditions is through timely early identification (19, 20, 22). Given the insidious nature of sensoryimpairments, people commonly fail to seek vision or hearing check-ups during the early stages of sensory losses. For this reason, it is important to establish dedicated measures for universal, systematic screening for sensory (vision and hearing)
impairments, as highlighted in WHO’s World report on vision (2) and World report on hearing (1).
The prevalence of vision and hearing impairment in school-age populations presents a strong rationale for implementing combined screening programmes (13); these are more cost–effective than vision/eye and hearing/ear screening programmes undertaken individually. Using the same screening personnel can reduce time and associated costs (13). Such a joint approach could, therefore, facilitate widespread screening particularly in low- and middle-income countries that have limited resources.
