Page 6 - NAME OF CONDITION: REFRACTIVE ERRORS

importance of school teachers in suspecting this condition cannot be over emphasized.

They can be trained for screening of this condition and experience has shown that this
system is very useful to identify children who need ophthalmic care and support at the
school going level. The positive effect of outdoor activity for reducing myopic progression
has been documented in numerous studies. Physical activity, sports, and low
accommodative demands have been postulated as the cause of this protective effect.

V. OPTIMAL DIAGNOSTIC CRITERIA, INVESTIGATIONS,
TREATMENT & REFERRAL CRITERIA

Situation 1: At Secondary Hospital/ Non-Metro situation: Optimal

Standards of Treatment in Situations where technology and resources
are limited

a) Clinical Diagnosis:

A proper history taking remains a cornerstone of the diagnosis of this condition. A child
with uncorrected refractive error is restricted to the limits of its vision. Those who are not
so eloquent with their complaints would tend to read their books very close to their face
and sit closer to the black board or the television. The frustrated child becomes an
introvert, keeping away from other children of his age and avoids outdoor activities.

The myope’s main complaint is that he /she don’t see distant objects clearly. The defect
may also manifest as headache, watering from eyes and constant itching of the eyes – all
these symptoms are a result of the eyestrain induced by the refractive error. Conditions
like pathological myopia, if not diagnosed early and followed up regularly can result in
permanent loss of vision due to retinal scarring or retinal detachment. The progression of
myopia happens more often in the growing phase of a person’s life. The maximum growth

happens between the ages of 12 and 20. Frequent changes of spectacles may be required
during these years, and the myopic error usually stabilizes after the age of 20.

The hypermetropes complain that they are unable to do near work very well. Headache
and eyestrain following any prolonged near work like desk jobs or sewing can be
accompanying symptoms. These symptoms are collectively termed asthenopia. Although
hypermetropia can be detected at any age, it generally manifests more with increasing age
Presbyopes are usually people in their fourth decade, who find it increasingly difficult to
read the newspaper at their usual working distance in dim light and tend to keep it at a
distance to make out the letters. Simple tasks like threading a needle, putting one’s
signature on a document or making out the fine print on a visiting card become increasingly
difficult and sometimes embarrassing. For artists and artisans who depend on their near

vision for livelihood, it can even become economically crippling. Headaches and eye – strain
may occur after long hours of near work. The uncorrected disability hampers his/her
financial productivity and compromises their occupational skills. Left uncorrected, he/ she
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