Basic Eye Screening Test (BEST) for ASHA workers

1. Basic Eye Screening Test (BEST) for ASHA workers Dr. Srinivas Marmamula Associate Director – Public Health L V Prasad Eye Institute India

2. Objective of training ASHA workers in Basic Eye Screening • Set up a workstation • Do a good Basic Eye Screening • Referral of cases to VT / PMOO for eye examination • Logistic support and assistance • Registration • Crowd management • Referral counselling and follow after VT / PMOO examination

3. Objective Basic Eye Screening by ASHA Not normal Normal End of the tests Next Level of care

4. ASHA Tool kit for Basic Eye Screening

5. Place • Select a place that has good ventilation and good lighting condition • Vision testing area should be separate from waiting area • Call only subject at a time for vision testing

6. Preparation • Vision chart has two parts • 1) Distance Vision • 2 lines (line 1 & 2) • 2) Near vision • 1 line (line 3) • Tear and separate the distance and near vision part along the line

7. Preparation • Distance vision chart can be pasted on the wall at 3-meter distance • Near vision chart should be used at about 40 cm distance • Conduct eye screening of one subject at a time • Do not crowd the screening area • If a subject has spectacles, check the vision with spectacles

8. Demonstration Down • Demonstrate how a subject must respond by waving the hand pointing towards the open ends of ‘E’ • Up / Down / Left / Right • Make sure that the subject understands the test well Up Left Right

9. Steps • Step 1: Show the first line (Big E) • Pass = At least 2 letters are correct - Go to step 2 • Fail = One letter or no letter is correct – Refer for eye exam • Step 2: Show the second line (Small E) • Pass = At least 4 letters are correct - Go to step 3 • Fail = Three or less number of letter are correct – Refer for eye exam

10. Steps • Step 3: Show the near vision chart at about 40 cm distance with both eyes open • Pass = At least 4 letters are correct - Go to step 4 • Fail = Three or less number of letter are correct – Refer for eye exam for near vision glasses

11. Referral for Eye Examination Step 1 (Big E letters) Fail Pass (At least 2 letters correct) Referral for Eye Examination Step 2 (Small E Letters) Fail Pass (At least 4 letters correct) Referral for Eye Examination Step 3 (Near vision test) Fail Pass (At least 4 letters correct) Step 4 (Torchlight Exam) Referral for Eye Examination Fail Pass (Eye appears normal) End of Basic Eye Screening Test

12. Steps • Step 4: Observe each eye with a torch light at about 45 degrees from the subject • Pass: Eye appears normal - End of the screening • Fails: Eye appears abnormal / subject has complaint - Refer for eye exam

16. Torchlight Examination

17. Torchlight Exam

18. Torchlight Examination Abnormal Eye Normal Eye

19. Torchlight Examination Abnormal Eye

20. Points to note.. • For distance vision, always check Right Eye first • Ask the subject to cover other eye gently without applying pressure on the eye • Make sure that the subject does not squeeze his/ her eyes during the vision test • Always check near vision with both eyes open • If a subject has glasses, please check the vision with glasses • In case of any doubt, please refer for an eye examination

21. Referral All the subjects with any one of the conditions should be referred for eye examination • Subject failing the vision test in either eye • Subject who present with any abnormalities on torchlight test • Subject with any eye related complains • In case of any doubt, please refer for complete eye exam

22. Practical Session on Basic Eye Screening!!

23. Proposal • Step 1: Basic Screening by ASHA / ANM • Step 2: Refraction and glasses at PHC/CHC • Step 3: Cataract Sx / Glaucoma / Laser at NGO/DH • Step 4: Complex cases management at RIO / LVEPI

24. Work load Estimation *Vision impairment (<6/12) in the population **In population, if we go door to door ***In screening programmes, the percentages will be higher **** Need to be pilot tested in one mandal

25. Work load estimation

26. Thankyou!