 Good morning, Professor Murthy. Thank you very much for joining us today on Skype from Hyderabad We appreciate you taking time to speak to us You've been involved in the development of school screening programs in India for a long time. Could you give us a brief Background to this whole development Right, it's a pleasure to give you a brief idea about How this tool was developed and how the process of school screening has been conducted in India India actually had a school health program right from the 1960s But then the school health program did not look at Looking at the vision of school children. It was more of a health examination examination So way back in 1989 When we have the Danish International Development Agency supported program for the control of blindness in India they were working in five pilot districts and They felt that in addition to Catrack services, it was important to look at school going children and try and Provide services for refractive errors in school going children and that is how this idea first worked out five pilot districts spread across the country where they went and Tried out a number of tools using different vision cutoffs Before finally settling on a particular vision cutoff The same methodology has been used now Since 1989 till date But it is now run rather than by the leader by the national program for control of blindness and Over these years 25 million children who go to school are and are in grade six to nine Have been covered under the program and about point two million children have received free spectacles under the program it is a Methodology adopted right across the program But some states do better than the others, but otherwise the methodology is exactly the same Professor Morty, could you tell us how was the cutoff for the screening test established between Six nine and six twelve. Yeah, so there were a couple of issues which were considered when one the Cutoff tool was identified and two Specific age groups were identified So this program looked at children aged 10 to 14 years were in school because nearly 17% of the Indian population is aged 10 to 14 years and about 70 to 75% of them are enrolled in secondary school, which covers grades six to nine So that was the reason why these school children were taken up the operational feasibility Because school teachers will be used for the screening exercise and therefore they just had a One-day training in this they had to go and pick up When they had a one-day training, it was important that they were able to pick up as many children as Possible amongst those who are being screened So an experiment was done in two of the districts which were being covered in 1989 by the Dunedin program and they tried out two different vision acuity charts One they used a six nine optotype and another they used a six twelve They did a validation both of Using teachers at both the cutoff points. So that was one validation. The second validation was of the optotype So when they looked at the validation of teachers versus an optometrist the sensitivity of the teacher to pick up Individuals or school children was about 86% and the specificity was 98% When they looked at the vision card and they look at the six one nine optotype It was about 71% sensitivity and 94% specificity When they looked at the six twelve optotype the Sensitivity improved or increased further the specificity. There was not much of a change When they looked at the teachers and spoke to the teachers the teachers were very Unhappy when they picked up only say one child per school when he used a six by twelve optotype Compared to about five to six children per school when he used a six by nine any eye optotype So to look at the operation of a program which would involve the teachers and keep their interest going So there was this toss up between Using six twelve or six nine looking at the highest sensitivity and specificity rates with six nine any eye It was decided to use the six nine optotype in the national program in India Right. I'd also like to share the tool that he is that is used for the schools training in India this is Eliminated card a Cardboard cut out it has an e in front which is in the vernacular language and if you reverse this card You will find that there are four optotypes Which are equivalent to the six by nine optotype? so what the teacher does is that She or he holds the card at a distance of six meters and the child is asked to read each of the optotypes Which is pointed out if the child can read three out of the four Then the child is passed on the screening test and if the child cannot read at least three Then the child is referred on to the ophthalmic assistant Once one eye is completed the teacher just rotates the card so the child can then read it again So rotating the card for each of the eyes Then protects the children in that group from memorizing the order of the ease that are on the card So it's a very simple tool very easy for the teacher and on the inside of the card are the instructions Which become a ready-recognised? For the school teacher so after the training they could refer to these points Which are in the vernacular for them to actually conduct the screen Professor Morty, thank you very much for joining us today and for sharing your experiences With the national school vision testing program in India