Optometry lecturer, Dr Naimah Ebrahim Khan’s PhD study focused on the development of a paediatric vision screening tool. Supervised by Professor Rekha Hansraj, Ebrahim Khan developed a software programme, Basic Ocular Ngane Assessment (BONA) that can be used by non-optometrists to conduct vision screening in primary schools.
‘BONA is comprehensive and conforms to the standards set by the Health Professions Council of South Africa (HPCSA). It would be a useful tool to screen children across South Africa and decrease the burden of avoidable blindness,’ said Ebrahim Khan.
BONA contains images that South African schoolchildren are familiar with and is currently available in English and isiZulu but can be translated into other languages. According to Ebrahim Khan, it provides an efficient, accurate, enjoyable user experience and is a competent vision screening tool.
‘Competent vision screening during the early childhood years is integral to early intervention and a favourable prognosis,’ said Ebrahim Khan. She added that while vision screening occurs at some schools in South Africa, it is not performed regularly in rural schools as there are too few optometrists. As a result, many vision problems remain undetected.
The development of the software occurred in two phases. The first was the design of BONA which involved identifying the school screening protocol via a review of HPCSA guidelines pertaining to vision screening; planning the design and implementation with software engineers; modifying traditional tests by incorporating ecologically valid targets and digitising, software development and pilot testing proof of the concept; grading using a technology readiness level indicator; translating the screening program interface into isiZulu; and the development of instruction manuals in English and isiZulu.
The second phase involved a logistic applicability exercise in the community to compare BONA to the traditional testing method on 355 primary school learners (Grades R to 3) in rural schools.
Ebrahim Khan said that, compared to traditional vision screening tests, BONA showed minimal differences in pass/fail results. ‘BONA was preferred by 78% of the participants compared to the 16% who preferred the traditional screening protocol.
‘It takes an average of 5.30 ± 0.9 minutes to administer BONA and an average of 10.30 ± 1 minute to screen via the traditional method. Equipment requirements to conduct BONA are more accessible and cheaper than that required to conduct traditional screening.’
Research participants indicated that BONA was preferred since it was more fun, quicker and easier. ‘BONA makes use of an e-Health platform and can screen children for vision problems in all communities,’ said Ebrahim Kahn.
The study adopted a multidisciplinary approach. Having identified a public health need and gained insight from healthcare professionals and teachers, Ebrahim Khan used her optometry background and worked with IT professionals to incorporate ecologically valid targets into technology to produce a workable vision screening tool.
Ebrahim Khan hopes to continue with her research by performing a full validation of BONA to be able to apply for a patent. ‘I would also like to engage in talks with the necessary national regulatory offices so that BONA can get a wider reach in order for more children to be screened.’ She hopes to explore other options to bring technology to the optometry field in South Africa and Africa.
Ebrahim Khan completed her undergraduate and master’s degree at UKZN. ‘I chose to pursue my PhD at UKZN because the University had the necessary resources and infrastructure to assist me in finding a suitable South African solution to the vision screening challenge in our country.’
Words: Nombuso Dlamini