What level of prevention is represented by early detection and treatment of a refractive error with corrective glasses to prevent further vision deterioration?

Secondary Prevention

This scenario represents secondary prevention (Answer C). The detection of low vision during a school health screening, followed by diagnosis and correction of refractive error with glasses, exemplifies early detection and treatment of an existing condition to prevent further deterioration and complications.

Understanding the Levels of Prevention

Why This is Secondary Prevention

Secondary prevention focuses on early detection and treatment of disease in asymptomatic or minimally symptomatic individuals to prevent progression and complications. 1 This scenario perfectly illustrates this concept:

• The student had an existing refractive error (disease already present) 1
• It was detected through screening before significant functional impairment occurred 1, 2
• Corrective treatment (glasses) was provided to prevent further vision deterioration and potential complications like amblyopia 1, 2
• The goal is to preserve or improve vision and prevent loss of functional vision 1

Distinguishing from Other Prevention Levels

Primary prevention would involve interventions to prevent the refractive error from developing in the first place, such as outdoor time to reduce myopia progression in children without existing myopia, or atropine drops to prevent myopia development. 1 This student already had the refractive error, so primary prevention does not apply.

Tertiary prevention addresses rehabilitation and prevention of complications in established, symptomatic disease. 3, 4 This would apply if the student already had developed amblyopia or significant visual impairment requiring more intensive rehabilitation. The scenario describes early detection before such complications occurred.

Primordial prevention (not applicable here) focuses on preventing risk factors from developing in entire populations, which is not relevant to individual refractive error management. 3

Clinical Significance of Early Detection

Vision screening in school-age children is critical for identifying refractive errors that predispose to amblyopia, with earlier detection and treatment providing greater likelihood of preventing amblyopia and successfully treating it if present. 1 The American Academy of Ophthalmology emphasizes that refractive errors account for 21.1% of all outpatient ophthalmology visits and have significant socioeconomic relevance. 5

Uncorrected refractive errors can lead to progressive visual impairment, with high myopia carrying particularly severe visual consequences and increased lifetime risk of visual impairment (OR 22.0 for myopia greater than -10D). 6 Early correction prevents these outcomes.

Common Pitfalls to Avoid

• Do not confuse screening programs with primary prevention - screening detects existing disease early (secondary prevention), it does not prevent disease occurrence 3
• Do not delay treatment once refractive error is detected - the goal of secondary prevention is immediate correction to prevent complications like amblyopia, which has better outcomes when treated early 1, 2
• Recognize that proper optical correction in children is indicated when refractive errors are sufficiently large to cause amblyopia or impair normal function 2