IU in Rwanda

Solange Mutuyimana nervously approached the classroom, hands in front of her, no smile on her face. She was one of hundreds of Kabwende Primary School students who had lined up throughout the week to undergo a vision screening.

Although Indiana University clinical professor Don Lyon only knew a few words to communicate with the 14-year-old, it was clear she would be one of the more serious cases he would see during his week in Rwanda. Having never had a vision screening before, Solange wasn't sure what to expect.

"Solange first came to us very quiet, and she seemed quite nervous," said Lyon, director of residencies at the IU School of Optometry. "She did not respond well to the visual acuity test or the rest of the tests. Basically, she was living in a world where the only things in focus had to be about 20 centimeters away from her face. Everything else was blurry for her."

However, thanks to a donation from the nonprofit Eye Care 4 Kids, which partnered with IU to make the vision screenings a possibility through the donation of 300 pairs of glasses, Lyon improved her eyesight to 20/80 in both eyes. He is now working on providing funding for Solange to receive the stronger prescription needed at a local hospital.

Although she couldn't verbally express her appreciation, the look on her face when she saw clearly for the first time was a vision Lyon will never forget.

"When I put those glasses on her face, she immediately brightened up, she stood up a little taller and she became more engaged," Lyon said. "She became more vocal and surer of her answers. Then I saw her a few days later at the closing ceremony, and she had her glasses on and a big smile on her face. I see kids every day that I give glasses to for the first time, but this case was really an emotional moment for all of us."

Vision for the Future

For the past 18 years, Lyon has worked in pediatric eye care, providing vision care for children in Indiana.

In 2015, Lyon and colleague Katie Connolly started Vision for the Future, which provides advanced-level vision care to Head Start children in three Indiana counties and educates parents and teachers about the importance of early vision care.

Two years ago, after meeting with IU alumna and Books and Beyond visionary Nancy Uslan, Lyon and Uslan teamed up with Books and Beyond program director Vera Marinova to expand Vision for the Future in Rwanda. The partnership made sense, particularly since Books and Beyond's mission is to encourage literacy among students. But without proper vision care, that goal can be impossible to meet.

Optometry is not a recognized profession in Rwanda, and there are less than 20 ophthalmologists in a country of more than 11 million people. Although the Rwandan government declared earlier this year that it will provide universal eye care for its residents, access to vision care is still a struggle, especially for people living outside the country's capital. Like the case with Solange, cost also plays a factor for many families.

"The fact is, these children don't have as much access to vision care as children in the United States," Lyon said. "The nearest ophthalmologist is 20 miles away, and a pair of glasses costs 80 U.S. dollars, which is outrageous for these families to have to pay for. So, the goal with Vision for the Future, just like at home, is trying to work in ways to help these kids get better access to vision care and to get glasses at a reduced cost to where they can actually use them."

During his time in Rwanda, Lyon partnered with nursing students from the University of Rwanda who not only helped perform the vision screenings but served as translators.

With their help, and that of Uslan, Lyon was provided screenings to more than 250 children and 62 teachers. Of those students, 26 percent needed glasses or additional treatment, and 51 percent of the adults needed glasses or additional treatment.

"The team of nursing students not only performed some examination techniques for me, but they were monumental in educating and talking to the children about what we need to do," Lyon said.

Yves "Jimmy" Iradukunda was one of the nursing students who helped with the vision screenings. Having attended Kabwende Primary School as a child -- his father is the school headmaster -- Iradukunda is familiar with the Books and Beyond program and the impact it has made on the school over the past 10 years. Having volunteered with the program in the past, Iradukunda was excited to volunteer with the vision screenings.

The experience had such a great impact that Iradukunda, a student of general nursing, would now like to pursue a career in vision care.

"I'm proud of working with Don. He's a good man, and working with him, he taught me so many things," Iradukunda said. "Now, in the future, I would hope to be an ophthalmologist -- because when you provide the glasses to the kids, they smile, they are happy. With the glasses, the students will now be able to see, so their performance in the classroom will be higher. That makes me attracted to working with eye care in the future."

That enthusiasm sparked a conversation between Lyon and administration at the University of Rwanda about the possibility of working together to bring the study of optometry to students like Iradukunda.

"Vision screenings for children are hugely important if they are to have the best opportunities to learn," said Philip Cotton, vice chancellor at the University of Rwanda. "We were grateful to be involved with Don on his recent project and to provide our students with a learning experience. We have also started conversations with Don and our faculty about creating curriculum and training in optometry at the University of Rwanda."

After his recent trip to Rwanda, Lyon is determined to create a sustainable program in Rwanda that will not only provide much needed vision care to students and teachers at Kabwende, but will hopefully start the path for optometry becoming a recognized profession in Rwanda so people young and old throughout Rwanda have the opportunity to receive proper vision care.

"I would love to see optometry recognized in Rwanda," Lyon said. "I want optometrists in Rwanda to be able to practice at the highest levels of the profession. Once this occurs, the citizens of Rwanda will have improved access to primary eye care. On a personal note, I hope that more children will receive the care they need to reach their academic potential by diagnosing and properly treating vision problems."