Childhood Blindness In India Research Articles

Assessment of visual impairment and need of rehabilitation services for children attending schools for blind in an urban city of North India

ABSTRACT Background/Aims: By understanding the prevalence and causes of childhood blindness, stakeholders can work toward comprehensive strategies that encompass prevention, treatment, rehabilitation, and support, ultimately improving the quality of life for affected children. The information about the pattern and causes of childhood blindness in Northern Indian states is limited, it highlights the need for further research and data collection to better understand and address the specific challenges in this region. Therefore, the present cross-sectional study was planned to ascertain the different causes and patterns of childhood blindness and to understand the barriers to the use of LVAs and its compliance among the students attending schools for the blind in a North Indian State. Study Design and Setting: Students from two schools for blind were examined in Chandigarh and its vicinity in North India. The different causes of severe visual impairment/blindness were classified as per the World Health Organization/Prevention of Blindness standard recording form. Results: A total of 89 students attending schools for the blind were examined. The mean age was 13.10 years (range = 4–16 years). Male, female ratio was 3.3:1. The major causes of blindness were congenital anomalies (whole globe anomalies 37.08%), followed by retinal conditions (16.7 = 8%), undetermined/other (12.3), and lenticular conditions (112%). More than one-third of children (34.8%) were blind due to avoidable causes of blindness. Conclusion: The current study data append on the existing national available data about childhood blindness in India. Though the sample size of the current is comparatively low, observed different results as compared to previously published reports from other regions, emphasize the strengthening of pediatric ophthalmology services as well as of low vision services in this particular region of North India.

Outcome of pediatric cataract surgery including color vision, stereopsis, and cognition in a tertiary eye care center in India.

Pediatric cataract is an important cause of avoidable childhood blindness in India. Although there are studies on clinical features and visual acuity outcomes of pediatric cataract surgery, there are no studies that look into aspects of color vision, stereopsis, and cognitive functions in children with cataracts. Studying these parameters pre- and postsurgery will help us assess the overall components of visual function that are critical for the child's development. With this in mind, we aimed to study the clinical features, outcome of treatment, color vision, stereopsis, and cognitive functions in children with cataracts. Design: Hospital-based prospective descriptive study. Data of 68 children (0 < 18 years) were collected, on the clinical features, visual acuity, color vision, stereopsis, and social and intelligence quotient before and after surgery. Data analysis was performed using Graph Pad Prism software version 9.4.0 (673). Ninety eyes of 68 children (36-bilateral/32-unilateral) were operated. A total of 46 children were available at 6 months' follow-up (28 bilateral cataracts (46 eyes) and 18 unilateral cataracts). Nineteen (67.8%) of the bilateral, had a best corrected visual acuity of 6/6-6/18 in the better eye and nine (50%) of the unilateral had a visual acuity of 6/18-6/6 in the operated eye. Preoperatively, 61.5% of the children had a stereopsis of 100-600 arc-secs. Post-operatively, 84.4% of the children had a stereopsis in the range <50-600 arc-secs. All children had color vision deficiency. Preoperatively, 62% of the children had strong and moderate deficiency, whereas postoperatively, 66.6% had mild deficiency. We found negative correlation (r = -0.503) between social quotient and percentage of visual impairment indicating that when visual impairment increases social quotient decreases. The mean IQ preoperatively was 94.36 ± 2.98 and postoperatively 101.38 ± 2.77, with 95% confidence interval P value was statistically significant (P = 0.0001). This shows better and faster performance postoperatively. Majority of the children had improved visual acuity after surgery. This outcome can be extrapolated to the overall improvement in stereopsis, color vision, and higher cognitive functions.

A Literature Review on Prevalence and Causes of Childhood Blindness in India

Target of vision 2020- right to sight is to control blindness. Blindness in children affects their psychological and social growth. Various research were done on community and in blind school to know about the prevalence and causes of blindness in children. Total five- community based studies were done for knowing about the prevalence of blindness that also includes two refractive error studies for the children below 16 years of age in India. Result of data collected from blind school showed that blindness in children shifted from corneal causes to whole globe abnormalities.&#x0D; Blindness in children has different impact in different region based upon the socioeconomic development of that region, primary health care centre present in that region and also the eye care services provided to the people. The strategies to control blindness should be region specific. Solution has to be drafted based on regional challenges, in such a way that it helps to cure the blindness and also help to reduce the chances of blindness in future. Prevention strategies is targeted towards proper and timely immunization, control of Vit A deficiency by providing healthy and balanced diet and to educate people about the outcome of blindness and also providing tertiary level care to treat the causes. No available data is present to know about the causes and incidence of blindness in children. Rehabilitation programme done on community level help to identify the incidence and causes of blindness in children present in India.&#x0D; In this article we have discussed about childhood blindness, prevalence of childhood blindness, causes of childhood blindness, prevention of childhood blindness, control of childhood blindness, programmes running for childhood blindness. Refractive error such as myopia leads to blindness in children. School going children are at increase risk for developing blindness due to refractive error that is not corrected. Control of blindness in children is very important because a child suffer more years from blindness than adults. Around 1.4 million are affected by childhood blindness globally. Per year approx 500000 children are affected and became blind. The cause that is most common and in fact single for childhood blindness worldwide is vit A deficiency. By the year 2020, WHO has took the initiative to eliminate blindness. Some of the factors that can help are good nutrition to child, taking proper care of mother and child, proper immunization of mother and child, health education etc.

Changing pattern of childhood blindness in eight North-Eastern states and review of the epidemiological data of childhood blindness of India.

Purpose:To assess the causes of visual impairment and blindness in children in all the schools for the blind in eight northeastern states and to determine its temporal trend, and to analyze the result with reference to various regional epidemiological data on childhood blindness in India.Methods:Children aged ≤16 years, with a visual acuity of ≤6/18 in the better eye, attending 17 schools for the blind were examined between November 2018 and March 2020. WHO protocol and reporting format was used for the evaluation, diagnosis, and classification of the causes.Results:Out of 465 eligible study participants, 93.76% were blind and only 12.26% of causes were avoidable. Anatomical causes of childhood blindness were whole globe (43.2%), cornea (17.20%), optic nerve (12.04%), retina (9.68%), and lens (9.46%). Etiological causes were unknown (52.69%), hereditary (26.02%), intrauterine (15.05%), and 26.08% had blinding congenital ocular abnormality (s). Regional temporal trend revealed a decrease in corneal and childhood causes and an increase in retina, optic nerve, hereditary, and intrauterine causes.Conclusion:A constellation of causes were differentiable but matched with the overall emerging trend of childhood blindness in India. Higher corneal, unavoidable, and unknown causes suggest a region-specific action plan for controlling childhood blindness as well as rehabilitation.

Prevalence and causes of childhood blindness in India: A systematic review.

Childhood blindness is one of the priority targets of Vision 2020—Right To Sight due to its impact on the psychological and social growth of the child. An extensive search was performed to locate research papers on childhood blindness prevalence and its causes in the community based and blind schools, respectively, conducted from 1990 onward up to the present. Cross references were also manually searched along with expert consultation to enlarge the reference data. A total of five community-based studies on the prevalence including two refractive error studies conducted all over India in children less than 16 years were found. The causes of childhood blindness from the available blind school studies revealed that causes of childhood blindness have mainly shifted from corneal causes to whole globe abnormalities. This article highlights that though with the availability of proper healthcare facilities, the trend is changing for the causes but still a lot of effort in the form of timely neonatal eye care facilities, pediatric surgical services and proper refraction strategies is required.

Emerging trends in childhood blindness and ocular morbidity in India: the Pavagada Pediatric Eye Disease Study 2

To discuss the aims, methods, and results of a population-based cross-sectional prevalence survey of children ≤15 years, in South India and compare it with a study conducted earlier, in the same area. We also discuss the changing trends in the domain of childhood blindness in India. A population-based cross-sectional prevalence survey of children ≤15 years, in Pavagada and Madhugiri taluks of Tumkur district in Karnataka state in south India, was conducted in 2 phases. One trained medical-social-worker and one field-investigator identified eligible children and brought them to a makeshift clinic in the village school, where they were examined by an ophthalmologist. Children with minor problems were treated on the field and those with major conditions were referred to the pediatric ophthalmologist in the tertiary hospital. The prevalence of specific diseases were calculated in percentages. The prevalence of childhood ocular morbidity (COM) was 6.54%. Refractive errors (2.77%) constituted the major cause of COM. The prevalence of blindness (best corrected visual acuity of <3/60 in the better eye) was 0.09%. Whole-globe anomalies (25%) and uveal coloboma (25%) constituted the main cause of blindness. A major proportion of the blindness was due to unavoidable causes. Unlike several earlier studies, corneal blindness is no longer the main cause of blindness. This shows that there is a changing trend in the pattern of childhood blindness in India. The current data demonstrate the need for low vision rehabilitative services and a review of public health strategy in India.

Commentary: Childhood blindness in India: Regional variations.

Commentary: Childhood blindness in India: Regional variations.

A Study to Assess the Knowledge regarding Retinopathy of Prematurity among Staff nurses in a Tertiary Care Centre, Kerala

Retinopathy of Prematurity (ROP) or Terry Syndrome, previously known as Retrolental Fibroplasia is a disease of the eye affecting prematurely born babies and is increasingly being recognised as an important cause of childhood blindness in India. ROP is sensitive to the quality of neonatal inpatient care provided and nurses play a pivotal role in the NICU management of these tiniest babies.1 Neonatal nurse's specialised knowledge and competent nursing skills as well as widespread timely screening and management are urgently called for to control the third epidemic of ROP. The main aim of this descriptive study was to assess the knowledge of staff nurses regarding ROP in a selected hospital in Kerala. The sample consisted of 60 staff nurses selected randomly and data was collected using a socio personal data sheet and a structured knowledge questionnaire developed by the researcher to assess the level of knowledge regarding ROP. Content validity of the tool was established after consultation with subject experts. Reliability of the tool was done and found to be 0.81. The study showed that 43% of nurses had good knowledge, 50% had average knowledge and 7% had poor knowledge regarding ROP. The knowledge score ranged from 3 to 15 with a mean of 9.3 and standard deviation 2.68. There was no significant association between level of knowledge of staff nurses and their selected personal variables exceptage.

Current Perspectives in the Management of Retinopathy of Prematurity

Mangat R Dogra MD Professor of Ophthalmology Advanced Eye Center, Postgraduate Institute of Medical Education and Research Chandigarh, India Email: drmangatdogra@gmail.com *Address for correspondence Retinopathy of prematurity (ROP) is a new and fast emerging cause of childhood blindness in India due to increased survival of premature babies, lack of awareness and mandatory screening program. Evidence has shown that higher birth weight and more mature babies are developing severe ROP in our country. Guidelines as proposed by the National Neonatology Forum of India needs to be followed so that treatable ROP is not missed among heavier premature babies. Strategy of timely screening at day 30 after birth need to be emphasized and implemented. Current standards of care in ROP include prevention of ROP with strict monitoring of oxygen saturation levels, timely confluent laser treatment with green or diode laser photocoagulation and early lens sparing vitrectomy in progressive ROP. Anti-VEGF therapy should be reserved for selective cases as rescue therapy along with laser photocoagulation in view of safety issues. Long term follow up is mandatory for development of vision after treatment of ROP.

Association of Asthenopia and Convergence Insufficiency in Children with Refractive Error- A hospital based study

Introduction: It is estimated that about 14% of people in India with visual impairment are suffering from refractive errors. The prevalence of childhood blindness in India is 0.17% and refractive errors alone are the major treatable cause (33.3%) of the blindness. Assessment of Visual acuity should not be the only criteria for detection of ametropia, as children have strong accomodation. Thus it is emphasizing the importance of refraction testing under cycloplegic drugs. Convergence insufficiency is prevalent in about 7.5% of population. Purpose: To study the association of asthenopia and convergence insufficiency with refractive error in children. Methods: 2130 ametropic children up to 16 yrs were screened for asthenopia and convergence insufficiency. Result: Ametropia was found in 40.24% of children .Myopia was prevalent in 47.41% children. Hypermetropia was detected in 15.49% children. Convergence insufficiency was observed in 34.14% of children and asthenopia was found in 82.19% ametropic children. Conclusion: The study reveals that, asthenopia and convergence insufficiency are found to be the most common ocular conditions associated with ametropia.

Effect of education sessions of a structured school eye screening programme on Indian schoolteachers’ knowledge and responsibility for children’s eye health

Objective: To evaluate the effect of education sessions on Indian schoolteacher awareness of childhood eye health issues, responsibility for children’s eye health, and successful participation in a teacher-led eye screening health intervention programme in primary schools aimed at addressing avoidable childhood blindness in India. Design: Quantitative study, pre-intervention and post-intervention surveys and questionnaires. Setting: One hundred and four government-employed schoolteachers in primary schools of Hyderabad, India. Method: Prior to the screening intervention programme, questionnaires were administered to evaluate baseline teacher knowledge and observed responsibility for management of children’s eye health. The intervention consisted of three one-hour educational training sessions at central community locations about children’s eye health and proper screening practices, followed by on-site monitoring of teacher screenings after a period of 10 school days. Post-programme questionnaires and surveys were administered to evaluate changes in knowledge and attitudes. Results: Despite low levels of pre-programme knowledge and felt responsibility, teachers demonstrated significant improvements in overall knowledge of eye parts and functions, common childhood diseases, and local myths (39.3% to 63.7%, p &lt; 0.01) and significant increases in felt responsibility for children’s eye health (45.5% to 77.8%, p &lt; 0.01) through the course of the programme. Conclusion: Apart from technical training, educational sessions may play an important role in promoting sustained teacher interest in school-based health intervention programmes and overall impact on community health. Urban schoolteachers have therefore been identified as promising candidates in the continued effort to eliminate avoidable childhood blindness in India and other parts of the developing world.

The importance of prenatal factors in childhood blindness in India.

The causes of visual loss in 1411 children attending schools for the blind in different geographical areas in India are described. Ninety-three percent (1318) of the children were severely visually impaired (SVI) or blind (i.e. corrected acuity in the better eye of <20/200 [<6/60]). In 60% of SVI/blind children vision loss was attributable to factors operating in the prenatal period, in 47% the prenatal factors were known and definite, and in 13% prenatal factors were the most probable causes. Hereditary retinal dystrophies and albinism were seen in 19% of SVI/blind children and 23% had congenital ocular anomalies. There were variations in the relative importance of different causes by state. The observed pattern of causes of visual loss is intermediate between those seen in industrialised countries and in the poorest developing countries. This suggests that strategies to combat childhood blindness in India need to address concurrently both preventable and treatable causes. The need for aetiological studies, particularly on anophthalmos and microphthalmos, is highlighted.

Childhood blindness in India: causes in 1318 blind school students in nine states.

It is estimated that at least 200,000 children in India have severe visual impairment or blindness and approximately 15,000 are in schools for the blind. Although this represents a small percentage of the estimated 5 million blind in India, it is significant in terms of 'blind-years'. Strategies to combat childhood blindness require accurate data on the causes to allocate resources to appropriate preventive and curative services. Since socio-economic factors vary in different areas of this industrializing country data should be representative of the country as a whole. This is the first multi-state study to be undertaken in India using the Record for Children with Blindness and Low Vision from the World Health Organization/PBL Programme. A total of 1411 children in 22 schools from nine states in different geographical zones were examined by an ophthalmologist and optometrist. Of these, 1318 children were severely visually impaired or blind (SVI/BL). The major causes of SVI/BL in this study were: (1) corneal staphyloma, scar and phthisis bulbi (mainly attributable to vitamin A deficiency) in 26.4%; (2) microphthalmos, anophthalmos and coloboma in 20.7%; (3) retinal dystrophies and albinism in 19.3%; and (4) cataract, uncorrected aphakia and amblyopia in 12.3%. This mixed pattern of causes lies in an intermediate position between the patterns seen in developing countries and those seen in industrialised countries. The causes identified indicate the importance both of preventive public health strategies and of specialist paediatric ophthalmic and optical services in the management of childhood blindness in India.