Prevalence of visual impairment in children: a review of available data

Risk of Congenital Ocular Anomaly After Prenatal Exposure to Medications: A EUROmediCAT Study

BACKGROUND

In Europe, the prevalence of congenital ocular anomaly (COA) is estimated at 3.7 per 10,000 births. While certain COAs have a genetic origin, the cause for most patients remains unknown. The role of medications administered during pregnancy in COA genesis in humans is unclear.

OBJECTIVE

To investigate any association between fetal exposure in the first trimester of pregnancy to medications and the occurrence of COA.

METHODS

We conducted a case-malformed-control study using data on 298,351 cases registered as having congenital anomalies (CA) from 19 registries and one healthcare database in 13 European countries. Two analyses were performed: (i) A signal confirmation analysis of signals from the literature, examining associations between COA and specific medications (nitrofurantoin, NSAIDs, opioids, alprazolam, antihypertensives, asthma medications, pyridoxine, and hydroxyethylrutoside). (ii) A signal detection analysis of all medications reported in the database.

RESULTS

We identified 4185 COA cases and 232,718 nongenetic and 38,409 genetic controls. We confirmed the association between prenatal opioid exposure and COA (aROR: 2.66, 95% CI: 1.18, 6.02, and 3.22, 95% CI: 1.35, 7.69, for nongenetic and genetic controls, respectively). Signal detection analysis revealed consistent associations for antiglaucoma preparations and miotics (p < 0.01) related to COA. Other associations included congenital cataracts and lens anomalies with desloratadine, congenital glaucoma with antiepileptics, and eyelid malformations with dermatological hydrocortisone.

CONCLUSIONS

This pharmacoepidemiological study in Europe analyzing COA following fetal medication exposure confirmed reported signals regarding opioids and COA and identified new associations. Validation in independent datasets is necessary to consolidate these findings.

The first review on prenatal drug exposure and ocular malformation occurrence

Even though a non-negligible portion of congenital eye anomalies has a clear genetic origin, an etiology is not found for most patients. Prenatal medication exposure is recognized to be involved in fetal malformations and several medications are specifically known to alter eye morphogenesis during embryonic development leading to congenital eye defects. We explored and reviewed the role of medications described in the genesis of ocular malformations, a role that has been little evaluated and probably still underestimated especially since several studies have shown the wide exposure of pregnant women to medication. We present our results in two sections; the first describes medications reported to be associated with ocular malformations in humans; the second details medications responsible for ocular malformations in animal models. We have summarized these results in tables, providing a relevant tool for clinicians. As most of the associations between medication exposure and congenital eye defects are either old or single case reports, this study highlights the needs for high epidemiological vigilance, accurate clinical description as well as a combination of studies on human genetics and experimental studies. Since medication exposures are potentially modifiable risk factors for congenital anomalies, this represents an important opportunity to implement preventive measures.

Visual acuity and reading print size requirements in children with vision impairment

CLINICAL RELEVANCE

The support of students with a vision impairment throughout education could be enhanced by assessing the functional reading ability of the individual. This visual assessment could inform educators of individualised student needs and potentially improve the academic achievement for these students.

BACKGROUND

Support for children with a vision impairment within a classroom is typically based on clinical findings of distance visual acuity and visual fields. Therefore, determining optimal print size for reading is essential to ensure best academic outcomes. Secondary aims were to investigate the possible impact of underlying pathology on reading ability.

METHODS

Forty-seven participants were recruited from a state-wide support service for children with a vision impairment in South Australia. Three visual acuity groups were formed based on World Health Organisation definitions of mild, moderate, and severe vision impairment. Correlation between clinical measures of distance visual acuity using the Freiburg Visual Acuity Test, were compared with reading acuity and critical print size (smallest font before reading speed reduced) using Minnesota low vision reading chart (MNREAD).

RESULTS

No significant correlations were found for mild (0.20-0.49 logMAR) and severe (1.00-1.52 logMAR) vision impairment groups between distance visual acuity and reading acuity read (p = .64, CI [-.585, .395]/p = .82, CI [-.48, .58]) or critical print size (p = .78, CI [-.57, .45]/p = .43, CI [-.34, .68]. A significant correlation was found for the moderate vision impairment group: 0.50-0.99 logMAR for minimum reading acuity (p < .001, CI [.44, .91]) and critical print size (p = .03, CI [.05, .80]).

CONCLUSIONS

Standard clinical measures of distance visual acuity are an unpredictable estimate of reading ability in children with mild and severe vision impairment. Additional measures of functional near reading ability could provide a more meaningful indicator of reading ability and help provide optimum support to students through education.

Correlation of optic nerve on magnetic resonance imaging with visual acuity in children with cerebral visual impairment

AIM

The aim of the study was to correlate the optic nerve dimensions at various locations on magnetic resonance imaging (MRI) with the visual acuity of children with cerebral visual impairment (CVI).

MATERIALS AND METHODS

A 1-year cross-sectional study was conducted in a tertiary care hospital involving 60 children aged 1 to 12 years diagnosed with CVI but without ocular pathologies. Visual acuity was evaluated using teller acuity cards (TACs). MRI of the brain and orbit was performed using three-dimensional high-resolution, volumetric heavily T2-weighted sequences to screen for brain pathologies and measure optic nerve dimensions at two locations. The correlation between visual acuity and optic nerve dimensions was analyzed. The Chi-square test was employed to assess significance using SPSS software.

RESULTS

In our study, 64% (n = 38) of the participants were children under 3 years of age. The severity and characteristics of CVI influenced visual functioning at different ages. As children with CVI grew older and moved from Phase I to Phase III, the proportion with very low visual acuity significantly decreased from 85.2% in Phase I to 22.2% in Phase III and from 63.2% in the <3-year age group to 18.2% in more than 5-year age group. No direct correlation was found between optic nerve dimensions and visual acuity but optic disc changes such as optic disc pallor significantly correlated with low visual acuity.

CONCLUSION

Our findings suggest that there may not be a direct correlation between optic nerve dimensions and visual acuity in children with CVI. However, optic disc changes do correlate with visual acuity, but optic disc changes alone are not a criterion for assessing visual function. Additionally, our study highlights the significance of a combined assessment by a neuro- ophthalmologist and neuro-pedaitrician in children with CVI.

Prevalence of Refractive Errors Among Children at a Tertiary Care Center in Karnataka: A Cross-Sectional Study

BACKGROUND

Refractive errors (REs) are the major cause of blindness and impaired vision with considerable morbidity. Finding the prevalence with early detection of REs with appropriate corrective measures can bring down eye morbidity in children.

AIM

The aim of the study was to find the prevalence of REs among children attending Raichur Institute of Medical Sciences Teaching Hospital in Karnataka State of South India.

METHODOLOGY

This hospital-based cross-sectional study was conducted with a total of 420 study subjects. Examination of the eyes for REs was carried out using a refractometer. The REs were noted in myopia < -0.5 dioptres (D), hypermetropia > + 0.5 D, and astigmatism > 0.5 cylinder D. The data were statistically subjected to a statistics test. Categorical measurement was presented as frequency (percentage). The association between the parameters was done using the chi-square test. A p-value < 0.05 was considered statistically significant.

RESULTS

Out of 420 examined, REs were present among 147 (35%) study subjects, and myopia 67 (16%) was the highest prevalent in comparison to hypermetropia 42 (10%) and astigmatism 38 (9%). The male subjects had 77 (34.4%) REs, and the female subjects had 70 (35.7%) REs. In both genders, myopia was the highest prevalent, followed by hypermetropia and astigmatism.

CONCLUSION

 The prevalence of REs among children is alarming, and it should be corrected at an early age to prevent further complications in adulthood. Ophthalmologists should generate regional data about the prevalence of REs, create awareness about the prevention of REs among the risk population, and utilize government-sponsored blind eradication programs for comprehensive eye care in the larger interest of the affected population and risk population.

The EFEMEREYE Study: prenatal medication exposure and ocular anomaly occurrence in EFEMERIS health database

PURPOSE

To describe ocular anomalies (OAs) in children and fetuses in a French general population, to estimate their prevalence, and to investigate a possible association between prenatal medication exposure and the occurrence of OA in utero or in early childhood.

METHODS

We conducted a case-control study using the EFEMERIS cohort, a database containing pregnancies registered in Haute-Garonne and their outcomes. We collected OA descriptions of fetuses at the time of pregnancy termination or of children at birth and the results of eye examinations of children at 9 months and 2 years of age.

RESULTS

The prevalence of overall OAs was 2.13%, of which 0.04% were congenital ocular malformations (COMs). A total of 2,968 cases and 136,619 controls were selected for analysis. There was a significant difference between the two groups with regard to prenatal exposure to medications for the digestive tract and metabolism, the cardiovascular system, and the respiratory system. Multivariable analysis revealed an increased risk of OA in children of mothers exposed to magnesium during and 1 month before pregnancy (OR = 1.24; 95% CI, 1.11-1.38).

CONCLUSIONS

This first pharmaco-epidemiological study on OA in France suggests that OA may be associated with exposure to commonly used medications. Given the rarity of COM, larger, international studies are warranted.

Oral health in youth with visual impairment: A longitudinal survey

This longitudinal survey aims to demonstrate improvement in oral hygiene among a group of youth with visual impairment (VI) achieved by repeated oral hygiene training, compare their progress with healthy peers (CG) and assess their oral health knowledge. In 100 VI (55♀, 45♂; ± 17.8 years) and 45 CG (23♀, 22♂; ± 17.2 years) oral hygiene training and a Quigley-Hein Plaque Index (QHI) rating were repeated six times at three-month intervals. The VI were divided into four subgroups according to the toothbrush hardness/type. A questionnaire was given to both groups. Appropriate statistical analyses were performed at 5% significance level. Both groups showed reduction in QHI, the VI had overall higher QHI values than CG. Use of an electric toothbrush in VI led to lower QHI in the last examination (p < 0.03). 69% of participants recommended dental specialists to improve communications by acquiring more illustrative aids. VI changed toothbrush less often (p < 0.02). A higher incidence of dental plaque was confirmed in VI compared to CG. After education and individual training, gradual plaque reduction has occurred in both groups. Using an electric toothbrush in VI resulted in better QHI outcomes. Repetitive preventive intervention in youth with VI helped them to adopt healthier oral hygiene habits.

A systematic review of the impact of childhood vision impairment on reading and literacy in education

PURPOSE

This systematic review evaluates current literature on the impact vision impairment has on reading and literacy levels within education.

METHODS

Six databases were searched with inclusion criteria of trials or studies involving children who are blind or vision impaired, and impact on academic or school performance - including reading and literacy. 1262 articles were identified, with 61 papers undergoing full screening. Quality appraisal was performed using Critical Appraisal Skills Program (CASP) and seven articles deemed eligible for inclusion.

RESULTS

Included articles achieved a quality score of over 70 % using the CASP checklists. Direct comparison of articles was not possible due to methodological differences in assessing reading and literacy levels. All seven studies investigated aspects of reading speed, with additional measures of reading performance, such as reading reserve, comprehension, and reading accuracy.

DISCUSSION

Underlying trends highlighted students with a vision impairment do not perform at same level as their normally sighted peers with respect to reading performance - in terms of speed, but not ability. Additionally, early intervention to enhance literacy skills may help improve educational outcomes. Future direction should be aimed at identifying specific obstacles to learning these students face and providing interventions to improve academic outcomes.

Retinopathy of Prematurity-Targeting Hypoxic and Redox Signaling Pathways

Retinopathy of prematurity (ROP) is a proliferative vascular ailment affecting the retina. It is the main risk factor for visual impairment and blindness in infants and young children worldwide. If left undiagnosed and untreated, it can progress to retinal detachment and severe visual impairment. Geographical variations in ROP epidemiology have emerged over recent decades, attributable to differing levels of care provided to preterm infants across countries and regions. Our understanding of the causes of ROP, screening, diagnosis, treatment, and associated risk factors continues to advance. This review article aims to present the pathophysiological mechanisms of ROP, including its treatment. Specifically, it delves into the latest cutting-edge treatment approaches targeting hypoxia and redox signaling pathways for this condition.

Barriers to the uptake of eye health services of the children in rural Bangladesh: A community-based cross-sectional survey

Globally, ocular morbidity and disability among children are major public health concerns. This study was designed to explore the health-seeking behaviours of parents in Bangladesh whose children have ocular problems. A cross-sectional mixed method was followed for this study. The method was designed to measure the eye health care-seeking practices of caregivers/parents with children with ocular morbidity in three unions (the lowest administrative geographical area comprising 30,000-50,000 population) of the Raiganj Upazila under the Sirajganj District of Bangladesh. The study period was from January to April 2017. Face-to-face interviews using a semi-structured quantitative questionnaire with the caregivers and KI were conducted among the health service providers during the study period. This was the first community-based study conducted in Bangladesh to find out caregivers' health-seeking behaviour with identified ocular morbidity. Among 198 confirmed cases of childhood ocular problems, only 87 (43.9%) parents sought health care for their children's ocular morbidities. Better health-seeking behavior was found among the wealthier families. Proportions were 55.3% and 36% among wealthy and low-income families, respectively. Affluent families sought care from qualified service providers. Educated household heads chose qualified service providers for their children at a higher rate than illiterate household heads. Lack of knowledge, lack of awareness and financial constraints are significant barriers to seeking proper health care. More than half of the caregivers did not seek any eye care services for their children. Socio-demographic factors, and financial constraints play an essential role in the health-seeking behaviour of the parents.

Cerebral visual impairment and effect of phase-wise stimulation strategies-An interim analysis

Context

Cerebral visual impairment (CVI) is an overarching term, defined as a brain-based visual impairment with onset in childhood, unexplained by an ocular disorder and associated with unique visual and behavioral characteristics. Good vision and awareness of visual function in a child are highly essential as neuroplasticity is maximum in the first three years of life and response to intervention is utmost in this period. Awareness is lacking regarding CVI, and the diagnosis is largely missed. This can be easily addressed if a structured approach is employed.

Purpose

This study aims to evaluate the etiology and radiological correlation with the severity of CVI and outcome after structured intervention in children with CVI.

Settings and Design

Prospective-interventional study.

Methods and Material

Children attending the Child Development Centre (CDC) of a tertiary care hospital in North Karnataka and diagnosed with CVI in the age group of six months to 12 years and meeting the sampling criteria were screened and enrolled consecutively after obtaining parental consent/assent. Statistical analysis used is nonparametric test with SPSS software.

Results

Age showed a significant association with the phase of CVI. Perinatal insult was associated significantly with the severity of CVI. Magnetic resonance imaging (MRI) findings did not hamper the recovery of CVI.

Conclusions

Enrolment in early intervention programs tailored according to child's specific needs should be encouraged, with stress on ophthalmic screening of preterm and high-risk babies with perinatal hypoxia and history of convulsions, as early as six months.

Causes of Moderate to Severe Visual Impairment and Blindness Among Children in Integrated Schools for the Blind and Visiting a Tertiary Eye Hospital in Nepal: The Nepal Pediatric Visual Impairment (NPVI) Study

Purpose

To study the causes of moderate and severe visual impairment (VI) and blindness and its changing trends in Nepalese children.

Patients and Methods

A cross-sectional descriptive study was conducted. Participants, aged 7 to 17 years were recruited from integrated schools for the blind and the outpatient department of a tertiary eye hospital in Kathmandu. VI and blindness were categorized according to World Health Organization (WHO) categories and its protocol for eye examination of children with blindness and VI was followed. Findings were compared to former studies from Nepal.

Results

A total of 200 children were included, of whom 45% had moderate VI, 5% had severe VI, and 50% were blind. Mean age of children with VI and blindness was 11.1 (SD = 3.3) and 12.9 (SD = 3) years, respectively. Forty percent of children with VI and 38% of blind children were female. In our study, retina (39%) and whole globe (32%) were the most common anatomical site of involvement in children with VI and blindness, respectively, while cornea was the most common anatomical site of involvement in former studies. Heredity (43%) was the most common etiological factor although in 24.5% of all children, etiology was unknown. In 43.5% of children, blindness and VI was due to avoidable causes.

Conclusion

In relatively many children, the etiology of VI and blindness could be either prevented or treated. Compared to former studies from Nepal, there is a changing trend in the etiology of severe VI and blindness.

Prevalence of pediatric eye disease in the optumlabs data warehouse

PURPOSE

To define the prevalence of medical eye disease diagnoses among children enrolled in commercial insurance plans in the United States and to evaluate differences among groups based on the US census region, race/ethnicity, and familial net worth.

METHODS

: Retrospective study of de-identified claims data from the OptumLab® Data Warehouse (OLDW) between 2007 and 2018. All children (<19 years) in the OLDW with coverage were studied and those with a claim for a significant eye disease (strabismus, amblyopia, nystagmus or structural eye disorders) with minimum 6-months follow-up were studied. Baseline characteristics were extracted for the calculation of eye disease prevalence, including age, sex, race/ethnicity, region of residence, and family net worth. The prevalence of each type of eye disease was calculated among all children and by baseline characteristics.

RESULTS

: 10,759,066 children met the study criteria. The presence of any significant eye diagnosis was 6.7%. Disease was diagnosed more often in whites (6.9%) than blacks (5.6%) and Hispanics (5.9%). The most common eye disease diagnosed was strabismus (3.2%) followed by amblyopia (1.5%). In the North-East region, there was a 10.6% prevalence of any significant eye disease diagnosis, whereas in the Mid-West, it was 7.4% followed by the South and West (5.9% and 5.3%, respectively) (p < .001). There was an increase in eye disease diagnoses with increasing income (5.5% in<$25,000 and 9.4% in >$500,000 household net worth groups, p > .001).

CONCLUSION

: Diagnosis of significant eye diseases is relatively common in American children. The most common medical eye disease diagnosis is strabismus. Prevalence of eye disease diagnosis from claims data varies between geographical regions and different income groups. This may reflect differences in healthcare utilization rather than true disease prevalence.

WHO Vision 2020: Have We Done It?

BACKGROUND

Eye health has widespread implications across many aspects of life, ranging from the individual to the societal level. Vision 2020: The Right to Sight is an initiative that was conceptualised in 1997 and launched in 1999. It was led by the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) in response to the increasing prevalence of blindness. Approximately 80% of the causes of blindness were avoidable. Hence, the initiative set out to eliminate the major causes of avoidable blindness. These included cataract, uncorrected refractive error, trachoma, onchocerciasis, and childhood blindness.

METHODS

An electronic literature search was performed using PubMed, MEDLINE and Embase databases to assess the impacts of the Vision 2020 initiative.

RESULTS AND CONCLUSION

The Vision 2020 initiative was ambitious and was essential in catapulting the issue of avoidable blindness in the spotlight and putting it on the global health agenda. The causes of avoidable blindness remain and have not been eliminated. However, there have been noticeable changes in the distribution of the causes of avoidable blindness since the conception of Vision 2020, and this is mainly due to demographic shifts globally. We highlight some of the remaining challenges to acheiving avoidable blindness including, population size, gender disparities in access to eyecare services, and the professional workforce.

Visual impairment in children with multiple disabilities in schools for children with special needs in South India

Purpose:

To understand/assess ocular and functional vision impairment in children with multiple disabilities with a functional vision assessment battery in addition to standard ophthalmic examinations in an outreach setting.

Methods:

Seven schools for children with special needs, 243 children in total, were screened for ocular disorders and functional vision impairment through school camps.

Results:

Among them, 37% had refractive errors needing spectacle correction. With standard ocular testing methods, the visual impairment was around 32%, but when functional vision was assessed, the functional vision impairment amounted to 70% in these children. The presence of functional vision impairment was found to be independent of the associated disability. Assessment of visual capacities such as visual closure, saccade pursuits, optic ataxia, and developmental milestones early on can help in suspecting the presence of CVI

Conclusion:

Children with multiple disabilities are more at risk of functional vision impairment, which significantly impairs their ability to function in daily life. A complete functional vision assessment becomes essential to plan early intervention for these children. The significant proportion of vision impairment and functional vision loss in our study indicates the need for coordinated structured programs to address vision-related problems in children with multiple disabilities.

Eye disorders spectrum: a tertiary hospital pediatric ophthalmology clinic based in Ethiopia

Background

Epidemiological studies to determine the pattern of eye disorders among children are important for proper health care planning and management. This study aimed to document the spectrum and frequency of eye diseases in children who attended the pediatric ophthalmology clinic of a tertiary teaching hospital in Addis Ababa, Ethiopia.

Methods

A cross-sectional and convenient sample of 1237 male and female children (16 years and below) with ocular disorders presenting for the first time and those children with a settled diagnosis coming for a follow-up visit between June 1, 2018, and May 31, 2019, were included in the study. Data on presentation age, sex, and diagnosis were collected and analyzed. Eye disorders were classified into various categories. Children were grouped into four age groups. Ratios, percentages, and chi-square associations were calculated. P < 0.05 was considered statistically significant.

Results

Of the children, 60% were male. The mean age (standard deviation) of the children was 4.26 (± 4.1) years. Patients aged 0– < 6 years old were the largest group, constituting 70.5%. Ocular motility imbalances were the most common ocular disorders seen (32.8%), followed by childhood cataract (18.4%) and infection and inflammation of the eye and adnexa (8.3%). Ocular motility imbalances were observed more frequently and statistically significantly (p < 0.001) in children aged 1- < 6 years. Within the childhood cataract category, congenital cataracts were more prominent (7.1%). Within the infection and inflammation category, corneal/scleral infections were more common (3.7%).

Conclusions

The study highlights common eye disorders seen in children in a specialized hospital ophthalmic clinic. Ocular motility imbalance, childhood cataracts, infection and inflammation of the eye and adnexa were the most commonly occurring disorders. Early presentation was common, and males were more affected than females.

Global burden of paediatric vision impairment: a trend analysis from 1990 to 2017

OBJECTIVE

To assess the trend of paediatric visual impairment and its disparities by year, sex, age and national socioeconomic levels using disability-adjusted life years (DALYs).

METHODS

It is a retrospective analysis of data from the Global Burden of Disease (GBD) 2017. Global and national DALY numbers and rates of vision impairment in three paediatric age groups of 1-4 (preschool children), 5-9 (school children) and 10-14 years (teenagers) years were obtained from the GBD 2017 database. The socioeconomic indices for 195 countries were derived from international open databases. Main outcome measures were comparison of DALYs due to paediatric vision impairment in different age groups by socioeconomic indicators in 2017 and analysis of the trend from 1990.

RESULTS

The global prevalence of distance and/or near vision impairment for 1-14 years was 2.8% (95% uncertainty interval (UI): 2.5-3.1) in 2017. The highest DALYs for distance and/or near vision impairment [number=589.93 thousands (95%UI: 367.71-933.29), rate = 92.72 (95%UI: 57.79-146.68)] were observed in teenagers. DALY rate of distance and/or near vision impairment was not associated with socioeconomic indicators, however, DALY rate of refractive disorders had positive correlation with national socioeconomic development. The global trends of DALY numbers in distance and/or near vision impairment as well as refractive and other causes remained stable from 1990 to 2015 (0.128 ≤ P ≤ 0.738), however, DALY rates had a statistically significant trend of reduction in all paediatric age groups (0.003 ≤ P ≤ 0.024).

CONCLUSION

The global health burden of paediatric vision impairment decreased from 1990. Refractive, near vision impairment and other causes were associated with socioeconomic development.

Retinal vessel oximetry in children with inherited retinal diseases

BACKGROUND

Retinal vessel oximetry (RO) has been used to show altered metabolic function in patients with inherited retinal diseases (IRDs). The aim of this study was to investigate RO parameters of children with IRDs and presumed IRD carriers (pIRDc) and to compare them to controls.

METHODS

In this cross-sectional cohort study, 142 eyes from 71 Caucasian subjects were included: 40 eyes with IRDs, 26 eyes with pIRDc and 76 control eyes. The oxygen saturation was measured with the Retinal Vessel Analyser (IMEDOS Systems UG, Jena, Germany). Mean oxygen saturations in the peripapillary retinal arterioles (A-SO₂ ; %) and venules (V-SO₂ ; %) were estimated, and their difference (A-V SO₂ ; %) was calculated. In addition, we evaluated the mean diameter in all major retinal arterioles (D-A; μm) and venules (D-V; μm). anova-based linear mixed-effects models were calculated with SPSS^® .

RESULTS

In general, children suffering from IRDs differed from controls when the A-SO₂ and A-V SO₂ were taken into account: both the A-SO₂ and the A-V SO₂ were significantly increased (p = 0.012). In subgroup analyses, children suffering from rod-cone dystrophy (RCD) presented an A-SO₂ increase (99.12 ± 8.24%) when compared to controls (91.33 ± 10.34%, p = 0.014) and pIRDc (92.37 ± 6.57%, p = 0.065). For V-SO₂ significant changes in RCD (67.42 ± 9.19%) were found in comparison with controls (58.24 ± 11.74%, p < 0.041), pIRDc (56.67 ± 7.16%, p = 0.007), cone-rod dystrophies (CRD, 52.17 ± 5.32%, p < 0.001) and inherited macular dystrophies (IMD, 55.74 ± 6.96%, p = 0.004), In addition, A-V SO₂ was decreased in RCD (31.69 ± 3.92%) when measured against CRD (41.9 ± 8.87%, p = 0.017) or IMD (39.52 ± 8.95%, p = 0.059).

CONCLUSION

In general, we found that children with IRDs presented early metabolic changes. Within IRDs, children with RCD showed more affected metabolic changes. Thus, RO may support early screening to rule out IRDs in children, and more precisely may help to differentiate those suffering from RCD.

Children's visual impairment and visual care related to socioeconomic status in Catalonia (Spain)

BACKGROUND

The objective of this study is to assess the prevalence of visual impairment and visual care practices and its association with socioeconomic conditions in the infant population in Catalonia.

METHODS

The Catalan Institute of Statistics provided a random sample of 0 to 14-year-old non-institutionalized children whose parents were interviewed in a continuous health survey from 2011 to 2015 in Catalonia. A multistage stratified and random sampling procedure considering age, sex, county and town was followed. All results have been weighted according to the sample design and are presented as the proportion of the condition with its 95% confidence limits. Chi-square tests were performed to evaluate the association between categorical variables. To study the association of visual care with independent variables, a multiple logistic regression model was used.

RESULTS

In 0 to 14-year-old children, a 12.9% (95% confidence interval [CI] [11.8-13.9]) prevalence of correctable visual impairment was observed. The prevalence of non-correctable visual impairment was 0.9% (95% CI [0.6-1.2]). Non-correctable visual impairment was more prevalent in families with lower education levels, manual professions or unemployed. Of children without visual impairment, 13,5% (95% CI:12.3-14.6) visited a visual care professional in the last 12 months while this proportion was 67.4% (95% CI [63.3-71.5]) among those with correctable visual impairment. When parents have a university degree or non-manual professions, a higher level of visual care was observed. In children with correctable visual impairment, visual reviews were more frequent when parents are employed in a non-manual profession.

CONCLUSIONS

For the first time, indicators related to visual impairment in children in Catalonia have been recorded. There is an association between lower socioeconomic status and having non-correctable visual impairment, and conversely, having correctable visual impairment was significantly associated with employed parents. More visual care is associated with higher socioeconomic status.

Causes of vision impairment and blindness among children in schools for the blind in South Indian States of Andhra Pradesh and Telangana

Purpose:

To study the causes of severe vision impairment (SVI) and blindness among children in Andhra Pradesh (AP) and Telangana State (TS) in South India.

Methods:

A total of 299 children from 10 schools for the blind were examined between January and December 2017. The schools were chosen from 3 districts of AP (Guntur, Krishna and West Godavari) and 2 districts of TS (Adilabad and Mahabubnagar). The World Health Organization Prevention of Blindness' eye examination protocol for children with blindness or visual impairment (VI) was followed.

Results:

Based on presenting visual acuity (PVA), 248 children (82.9%) were blind, 16 children (5.3%) had SVI, 18 (6%) had moderate VI, and 17 (5.7%) were normal. The most common anatomical cause of blindness or SVI was whole globe anomaly (32%), followed by an abnormality in the retina and vitreous (26.6%). While whole globe anomalies were high both in AP (33.8%) and TS (21.6%), lens-related pathologies were higher in TS (29.7%) and retina-related abnormalities were higher in AP (29.3%). The most common cause was related to heredity (40.5%). Etiology was unknown in 33.5% of cases. Overall, 37.1% of the causes were avoidable. In AP, 33.4% were avoidable whereas in TS nearly 60% were avoidable.

Conclusion:

Whole globe anomaly constitutes a major cause of SVI and blindness, especially in AP. Lens-related pathologies were higher in TS. Nearly 40% of the causes were avoidable. Hence, robust screening methods and strategies must be established for timely intervention to reduce the burden on VI in children.

Sex and rural-urban differences in the prevalence of childhood visual impairment in Taiwan: A nationwide population-based study

BACKGROUND

Visual impairment (VI) is a major developmental disability in children, but data at the national level are limited.

AIMS

We conducted a nationwide study in Taiwan to assess the sex and rural-urban differences in VI.

METHODS AND PROCEDURES

Using data from the national disability registry, we calculated prevalence rates by age, sex, and geographic area and assessed changes from 2004 to 2010. We excluded cases under 3 years old because the government discourages certification at this age.

OUTCOMES AND RESULTS

Between 2004 and 2010, the overall prevalence rate fluctuated between 3.48/10,000 and 3.66/10,000. Boys had higher prevalence rates in all years, and the boy-to-girl prevalence rate ratios ranged from 1.24 to 1.30 (p < 0.05 in all years), without an apparent time trend. The rates generally decreased over time in rural areas (p=0.008), but increased in urban areas (p=0.029); this resulted in a decreasing time trend (p = 0.001) in the rural-to-urban prevalence rate ratios (1.32 to 1.09; p < 0.05 except for 2010).

CONCLUSIONS AND IMPLICATIONS

Boys are more likely to experience VI in Taiwan. Rural areas had higher prevalence rates than urban areas, but the difference has been decreasing over time. Identifying factors underlying this reduction may help the prevention of VI.

Lessons Learned from 23 Years of Experience in Testing Visual Fields of Neurologically Impaired Children

We sought to investigate the reliability of standard conventional perimetry (SCP) in neurologically impaired (NI) children using the examiner-based assessment of reliability scoring system and to determine the difference in time to diagnosis of a visual field defect between SCP and a behavioural visual field (BVF) test. Patient records of 115 NI children were retrospectively analysed. The full field peritest (FFP) had best reliability with 44% 'good' scores versus 22% for Goldmann perimetry (p < .001). The mean age of NI children able to perform SCP was 8.3 years versus 4.6 years for the BVF test (p < .001). Use of the BVF test may significantly reduce time to diagnosis.

Early intervention for children at risk of visual processing dysfunctions from 1 year of age: a randomized controlled trial protocol

Background

An increasing number of children are suffering from brain damage-related visual processing dysfunctions (VPD). There is currently a lack of evidence-based intervention methods that can be used early in development. We developed a visual intervention protocol suitable from 1 year of age. The protocol is structured, comprehensive and individually adaptive, and is paired with quantitative outcome assessments. Our aim is to investigate the effectiveness of this first visual intervention program for young children with (a risk of) VPD.

Methods

This is a single-blind, placebo-controlled trial that is embedded within standard clinical care. The study population consists of 100 children born very or extremely preterm (< 30 weeks) at 1 year of corrected age (CA), of whom 50% are expected to have VPD. First, children undergo a visual screening at 1 year CA. If they are classified as being at risk of VPD, they are referred to standard care, which involves an ophthalmic and visual function assessment and a (newly developed) visual intervention program. This program consists of a general protocol (standardized and similar for all children) and a supplement protocol (adapted to the specific needs of the child). Children are randomly allocated to an intervention group (starting upon inclusion at 1 year CA) or a control group (postponed: starting at 2 years CA). The control group will receive a placebo treatment. The effectiveness of early visual intervention will be examined with follow-up visual and neurocognitive assessments after 1 year (upon completion of the direct intervention) and after 2 years (upon completion of the postponed intervention).

Discussion

Through this randomized controlled trial we will establish the effectiveness of a new and early visual intervention program. Combining a general and supplement protocol enables both structured comparisons between participants and groups, and custom habilitation that is tailored to a child’s specific needs. The design ensures that all included children will benefit from participation by advancing the age at which they start receiving an intervention. We expect results to be applicable to the overall population of children with (a risk of) VPD early in life.

Trial registration

Netherlands Trial Register: NTR6952. Registered 19 January 2018.

Role of a Community-based Program for Identification and Referral of Pediatric Cataract Patients in Kinshasa, Democratic Republic of the Congo

PURPOSE

The purpose of this study is to describe the methodology and to assess the effectiveness of a community-based rehabilitation (CBR) program to identify and refer children with blinding cataract for the management and surgery to reduce the burden of childhood blindness due to cataract in Kinshasa.

METHODS

Church-based volunteers were trained to identify children with presumed eye disorders in their localities and households and to refer them for cataract identification by an ophthalmic nurse during parishes' visits. Volunteers were parishioners living in the quartiers where identification took place and worked as community workers with the CBR program. Nurses used a lamp-torch to rule out cataract. Selected children were referred to the tertiary eye health facility at St Joseph Hospital for diagnosis and management.

RESULTS

Identification took place in 31 out of 165 parishes in the Archdioceses of Kinshasa from 2000 to 2016 and 11,106 children aged <16 years were screened. Among them, 1277 children (11.5%) were presumed to have cataract. Ninety-two children among them died before surgery; 107 children were lost to further follow-up and did not report to the CBR center for referral. Reasons given were change of home address, moving in their lieu of origin, death, and refusal of treatment by the parents. Finally, only 1078 children were referred to the pediatric ophthalmologist and 705 children (65.4%) were definitively diagnosed to have treatable cataract, while in 373 children (34.6%), cataract surgery was not indicated for several reasons. There was a positive history of familial cataract in 36 children (2.8%).

CONCLUSION

Using church-based volunteers and ophthalmic nurses during community screening proved efficient in the identification and referral of pediatric cataract. Keeping regular identification activities in the community and maintaining high-quality and accessible pediatric cataract surgery services can help to clear up the backlog of cataract blind children.

Model Registry of Early Childhood Visual Impairment: First-Year Results

This study obtained information on 406 children from birth to age 3 with visual impairments at the point of entry into specialized early intervention programs in nine states. It found that the majority of the children were legally blind and had disabilities in addition to visual impairment. Cortical visual impairment, retinopathy of prematurity, and optic nerve hypoplasia were the three most prevalent eye conditions in the sample. Furthermore, about a six-month mean lag was found between the diagnosis of children's visual impairment and referral for services.

Fundus examination of 199 851 newborns by digital imaging in China: a multicentre cross-sectional study

Background

The prevalence of ocular abnormalities of newborn in China has seldom been reported. To report the implementation of digital imaging in ocular screening of all newborns in multiple centres in China and to describe the abnormal findings of fundus examination, we did the cross-sectional study.

Methods

Fundus examinations were performed on newborns within the 42 days after birth using a RetCam wide-field digital imaging system. Digital images of the posterior pole, superior, nasal and temporal retinal fields of each participant were taken. All newborns were from eights centres across China from January 2009 to July 2017.

Results

A total of 199 851 newborns were included in the study. We detected 18 198 (9.11%) abnormal cases. The most frequent abnormality was severe retinal haemorrhage (RH) found in 12 810 cases (6.41%). The other anomalies included familial exudative vitreoretinopathy, retinopathy of prematurity, abnormal fundus pigmentation, subconjunctival haemorrhage, choroidal coloboma, idiopathic retinal venous tortuosity, exudative changes and other anomalies with uncertain identities.

Conclusion

This large-scale study of newborn fundus examination showed a relatively high prevalence of ocular abnormalities. Hundreds of neonates with rare disorders that severely impair ocular health were also detected at an early age. The long-term impact of other anomalies including RHs on the ocular system should be investigated by a perspective study. Our study suggested that fundus examination of newborns can play a beneficial role in ocular health.

The Shiraz Pediatric Eye Study; a Population Based Survey of School Age Children: Rationale, Design and Baseline Characteristics

Purpose:

To describe the rationale, study design, methodology, and baseline characteristics of the Shiraz Pediatric Eye Study, a population-based survey of schoolchildren in Shiraz, Iran.

Methods:

This population-based study included schoolchildren aged 6–12 years from all four educational districts of Shiraz who were recruited in years 2015–2016. Stratified random sampling was used to select 2400 participants from all districts. Data were recorded from a detailed interview and ocular evaluation of each eligible student. The eye examination comprised uncorrected and best corrected visual acuity measurement, refraction, external eye examination (including specific strabismus and lid evaluation tests), slit lamp biomicroscopy, intraocular pressure measurement, the Ishihara color vision test, and stereoacuity. Exophthalmometry, optical biometry, and optical coherence tomography were performed for a randomly selected subset of children. General characteristics and socioeconomic variables were also recorded to assess risk factors.

Results:

From a total of 2400 selected students, 2001 (83.3%) participated in the study. The mean age of the students was 9.1 ± 1.6 years, and 59.7% were girls. Most children had at least one parent with a diploma or less than diploma (63.5%), and 2.2% had illiterate parents.

Conclusion:

This study is expected to provide accurate estimates of the prevalence of visual impairments and their related determinants in Shiraz. In addition, it will identify children who should be targeted by blindness prevention programs.

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

AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Etiology of Childhood Blindness in Izmir, Turkey

PURPOSE

To identify the anatomic sites and the etiology of childhood blindness and to discern treatable and preventable causes.

METHODS

The records of 998 patients seen in the authors' pediatric ophthalmology unit between June 1998 and May 2002 were examined retrospectively. A total of 148 patients who had visual impairment and blindness according to World Health Organization criteria were included in the study. They are classified according to the etiology based on time of insult and the anatomic site of visual loss.

RESULTS

The most common anatomic site of visual loss was retina, with a rate of 25.0%. The etiology according to the time of insult was unknown in 45.2% of the patients, of whom 20.2% had cataract. Genetic disorders were responsible in 25.0% of the patients. In 69.6% of the patients, the causes of visual impairment were considered either preventable or treatable, including cataract, retinopathy of prematurity, genetic disorders, and refractive errors.

CONCLUSIONS

A high percentage of our patients had avoidable causes of childhood blindness. Genetic counseling services, as well as national screening programs for amblyopia, red fundus reflex, and retinopathy of prematurity, should be established.

Causes of Childhood Vision Impairment in the School for the Blind in Eritrea

SIGNIFICANCE

Our study provides the much-needed evidence on causes of childhood blindness in Eritrea. This will assist authorities to plan appropriate strategies and implement preventive, curative, and rehabilitative services to address these causes of vision loss in children in this resource-limited country.

PURPOSE

This study aims to identify the causes of severe vision impairment and blindness in children attending the only school for the blind in Eritrea.

METHODS

All children enrolled in the school were examined, and the World Health Organization form for the examination of visually impaired children was used to record the data. Examination included visual acuity, refraction, anterior segment, and fundus assessment. Causes of vision loss for children with severe vision impairment (visual acuity <6/60 to 3/60) and blindness (visual acuity <3/60) are reported. Causes were classified by the anatomical site affected and by underlying etiology based on the timing of the insult and causal factor.

RESULTS

A total of 92 children were examined, and 71 (77.2%) of them had severe vision impairment and blindness. The major causes of vision loss were corneal scars (16.9%), cataract (12.7%), phthisis bulbi (11.3%), congenital eye deformities (11.3%), optic atrophy (9.3%), and presumed chorioretinal Toxoplasma scars (7.0%). Hereditary factors were the major known etiological category (15.5%) followed by the sequel of eye injuries (12.7%). Blindness due to vitamin A deficiency was not found, whereas infectious causes such as measles and ophthalmia neonatorum were relatively absent (one case each). Potentially avoidable causes of vision impairment were accounted for in 47.9% of children.

CONCLUSIONS

This study provides the first direct evidence on childhood vision impairment in Eritrea. Despite the limitations, it is clearly shown that nearly half of the vision loss is due to avoidable causes. Thus, preventive public health strategies, specialist pediatric eye care, and rehabilitative services are recommended to address childhood vision impairment in Eritrea.

Ocular morbidity patterns among children in schools for the blind in Chennai

Purpose:

To identify the morbidity patterns causing blindness in children attending schools for the blind in Chennai and comparing our data with similar studies done previously.

Methods:

A cross-sectional prevalence study was carried out in two schools for the blind in Chennai. Blind schools were visited by a team of ophthalmologists and optometrists. Students with best-corrected visual acuity (BCVA) worse than 3/60 in the better eye were included and relevant history was noted. Every student underwent anterior segment evaluation and detailed fundus examination. Morbidity of the better eye was taken as cause of blindness. Health records maintained by the school were referred to wherever available.

Results:

The anatomical causes of blindness include optic nerve disorders in 75 (24.8%) cases, retinal disorders in 55 (18.2%), corneal disorders in 47 (15.6%), lens-related disorders in 39 (12.9%), congenital anomalies in 11 (3.6%), and congenital glaucoma in 20 (6.6%) cases. The whole globe was involved in six cases (1.99%). Among conditions causing blindness, optic atrophy seen in 73 (24.17%) cases was the most common, followed by retinal dystrophy in 44 (14.56%), corneal scarring in 35 (11.59%), cataract in 22 (7.28%), and congenital glaucoma in 20 (6.6%) cases.

Conclusion:

It was found that avoidable causes of blindness were seen in 31% of cases and incurable causes in 45%. Optic nerve atrophy and retinal dystrophy are the emerging causes of blindness, underlining the need for genetic counseling and low vision rehabilitation centers, along with a targeted approach for avoidable causes of blindness.

Global causes of blindness and distance vision impairment 1990-2020: a systematic review and meta-analysis

BACKGROUND

Contemporary data for causes of vision impairment and blindness form an important basis of recommendations in public health policies. Refreshment of the Global Vision Database with recently published data sources permitted modelling of cause of vision loss data from 1990 to 2015, further disaggregation by cause, and forecasts to 2020.

METHODS

In this systematic review and meta-analysis, we analysed published and unpublished population-based data for the causes of vision impairment and blindness from 1980 to 2014. We identified population-based studies published before July 8, 2014, by searching online databases with no language restrictions (MEDLINE from Jan 1, 1946, and Embase from Jan 1, 1974, and the WHO Library Database). We fitted a series of regression models to estimate the proportion of moderate or severe vision impairment (defined as presenting visual acuity of <6/18 but ≥3/60 in the better eye) and blindness (presenting visual acuity of <3/60 in the better eye) by cause, age, region, and year.

FINDINGS

We identified 288 studies of 3 983 541 participants contributing data from 98 countries. Among the global population with moderate or severe vision impairment in 2015 (216·6 million [80% uncertainty interval 98·5 million to 359·1 million]), the leading causes were uncorrected refractive error (116·3 million [49·4 million to 202·1 million]), cataract (52·6 million [18·2 million to 109·6 million]), age-related macular degeneration (8·4 million [0·9 million to 29·5 million]), glaucoma (4·0 million [0·6 million to 13·3 million]), and diabetic retinopathy (2·6 million [0·2 million to 9·9 million]). Among the global population who were blind in 2015 (36·0 million [12·9 million to 65·4 million]), the leading causes were cataract (12·6 million [3·4 million to 28·7 million]), uncorrected refractive error (7·4 million [2·4 million to 14·8 million]), and glaucoma (2·9 million [0·4 million to 9·9 million]). By 2020, among the global population with moderate or severe vision impairment (237·1 million [101·5 million to 399·0 million]), the number of people affected by uncorrected refractive error is anticipated to rise to 127·7 million (51·0 million to 225·3 million), by cataract to 57·1 million (17·9 million to 124·1 million), by age-related macular degeneration to 8·8 million (0·8 million to 32·1 million), by glaucoma to 4·5 million (0·5 million to 15·4 million), and by diabetic retinopathy to 3·2 million (0·2 million to 12·9 million). By 2020, among the global population who are blind (38·5 million [13·2 million to 70·9 million]), the number of patients blind because of cataract is anticipated to rise to 13·4 million (3·3 million to 31·6 million), because of uncorrected refractive error to 8·0 million (2·5 million to 16·3 million), and because of glaucoma to 3·2 million (0·4 million to 11·0 million). Cataract and uncorrected refractive error combined contributed to 55% of blindness and 77% of vision impairment in adults aged 50 years and older in 2015. World regions varied markedly in the causes of blindness and vision impairment in this age group, with a low prevalence of cataract (<22% for blindness and 14·1-15·9% for vision impairment) and a high prevalence of age-related macular degeneration (>14% of blindness) as causes in the high-income subregions. Blindness and vision impairment at all ages in 2015 due to diabetic retinopathy (odds ratio 2·52 [1·48-3·73]) and cataract (1·21 [1·17-1·25]) were more common among women than among men, whereas blindness and vision impairment due to glaucoma (0·71 [0·57-0·86]) and corneal opacity (0·54 [0·43-0·66]) were more common among men than among women, with no sex difference related to age-related macular degeneration (0·91 [0·70-1·14]).

INTERPRETATION

The number of people affected by the common causes of vision loss has increased substantially as the population increases and ages. Preventable vision loss due to cataract (reversible with surgery) and refractive error (reversible with spectacle correction) continue to cause most cases of blindness and moderate or severe vision impairment in adults aged 50 years and older. A large scale-up of eye care provision to cope with the increasing numbers is needed to address avoidable vision loss.

FUNDING

Brien Holden Vision Institute.

Retrospective data on causes of childhood vision impairment in Eritrea

BACKGROUND

Proper information on causes of childhood vision loss is essential in developing appropriate strategies and programs to address such causes. This study aimed at identifying the causes of vision loss in children attending the national referral eye hospital with the only pediatric ophthalmology service in Eritrea.

METHODS

A retrospective data review was conducted for all the children (< 16 years of age) who attended Berhan Aiyni National Referral Eye Hospital in five years period from January 2011 to December 2015. Causes of vision loss for children with vision impairment (recorded visual acuity less than 6/18 for distance in the better eye) was classified by the anatomical site affected and by underlying etiology based on the timing of the insult and causal factor.

RESULTS

The medical record cards of 22,509 children were reviewed, of whom 249 (1.1%) were visually impaired. The mean age of the participants was 7.82 ± 5.43 years (range: one month to 16 years) and male to female ratio was 1:0.65. The leading causes of vision loss were cataract (19.7%), corneal scars (15.7%), refractive error and amblyopia (12.1%), optic atrophy (6.4%), phthisis bulbi (6.4%), aphakia (5.6%) and glaucoma (5.2%). Childhood factors including trauma were the leading causes identified (34.5%) whereas other causes included hereditary factors (4%), intrauterine factors (2.0%) and perinatal factors (4.4%). In 55.0% of the children, the underlying etiology could not be attributed. Over two-thirds (69.9%) of vision loss was potentially avoidable in nature.

CONCLUSION

This study explored the causes of vision loss in Eritrean children using hospital based data. Cataract corneal opacities, refractive error and amblyopia, globe damage due to trauma, infection and nutritional deficiency, retinal disorders, and other congenital abnormalities were the leading causes of childhood vision impairment in children attending the tertiary eye hospital in Eritrea. As majority of the causes of vision loss was due to avoidable causes, we recommended primary level public health strategies to prevent ocular injuries, vitamin A deficiency, perinatal infections and retinopathy of prematurity as well as specialist pediatric eye care facilities for cataract, refractive errors, glaucoma and rehabilitative services to address childhood vision loss in Eritrea.

Prevalence of ocular morbidity in school going children in West Uttar Pradesh

AIM OF THE STUDY

This study aims to evaluate the prevalence and to make a comparison between the ocular morbidity pattern in school going children of urban and rural areas of West Uttar Pradesh.

MATERIALS AND METHODS

A school-based cross-sectional study design was adopted to examine children aged 5-15 years in randomly selected urban and rural schools of West Uttar Pradesh from June 2012 to August 2014. An optometrist did the vision and refraction, and a detailed ophthalmic examination was done by an ophthalmologist. Children needing further assessment were referred to a higher center. Interpretation and analysis of the data were done using Epi Info Software and t-test.

RESULTS

A total of 4838 students (2271 males and 2567 females) were screened. The prevalence of ocular morbidity was 29.35% (28.65% urban, 30.05% rural). Refractive error (17.36%) was the major cause of ocular morbidity followed by convergence insufficiency (2.79%), blepharitis (2.11%), Vitamin A deficiency (2.09%), allergic conjunctivitis (1.92%), bacterial conjunctivitis (0.95%), amblyopia (0.41%), stye (0.31%) and squint (0.27%). There was an increase in ocular morbidity with age, especially in refractive error and convergence insufficiency. On comparing urban and rural schools, Vitamin A deficiency showed a significantly higher prevalence (P < 0.05%) in the rural (3.03%) as compared to the urban sector (1.15%). The prevalence of visual impairment was 4.9/1000 children, and prevalence of blindness was 0.62/1000 children.

CONCLUSION

This study was the first of its kind in West Uttar Pradesh, reporting a considerable high prevalence (29.35%) of pediatric ocular morbidity, which was more in rural as compared to the urban sector. Since most of this morbidity is either preventable or treatable, school screening forms an effective method to reduce this load.

Need for optical intervention in children attending a school for the blind in Eritrea

PURPOSE

To identify the need for optical intervention including spectacles and low vision devices (LVDs) in children attending the only school for the blind in Eritrea.

METHODS

A total of 92 children were examined using the World Health Organization Prevention of Blindness program form for the recording of children with blindness and vision impairment. Examination included distance and near visual acuity (VA), refraction, trial of LVDs and evaluation of anterior and posterior segments. All the children who showed at least one line improvement in distance or near VA with refractive correction and/or LVDs were provided with these devices.

RESULTS

Six children had distance VA of ≥6/18 (no vision impairment, NVI) at presentation and were excluded from analysis. For the remaining 86 children, male to female ratio was 1.2:1.0 with a mean age of 11.8 ± 2.8 years (range: 6-17 years). At presentation, 47 (54.7 per cent) children were blind (VA <3/60) and 24 (27.9 per cent) were severely visually impaired (VA <6/60-3/60), which reduced to 42 (48.9 per cent) and seven (8.1 per cent) children after refraction, respectively. A further 5.8 per cent (five children) achieved NVI with refractive correction. Using distance LVDs, 26 (30.2 per cent) and 16 (18.6 per cent) children had NVI and moderate vision impairment (VA <6/18-6/60), respectively. In terms of near vision, eight (9.3 per cent) children had near VA better than 1.00 M at presentation, which improved to 11 (12.8 per cent) with refractive correction and 19 (22.1 per cent) with near LVDs. A total of 29 spectacles and 42 LVDs were provided.

CONCLUSION

A significant number of children at the school for the blind benefited from refractive correction and LVDs. With such optical intervention, many of these children could study at mainstream schools with print media. A system including comprehensive vision examinations before admission to the school, refractive services and low vision rehabilitation is required to ensure that children with adequate residual vision do not have to be limited to learning in Braille media.

Causes of severe visual impairment and blindness in students in schools for the blind in Northwest Ethiopia

Objectives

To determine the causes of severe visual impairment and blindness (SVI/BL) among students in schools for the blind in Northwest Ethiopia and to identify preventable and treatable causes.

Method

Students attending nine schools for the blind in Northwest Ethiopia were examined and causes assigned using the standard WHO record form for children with blindness and low vision in May and June 2015.

Results

383 students were examined, 357 (93%) of whom were severely visually impaired or blind (<6/60 in their better eye). 253 (70.9%) were aged 16 years or above and 228 (63.9%) were males. 100 students aged <16 years were blind and four were SVI, total 104. The major anatomical site of visual loss among those 0-15 years was cornea/phthisis (47.1%), usually due to measles and vitamin A deficiency, followed by whole globe (22.1%), lens (9.6%) and uvea (8.7%). Among students aged 16 years and above, corneal/phthisis (76.3%) was the major anatomical cause, followed by lens (6.3%), whole globe (4.7%), uvea (3.6%) and optic nerve (3.2%). The leading underlying aetiology among students aged <16 years was childhood factors (39.4%) (13.5% measles, 10.6% vitamin A deficiency), followed by unknown aetiology (54.8%), perinatal (2.9%) and hereditary factors (2.9%). In the older group, childhood factors (72.3%) (25% measles, 15% vitamin A deficiency) were major causes, followed by unknown aetiology (24.1%), perinatal (2.4%) and hereditary factors (0.8%). Over 80% of the causes were avoidable with majority being potentially preventable (65%).

Conclusion

Corneal blindness, mainly as the result of measles and vitamin A deficiency, is still a public health problem in Northwest Ethiopia, and this has not changed as observed in other low-income countries. More than three-fourth of causes of SVI/BL in students in schools for the blind are potentially avoidable, with measles/vitamin A deficiency and cataract being the leading causes.

Retrospective investigation of retinoblastoma in Chinese patients

This is a retrospective investigation of patients with Retinoblastoma (RB) conducted from 2013 to 2016 at the Quanzhou Maternal and Child Health Hospital (China). Demographic and clinical characteristics, treatment outcomes, and risk factors were studied.

In total, 436 patients were included in the study. Most of the findings obtained in this study are consistent with other previous reports. The male: female ratio was 1.41:1, and the unilateral: bilateral ratio was 1.51:1. Leukocoria was the most common presenting sign (79.44%), followed by strabismus (12.38%). While, the overall rates of enucleation (15.82%) and mortality (0.92%) were markedly lower than in other reports of RB in Chinese, and most of the patients received conservative therapy. There were signficant differences (p < 0.001) in the age of at first sign and diagnosis, and treatment modalities between patients with bilateral and unilateral RB. The treatment modalities did not show a specific trend over the 3-year study period. Our results suggest that an incorrect initial diagnosis and long lag time may be risk factors for ineffective treatment and a poor prognosis in patients with RB.

This was a comprehensive retrospective investigation in which the sample size exceeded most previous retrospective investigations of RB. Our study confirmed that early detection, accurate diagnosis, and active intervention are conducive to control of retention of patients’ vision. Fundus examinations, education regarding the early signs of RB, and optimization of the therapeutic strategy of RB may play important roles in ocular health.

Using Key Informant Method to Determine the Prevalence and Causes of Childhood Blindness in South-Eastern Nigeria

PURPOSE

To determine the prevalence and causes of childhood blindness in an underserved community in south-eastern Nigeria using the key informant method.

METHODS

This was a descriptive cross-sectional study. Key informants (KI) appointed by their respective communities received 1-day training on identification of blind children in their communities. Two weeks later, the research team visited the agreed sites within the community and examined the identified children. The World Health Organization eye examination record for blind children was used for data collection. Data entry and analysis were done with the Statistical Package for Social Sciences (SPSS) version 17.0.

RESULTS

Fifteen blind or severely visually impaired children (age range 3 months to 15 years) were identified in this community; nine of these were brought by the KIs. The prevalence of childhood blindness/severe visual impairment (BL/SVI) was 0.12 per 1000 children. By anatomical classification, operable cataract in 6 (40.0%) was the leading cause of BL/SVI in the series; followed by optic nerve lesions (atrophy/hypoplasia) in 3 (20.0%). The etiology of BL/SVI is unknown for the majority of the children (66.7%). It was presumed hereditary in four children (26.7%). Sixty percent of the blindness was judged avoidable. Only three children (20.0%) were enrolled in the Special Education Centre for the Blind.

CONCLUSION

The prevalence of childhood BL/SVI in our study population is low but over half of the blindness is avoidable. There may be a significant backlog of operable childhood cataract in south-eastern Nigeria. The KI method is a practical method for case finding of blind children in rural communities.

Screening Retinopathy of Prematurity in Extremely Low Birth Weight Infants in China and the Need for Earlier Screening Times

Purpose. To convey the need for a revised screening strategy for retinopathy of prematurity (ROP) for extremely low birth weight (ELBW) infants in China. Design. A retrospective longitudinal study. Methods. The medical charts of infants with a birth weight (BW) of less than 1 kg were reviewed. The infants were divided into three groups: group A, without ROP; group B, with ROP but not up to type 1 prethreshold or threshold ROP; group C, with type 1 prethreshold or threshold ROP. Data collected included gender, gestational age (GA), BW, postmenstrual age (PMA), age of onset of ROP, and age at which treatment was carried out, if required. Results. A total of 77 infants were involved. Fifty-six infants developed ROP at any stage and 38 infants developed type 1 prethreshold or threshold ROP. The mean BW and GA of infants in group A were significantly different compared with groups B and C. The mean PMA of onset of ROP in infants who developed mild ROP was 37 weeks compared with 34 weeks for infants who developed severe ROP. Conclusion. ELBW infants have a higher incidence of ROP in China which highlights the need for optimizing neonatal care for these infants. In ELBW infants, ROP tends to develop more severely when it occurs earlier. It is necessary for ELBW infants, especially for those with a BW less than 800 g or a GA less than 25 weeks, to be initially screened at an earlier time.

Visual impairment and blindness among the students of blind schools in Allahabad and its vicinity: A causal assessment

Background/Aims:

Information on eye diseases in blind school children in Allahabad is rare and sketchy. A cross-sectional study was performed to identify causes of blindness (BL) in blind school children with an aim to gather information on ocular morbidity in the blind schools in Allahabad and in its vicinity.

Study Design and Setting:

A cross-sectional study was carried out in all the four blind schools in Allahabad and its vicinity.

Materials and Methods:

The students in the blind schools visited were included in the study and informed consents from parents were obtained. Relevant ocular history and basic ocular examinations were carried out on the students of the blind schools.

Results:

A total of 90 students were examined in four schools of the blind in Allahabad and in the vicinity. The main causes of severe visual impairment and BL in the better eye of students were microphthalmos (34.44%), corneal scar (22.23%), anophthalmos (14.45%), pseudophakia (6.67%), optic nerve atrophy (6.67%), buphthalmos/glaucoma (3.33%), cryptophthalmos (2.22%), staphyloma (2.22%), cataract (2.22%), retinal dystrophy (2.22%), aphakia (1.11%), coloboma (1.11%), retinal detachment (1.11%), etc. Of these, 22 (24.44%) students had preventable causes of BL and another 12 (13.33%) students had treatable causes of BL.

Conclusion:

It was found that hereditary diseases, corneal scar, glaucoma and cataract were the prominent causes of BL among the students of blind schools. Almost 38% of the students had preventable or treatable causes, indicating the need of genetical counseling and focused intervention.

Establishing a surgical outreach program in the developing world: pediatric strabismus surgery in Guatemala City, Guatemala

PURPOSE

To report our experince in establishing a sustainable pediatric surgical outreach mission to an underserved population in Guatemala for treatment of strabismic disorders.

METHODS

A pediatric ophthalmic surgical outreach mission was established. Children were evaluated for surgical intervention by 3 pediatric ophthalmologists and 2 orthoptists. Surgical care was provided at the Moore Pediatric Surgery Center, Guatemala City, over 4 days. Postoperative care was facilitated by Guatemalan physicians during the second year.

RESULTS

In year 1, patients 1-17 years of age were referred by local healthcare providers. In year 2, more than 60% of patients were prescreened by a local pediatric ophthalmologist. We screened 47% more patients in year 2 (132 vs 90). Diagnoses included congenital and acquired esotropia, consecutive and acquired exotropia, congenital nystagmus, Duane syndrome, Brown syndrome, cranial nerve palsy, dissociated vertical deviation, and oblique muscle dysfunction. Overall, 42% of the patients who were screened underwent surgery. We performed 21 more surgeries in our second year (58 vs 37), a 57% increase. There were no significant intra- or postoperative complications.

CONCLUSIONS

Surgical outreach programs for children with strabismic disorders in the developing world can be established through international cooperation, a multidisciplinary team of healthcare providers, and medical equipment allocations. Coordinating care with local pediatric ophthalmologists and medical directors facilitates best practice management for sustainability.

Role of tele-medicine in retinopathy of prematurity screening in rural outreach centers in India - a report of 20,214 imaging sessions in the KIDROP program

Middle-income countries such as India are suffering from the third epidemic of retinopathy of prematurity (ROP). Improved survival and lower infant mortality rates have resulted in an increased number of preterm survivors in rural areas that unfortunately lack ROP specialists. We report our experience of a public-private partnership in rural India of an ongoing telemedicine program Karnataka Internet Assisted Diagnosis of Retinopathy of Prematurity program KIDROP that provides ROP screening by non-physicians. The analysis of 20,214 imaging sessions of 7106 from 36 rural centers in 77 months of activity are presented. The overall incidence of any stage and treatment requiring ROP was 22.39% and 3.57% respectively. We found a higher incidence of severe ROP in private (7.1%) vs government centers (1.7%). Fifty of the 254 babies (19.69%) who underwent treatment were outside the American screening guidelines cut-off. The report compares other "real-world" tele-ROP programs, summarizes the impact, and provides future strategies for outreach ROP screening in middle-income countries.

Causes of visual impairment and blindness in children in three ecological regions of Nepal: Nepal Pediatric Ocular Diseases Study

PURPOSE

To study the causes of blindness and visual impairment in children in three ecologically diverse regions of Nepal.

MATERIALS AND METHODS

This is a baseline survey report of a 3-year longitudinal population-based study. One district each from the three ecological regions - Terai, Hills, and Mountains - was selected for the study. Village Development Committees from each district were selected by random sampling. Three community health workers were given training on vision screening and identification of abnormal ocular conditions in children. Health workers who examined children and collected data using pretested questionnaire performed house-to-house surveys. Children with abnormal vision or ocular conditions were referred to and examined by pediatric ophthalmologists.

RESULTS

A total of 10,950 children aged 0-10 years, 5,403 from Terai, 3,204 from Hills, and 2,343 from Mountains, were enrolled in the study. Of them, 681 (6.2%) were nonresponders. The ratio of boys to girls was 1.03:1. Prevalence of blindness was 0.068% (95% confidence interval [CI] 0.02%-0.12%) and visual impairment was 0.097% (95% CI 0.04%-0.15%). Blindness was relatively more prevalent in Terai region (0.08%, 95% CI 0.02%-0.13%). The most common cause of blindness was amblyopia (42.9%) followed by congenital cataract. Corneal opacity (39%) was the most common cause of unilateral blindness.

CONCLUSION

More than two-thirds of the causes that lead to blindness and visual impairment were potentially preventable. Further, nutritional and genetic studies are needed to determine the factors associated with ocular morbidity and blindness in these regions.

Universal ocular screening of 1021 term infants using wide-field digital imaging in a single public hospital in India - a pilot study

PURPOSE

Universal eye screening of neonates is currently not standard of care. Early detection of abnormalities could offer prompt management and a reduction in visual morbidity. We report a pilot study using wide-field digital imaging to screen all infants at birth to explore its feasibility as a tool for universal screening.

METHODS

Consecutively enrolled 1021 term infants in a public hospital were imaged within 72 hr of birth using the Retcam shuttle (Clarity MSI, USA). Anterior and dilated posterior segment images were obtained. Infants with abnormal images were examined clinically, and medical or surgical treatment was given when needed, at no cost to the family.

RESULTS

Of the 1021 healthy full-term newborns, 48 babies had abnormal findings (4.7%). Retinal haemorrhages were the most common (52.1%) abnormality of which 24% were macular. A 'ridge' resembling retinopathy of prematurity in both eyes constituted 18.8% of all abnormalities. Nine infants (18.8% of abnormalities and 0.9% overall) had conditions meriting medical or surgical intervention and would have been missed otherwise. Seven of these nine babies (0.7%) needed medical attention with a systemic work-up for conditions such as posterior uveitis with linear perivasculitis, salt and pepper retinopathy or posterior synechia. Two of nine babies (0.2%) required surgical intervention for unilateral cataract and retinoblastoma.

CONCLUSION

Universal eye screening of all neonates using wide-field digital imaging is possible and safe. Extrapolating our results to the national scenario, we estimate that 226 950 infants requiring treatment would go undiagnosed annually. Universal infant eye imaging strategies must receive serious national consideration.