Epidemiology of visual impairment in Britain

Impact of vision problems on children's daily activities: Insights from a focus group discussion

Background/Purpose

There are approximately 18.94 million visually impaired children worldwide, with 90% of them living in low-middle income countries. Research shows that visual impairment (VI) has a significant impact on the quality of life (QoL) of those affected. Therefore, it is essential to investigate how VI affects the daily activities of these children to develop management strategies that can help minimize its impact on their QoL. Therefore, qualitative research design was utilized to explore the perceived impact of VI on the daily activities of children living with VI.

Methods

Using a qualitative approach, purposive sampling was used to identify information-rich participants to partake in focus group discussions (FGDs) and address the aim of the study adequately. Identified data sources were divided into two groups: one with 'experts' who worked with children regularly, and another with school-age children aged 6-17 years, from three rural schools in Sekhukhune district, South Africa. The FGDs were guided by semi-structured interview questions. All sessions were recorded, transcribed verbatim, cleaned, coded, and analysed under ten domains, identified from the literature.

Results

A total of 477 statements and comments related to children's vision were generated through the nine FGDs. Participants were nine experts working with children, and 49 children living with or without VI. Of the total number of statements, 60% (n = 287) were generated from FGDs with children, 63% (n = 299) were negative statements, and the remaining 19% (n = 92), and 18% (n = 86) were neutral and positive statements respectively. The most generated statements fell under the domains 'Hobbies, Leisure and Sport' 21% (n = 101), 'Education' 21% (n = 100), and 'Psychological and Emotional' 12.8% (n = 61).

Conclusion

This study offered comprehensive insights into the impact of VI on the daily activities of rural school-aged children and young people.

Prevalence of visual impairment and associated factors among primary school children in Ambo Town, Ethiopia, 2021

Background

Visual impairment is a functional limitation of the eye(s) or the visual system manifested as reduced visual acuity. At least 2.2 billion people have visual impairment worldwide, and 90% of people with visual impairment have either preventable or treatable causes with cost-effective interventions.

Objectives

To assess magnitude of visual impairment and associated factors among primary school children in Ambo Town, Ethiopia, in 2021.

Methods

A cross-sectional study was conducted in selected primary schools of Ambo Town. A simple random sampling technique was used to select schools and study participants. Data were collected using an interviewer-administered structured questionnaire and entered into Epidata version 3.1 for analysis by using SPSS version 23. Binary logistic regression was adopted to identify statistically significant factors which were associated with visual impairment. The Hosmer-Lemeshow test was used to evaluate how well the logistic regression model fits to the data.

Results

About 780 out of 838 primary school children were enrolled in the study, yielding a response rate of 93.07%. The estimated prevalence of visual impairment was 8.8% with 95% CI: 6.81-10.79. The main risk factor for visual impairment among primary school children were Students' grade level, exposure to mobile screen, family history of visual problems, and family awareness about the status of their child's eye problems were significantly associated with visual impairments (AOR = 2.375, 95% CI: 1.079-5.226; AOR = 2.44, 95% CI: 1.401-5.01; AOR = 2.41, 95% CI: 1.071-5.42; and AOR = 4.503, 95% CI: 2.12-9.55, respectively).

Conclusion

A high prevalence of visual impairment was observed among primary school children. Attending higher grades, being exposed to mobile screen, and having a family history of visual problems were significantly associated with visual impairment.

Development and Evaluation of the Quality of Life Scale for Children With Visual Impairments in China

BACKGROUND

Visual impairments related to non-correctable vision loss, including blindness and low vision, have been consistently shown to lower a person's health-related quality of life. This study assessed the reliability, validity, and discrimination of the Quality of Life Scale for Children with Visual Impairments (QOLS-CVI) in China.

METHODS

The Pediatric Quality of Life Inventory™ 4.0 and World Health Organization Quality of Life-Disability Scale for physical disability were selected to define conceptual frameworks and item libraries based on relevant existing studies. According to two rounds of expert consultations and group discussions, some items were modified, and the draft scale was developed. Two item selection processes based on classical test theory and item response theory were used to conduct a preliminary survey and a formal survey in special schools in Shanxi and Hebei Provinces. Finally, the reliability and validity of the quality of life scale for visually impaired children in China were verified.

RESULTS

The final QOLS-CVI consisted of 38 items, 10 subdomains, and 6 domains. Reliability was verified by Cronbach's alpha coefficient, split-half reliability, and test-retest reliability (Cronbach's alpha for the full scale, 0.841; split-half reliability, 0.629; and test-retest reliability, 0.888). The validity results showed that the multidimensional scale met expectations: exploratory factor analysis and confirmatory factor analysis indicated good fitting models for children with visual impairments.

CONCLUSIONS

The QOLS-CVI was determined to be reliable and valid and to have strong feasibility and effectiveness. This scale can be used as an evaluation tool to study the QOL and social-participation ability of children with visual impairments.

Prevalence of visual impairment among school children in three primary schools of Sekela Woreda, Amhara regional state, north-west Ethiopia

Background

Although there are limited studies, recent data are lacking to determine the prevalence of eye problems in Ethiopia accurately and there is no scientific evidence of such study in Sekela Woreda. The purpose of this study was to determine the prevalence of visual impairment among school children in Sekela Woreda, Ethiopia.

Methods

The study design was a community-based analytical cross-sectional with a multi-stage cluster random sampling technique from September to November 2016.Visual acuity was tested using Snellen's "E" chart while color vision was tested using Ishihara chart. The data were analyzed using SPSS version 20 software, and binary logistic regression was used to identify factors associated with visual impairment.

Results

A total of 875 participants, 466 (53.3%) males and 409 (46.7%) females, with an age range of 8-18 years were screened for visual acuity and color vision deficiency. The prevalence of visual impairment (visual acuity ⩽ 6/12) in "either eye" was 70 (8.0%). Among these, 37 (52.9%) were males and 33 (41.1%) were females. The prevalence of low vision (visual acuity ≤ 6 / 36 ) and blindness (visual acuity < 3/60) in "either eye" were 28 (3.2%) and 10 (1.1%), respectively. Thirty two (3.7%) had mild visual impairment ( v i s u a l a c u i t y ≤ 6 / 12 t o ≥ 6 / 18 ) . The prevalence of color vision deficiency was 36 (4.1%). Among these, 27 (3%) were males and 9 (1.1%) were females. The variables age (adjusted odds ratio (95% confidence interval) = 1.14 (1.01-1.28) and color blindness (adjusted odds ratio (95% confidence interval) = 3.93(1.69-9.09) were significantly associated with visual impairment.

Conclusion

The prevalence of blindness and low vision in school children were higher than the national prevalence in Ethiopia. Increasing age and color defective vision were factors associated with the children's visual impairment. The Woreda health office ought to work with responsible stakeholders to tackle the situation in early childhood.

Is there evidence that the yearly numbers of children newly certified with sight impairment in England and Wales has increased between 1999/2000 and 2014/2015? A cross-sectional study

OBJECTIVES

To use routine data capture from hospitals in England and Wales to identify whether there has been an increase in the annual numbers of children newly certified sight impaired in England and Wales between 1999/2000 and 2014/2015 and to examine causes of certifiable sight impairment in children certified in 2014/2015.

DESIGN

A cross-sectional study including an analysis of all certificates of vision impairment completed in hospitals in England and Wales each year between 2007/2008 and 2014/2015 and all certificates completed in hospitals in England and Wales in 1999/2000.

PARTICIPANTS

Certificates for all individuals aged 16 years or less at the time of certification in England and Wales for each financial year between 1 April 2007 and the 31 March 2015 and for individuals aged 15 years or less for the year ending 31 March 2000. We obtained information on the main cause of certifiable sight loss for all children certified in 2014/2015. We estimated crude and sex specific incidence estimates with 95% confidence intervals computed by Byars method.

RESULTS

In 1999/2000, the estimated incidence (95 % CI) of certification was 8.2 (7.7 to 8.8) per 1 00 000. In 2007/2008, the estimated incidence was statistically significantly higher at 10.1 (9.5 to 10.7). Since then a trend of increasing incidence with time has been observed until 2014/2015 when an estimated incidence of 13.3 (12.6 to 14.0) was observed. Hereditary retinal dystrophies, cerebral visual impairment and nystagmus were the most common single causes of certifiable sight impairment in children in 2014/2015.

CONCLUSION

Our findings show that in England and Wales there has been an increase in the number of children newly certified sight impaired by consultant ophthalmologists since 1999/2000. This mirrors our previous findings based on data originating within social service departments.

An overview of a UK paediatric visual impaired population and low vision aid provision

A retrospective study was carried out to evaluate the paediatric visual impaired population attending the Low Vision Clinic at Sheffield Teaching Hospitals NHS Foundation Trust, over a period of 14 years. Data were collected and analysed for children less than 17 years for prevalence, demographics, registration status, aetiologies, and types of low vision aids issued. The total number of children identified was 204. Of these, 19 percent of the children were registered blind, 45 percent were registered partially sighted, and 36 percent were not registered. The four diagnostic groups were genetic (29%), prenatal (36%), perinatal (23%), and childhood (12%). Describing local characteristics of paediatric visual impairment is a useful measure of current low vision service provision. This information can further inform educational, social, and health needs for the visually impaired children to ensure adequate service provision.

A population-based study of visual impairment among pre-school children in Beijing: the Beijing study of visual impairment in children

PURPOSE

To evaluate the prevalence and causes of visual impairment among Chinese children aged 3 to 6 years in Beijing.

DESIGN

Population-based prevalence survey.

METHODS

Presenting and pinhole visual acuity were tested using picture optotypes or, in children with pinhole vision < 6/18, a Snellen tumbling E chart. Comprehensive eye examinations and cycloplegic refraction were carried out for children with pinhole vision < 6/18 in the better-seeing eye.

RESULTS

All examinations were completed on 17,699 children aged 3 to 6 years (95.3% of sample). Subjects with bilateral correctable low vision (presenting vision < 6/18 correctable to >or= 6/18) numbered 57 (0.322%; 95% confidence interval [CI], 0.237% to 0.403%), while 14 (0.079%; 95% CI, 0.038% to 0.120%) had bilateral uncorrectable low vision (best-corrected vision of < 6/18 and >or= 3/60), and 5 subjects (0.028%; 95% CI, 0.004% to 0.054%) were bilaterally blind (best-corrected acuity < 3/60). The etiology of 76 cases of visual impairment included: refractive error in 57 children (75%), hereditary factors (microphthalmos, congenital cataract, congenital motor nystagmus, albinism, and optic nerve disease) in 13 children (17.1 %), amblyopia in 3 children (3.95%), and cortical blindness in 1 child (1.3%). The cause of visual impairment could not be established in 2 (2.63%) children. The prevalence of visual impairment did not differ by gender, but correctable low vision was significantly (P < .0001) more common among urban as compared with rural children.

CONCLUSION

The leading causes of visual impairment among Chinese preschool-aged children are refractive error and hereditary eye diseases. A higher prevalence of refractive error is already present among urban as compared with rural children in this preschool population.

6,220 institutionalised people with intellectual disability referred for visual assessment between 1993 and 2003: overview and trends

AIMS

To summarise the results of visual performance tests and other data of institutionalised people with intellectual disability referred to a visual advisory centre (VAC) between 1993 and 2003, and to determine trends in these data.

METHODS

A retrospective medical record review was undertaken of 6,220 consecutive people examined ophthalmologically according to a standard protocol by one VAC that specialised in visual assessment and treatment of people with intellectual disability, between 1993 and 2003. chi2 test for linear trend was used and linear regression coefficients were calculated.

RESULTS

The proportion of people aged > or =50 years increased from 19.3% to 34.2% between 1995 and 2003 (p<0.001); the combined figure of severe or profound intellectual disability decreased from 80.0% to 52.6% (p<0.001); the proportion of mobile people increased from 52.1% to 98.0% (p<0.001); the combined proportion of people with visual impairment or blindness decreased from 70.9% to 22.9% (p<0.001), and that of people with visual disorders decreased from 89.6% to 75.3% (p<0.001). Causes of intellectual disability were identified in 58.4% people; 20.8% had Down's syndrome.

CONCLUSION

Many ocular diagnoses were found, indicating the need for ophthalmological monitoring. Specialised centres are helpful, because assessment and treatment of people with intellectual disability is complicated and time consuming. Protocols for efficient referral will have to be developed. A major task lies ahead to improve the treatment rates of refractive errors, cataract and strabismus, and to find specific causes of intellectual disability.

Long-term visual outcomes in extremely low-birth-weight children (an American Ophthalmological Society thesis)

PURPOSE

The goal is to analyze the long-term visual outcome of extremely low-birth-weight children.

METHODS

This is a retrospective analysis of eyes of extremely low-birth-weight children on whom vision testing was performed. Visual outcomes were studied by analyzing acuity outcomes at >/=36 months of adjusted age, correlating early acuity testing with final visual outcome and evaluating adverse risk factors for vision.

RESULTS

Data from 278 eyes are included. Mean birth weight was 731g, and mean gestational age at birth was 26 weeks. 248 eyes had grating acuity outcomes measured at 73 +/- 36 months, and 183 eyes had recognition acuity testing at 76 +/- 39 months. 54% had below normal grating acuities, and 66% had below normal recognition acuities. 27% of grating outcomes and 17% of recognition outcomes were /=3 years of age. A slower-than-normal rate of early visual development was predictive of abnormal grating acuity (P < .0001) and abnormal recognition acuity (P < .0001) at >/=3 years of age. Eyes diagnosed with maximal retinopathy of prematurity in zone I had lower acuity outcomes (P = .0002) than did those with maximal retinopathy of prematurity in zone II/III. Eyes of children born at 28 weeks gestational age. Eyes of children with poorer general health after premature birth had a 5.3 times greater risk of abnormal recognition acuity.

CONCLUSIONS

Long-term visual development in extremely low-birth-weight infants is problematic and associated with a high risk of subnormal acuity. Early acuity testing is useful in identifying children at greatest risk for long-term visual abnormalities. Gestational age at birth of Collapse

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MESH Headings

• Birth Weight
• Child
• Child, Preschool
• Follow-Up Studies
• Gestational Age
• Humans
• Infant, Extremely Low Birth Weight/physiology
• Infant, Newborn
• Ocular Physiological Phenomena
• Predictive Value of Tests
• Retinopathy of Prematurity/physiopathology
• Retrospective Studies
• Risk Factors
• Vision Disorders/physiopathology
• Vision Tests/methods
• Visual Acuity/physiology

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Affiliation(s)

Rand Spencer Texas Retina Associates, Retina Foundation of the Southwest and Department of Ophthalmology, University of Texas Southwestern Medical School, Dallas, Texas, USA

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Collaborators Collapse

UK population based study of severe retinopathy of prematurity: screening, treatment, and outcome

BACKGROUND

Retinopathy of prematurity (ROP) is one of the few causes of childhood blindness in which severe vision impairment is largely preventable. Ophthalmic screening for ROP is required to identify disease that requires treatment whereby the development of potentially blinding disease can be minimised.

OBJECTIVES

To make the first UK population based estimate of the incidence of babies with severe ROP (stage 3 or more); to document their clinical characteristics and management and to evaluate the appropriateness of current ROP screening guidelines in the UK.

PATIENTS

Cases were recruited through a national surveillance programme with 1 year ophthalmic follow up and data from clinician completed questionnaires.

RESULTS

Between 1 December 1997 and 31 March 1999, 233 preterm babies with stage 3 ROP were identified. Severity (location, extent, and presence of plus disease) was associated with degree of prematurity, most severe in the most premature babies. Fifty nine percent were treated. The UK screening protocol was followed in two thirds of cases, but in the remainder it was begun too late or was too infrequent. Three quarters of the cases were followed up at 1 year, and 13% had a severe vision deficit as a result of ROP.

CONCLUSIONS

Visual deficit as a result of ROP in premature babies continues to be a severe disability in some of the survivors of neonatal intensive care. Further efforts are needed to organise treatment regionally to improve outcome and standards of practice.

Visual impairment in childhood: insights from a community-based survey

BACKGROUND

The concept of visual impairment (VI) in childhood has changed over the last 30 years. There has been a decrease in the number of children with an isolated visual problem and an increase in the numbers with VI and coexisting neurological disability. This study aimed to produce a profile of VI in childhood with a view to informing future services and to raise awareness of the need for comprehensive assessment including developmental remediation and educational advice.

METHODS

Children with a VI were identified from multiple sources including hospital- and community-based paediatricians and statutory blind registers.

RESULTS

Seventy-six children with a VI were identified giving a childhood prevalence of 1.61 per 1000. Thirty-two per cent had a normal pattern of development. Global delays/severe learning difficulty were found in 43%. Only 21% of the children had an isolated VI. Additional medical problems were present in 79% of which cerebral palsy, occurring in 33%, was the most common. Nine per cent of the children were classified as totally blind. Cortical visual impairment was diagnosed in 45%. Twenty-two per cent of the children were registered blind or partially sighted.

CONCLUSIONS

Most cases of VI in children did not appear on the statutory blind or partially sighted registers, thus these have limited value for service development. The implications for practice highlight the need for early assessment and advice from a co-ordinated team to optimize visual potential in childhood.

Visual impairment and blindness in Europe and their prevention

The European region currently differs in many aspects, such as political, socioeconomic, and geographical. After substantial political changes at the beginning of the 1990s, the majority of central and eastern European countries started to rebuild their healthcare systems. It is apparent that eastern Europe represents a highly diverse region where the difference among countries broadens year after year. In highly industrialised countries of Europe, the leading causes of childhood serious visual loss are lesions of the central nervous system, congenital anomalies and retinal disorders. In the middle income countries of Europe, congenital cataract, glaucoma and, mainly, retinopathy of prematurity are highly expressed. The major cause of serious visual loss in adults in industrialised countries is age related macular degeneration. The other conditions comprise cataract, glaucoma, diabetic retinopathy, and uncorrected/uncorrectable refractive errors, along with low vision. In people of working age, diabetic retinopathy, retinopathy pigmentosa, and optic atrophy are the most frequently reported causes of serious visual loss. In the middle income countries of Europe, advanced cataract, glaucoma, and diabetic retinopathy are more frequently observed.

Retinopathy of prematurity: clinical aspects

There have been many major advances recently that have improved the identification and management of retinopathy of prematurity (ROP). This chapter describes the clinical features of ROP and then considers briefly the incidence and epidemiology of acute phase disease. This is followed by a discussion of the two ROP epidemics and ROP-induced disability in high, low and middle income countries, and how this has been impacted by treatment. The principles and specifics of screening for ROP are considered, focusing on certain topical issues such as whether one screening guideline suits all populations. Treatment has undergone several advances, so that now laser therapy has overtaken cryotherapy as the preferred mode of treatment, and treatment at an earlier stage is now being considered. Finally, the authors attempt to look into the future and wonder how the criteria for treatment will change, and whether innovations in ocular imaging will impact ROP screening in both high and middle income countries.