A population-based study on the prevalence and causes of childhood blindness and visual impairment in North India

Mapping gaps and exploring impairment and disability prevalence in South Asian (SAARC) countries: a scoping review

Despite the considerable health and economic burden of disability in the South Asian (SA) region, there is limited evidence of impairments and disabilities prevalence and the need for Assistive Technologies (ATs). This scoping review aims to synthesise the evidence of the impairments and disabilities in SA countries. This review followed Arksey and O'Malley's methodological framework. EBSCOhost, EMBASE, PubMed, and Web of Science databases were searched for original research articles from SA countries. In this study, impairment and disability refer to functional limitations restricting individuals from performing activities, including visual, hearing, speaking, cognitive, mobility, and self-care difficulties. The review included full-text, English-language articles addressing any impairment and disability, without restrictions on publication date. This review identified 105 articles distributed over the six impairment and disability domains: visual, hearing, mobility, self-care, speaking, and cognitive. Most evidence originated from India (50.5%) and focused on visual impairments (53.3%). The review identified that heterogeneity in methodologies, case identification definitions, and study settings contributed to variations in prevalence estimation and restricted the comparability within and across countries. Besides, the uneven distribution of studies across countries suggests varying inclinations of countries toward specific impairment and disability domains. The review identified variations in prevalence due to differences in methodologies, definitions, and contexts. The review also identified the uneven distribution of studies, limited evidence on ATs, reliance on self-reported data, and lack of nationally representative research. Future research should use standardised case identification and evidence-based approaches to enhance comparability and minimise response biases.

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

Background/Aims

By understanding the prevalence and causes of childhood blindness, stakeholders can work toward comprehensive strategies that encompass prevention, treatment, rehabilitation, and support, ultimately improving the quality of life for affected children. The information about the pattern and causes of childhood blindness in Northern Indian states is limited, it highlights the need for further research and data collection to better understand and address the specific challenges in this region. Therefore, the present cross-sectional study was planned to ascertain the different causes and patterns of childhood blindness and to understand the barriers to the use of LVAs and its compliance among the students attending schools for the blind in a North Indian State.

Study Design and Setting

Students from two schools for blind were examined in Chandigarh and its vicinity in North India. The different causes of severe visual impairment/blindness were classified as per the World Health Organization/Prevention of Blindness standard recording form.

Results

A total of 89 students attending schools for the blind were examined. The mean age was 13.10 years (range = 4-16 years). Male, female ratio was 3.3:1. The major causes of blindness were congenital anomalies (whole globe anomalies 37.08%), followed by retinal conditions (16.7 = 8%), undetermined/other (12.3), and lenticular conditions (112%). More than one-third of children (34.8%) were blind due to avoidable causes of blindness.

Conclusion

The current study data append on the existing national available data about childhood blindness in India. Though the sample size of the current is comparatively low, observed different results as compared to previously published reports from other regions, emphasize the strengthening of pediatric ophthalmology services as well as of low vision services in this particular region of North India.

Ocular morbidity profiles of out-of-school children in a North Indian urban slum

PURPOSE

This study evaluates the recent trends in ocular morbidities and vision-related practices in "out-of-school" children in urban slums of Gurugram in North India.

METHODS

In this observational study, a validated questionnaire was administered to 161 students from two nonformal slum schools. Sociocultural, demographic data, vision-related practices, and visual acuity with subjective refraction of the children were recorded.

RESULTS

A total of 80 boys and 81 girls (9.17 ± 2.58 years) participated in this study. About 40% of the children were from lower socioeconomic status. The visual acuity recorded for all the children, except three children, was 6/6 in both eyes. One child had a pre-phthisical eye with no light perception, following a childhood trauma, with the other eye having 6/6 vision. Two children had refractive errors (myopia and compound myopic astigmatism), with a best corrected visual acuity (BCVA) of 6/6. Thirteen children (8%) had Bitot's spots and 67 (35.4%) had allergic conjunctivitis. Eight (5%) children complained of dry eye-related symptoms like redness and watering of eyes, while 19 (11.8%) had diffuse headache. Average number of years spent in school for these children was less than 1.7 years (range: 1 month-6 years). Only 10.5% of the children gave the history of watching television more than 30 h/week. Significant association was found between the income of father and use of digital devices in children below 10 years ( P = 0.003) and children playing outdoors ( P = 0.001). There was a significant association noted for age and use of digital devices ( P = 0.037).

CONCLUSION

The prevalence of refractive errors in "out-of-school" children of urban slum was much less than the national average. Almost one in three children suffered from eye allergies, while 8% children had Bitot's spots. The data about the prevalence of ocular comorbidities in underserved areas like urban slums can be used to update and strategize eye health-care delivery models for out-of-school children.

Causes of low vision in children: A systematic review

OBJECTIVE

To identify the ocular pathologies that are reported as causes of low vision in children.

MATERIAL AND METHODS

The systematic search was carried out in Medline (PubMed), Embase and Lilacs. Observational studies with populations between 0-18 years of age, reporting visual acuity data between 20/60-20/400 and reporting the frequency of ocular pathologies were selected. Studies in which the diagnosis of the condition had not been verified by a professional, or which covered only cases of blindness, uncorrected refractive errors, or amblyopia, were excluded. The methodological quality of the articles was evaluated using the Joanna Briggs Institute instrument for prevalence studies.

RESULTS

27 studies conducted in Asia (13 publications), Africa (6 studies), Oceania (4 studies), Europe and South America (2 studies each) were included. The most reported causes of low vision were: cataract, with prevalence between 0.8% and 27.2%; albinism with from 1.1% to 47%; nystagmus, with prevalence between 1.3% and 22%; retinal dystrophies between 3.5% and 50%; retinopathy of prematurity (ROP) with prevalence between 1.1% and 65.8%, optic atrophy between 0.2% and 17.6%, and glaucoma from 2.4% to 18.1%.

CONCLUSIONS

Cataract, albinism and nystagmus are the ocular pathologies most mentioned by studies as a cause of low vision in children, as well as retinal diseases such as ROP and optic nerve diseases such as atrophy. However, there are numerous eye conditions that can result in low vision in the pediatric population.

Myopia prevalence in a population-based childhood visual impairment study in North India - CHVI-2

Purpose:

The aim of the study was to determine the prevalence of myopia at the community level.

Methods:

A population-based, cross-sectional study was planned in 40 clusters among children identified with subnormal vision in the urban community of Delhi. House-to-house visits were conducted for visual acuity screening of 20,000 children aged 0–15 years using age appropriate visual acuity charts. All the children with visual acuity of < 6/12 in any eye in the age group between 3 and 15 years and inability to follow light in age group 0–3 years were referred for detailed ophthalmic examination.

Results:

A total of 13,572 (64.7%) children belonged to the age group of 6–15 years. Of these, a total of 507 (3.7%) were found to be having myopia (spherical equivalent of -0.50 DS or worse in one or both eyes) with positive association with higher age groups.

Conclusion:

The estimated prevalence of myopia is 3.7%; the proportion of uncorrected myopia was 45%, which reflects that refractive error services need to be improved further.

Development of age appropriate vision function questionnaire for children with visual impairment (CHVI-VFQ)

PURPOSE

To develop a new age-appropriate visual function questionnaire for visually impaired children.

METHODS

The study was conducted in north India in 20,955 (97.3%) children ≤15 years who underwent visual acuity examination. Of these 20,955 children, a total of 722 children were referred with unaided visual acuity less than 6/12 in any eye. Among these referred children, parents in the age group of 5-9 years and children between 10 and 15 years underwent interviews using LV Prasad Functional Visual Questionnaire-20 (LVP FVQ 20) and Indian Visual Functioning Questionnaire-33 (IND VFQ-33). Following this, multiple steps were undertaken that involved expert opinion for the removal of items on basis of zero variance and factor analysis along with calculation of Cronbach's alpha.

RESULTS

: A Cronbach' alpha of 0.834 was calculated for the younger age group and 0.931 for the higher age group of children.

CONCLUSION

: A new robust age-appropriate questionnaire was developed and it was observed that there was a significant change in median score (that was derived for various domains after calculating the median for the items in various domains asked pre- and post-intervention in the form of glasses or surgery) for quality of visual function in the visually impaired children. A significant change in functional vision of visually impaired children (P < 0.005) was observed in both age groups.