Need of optical aids for schools for blind students in Pune and Nasik districts and compliance of their use

Purpose: To assess the need for spectacles and low?vision aids (LVA) in students attending schools for the blind and study their compliance with use. Methods: Comprehensive ocular evaluation was performed using a hand?held slit lamp and ophthalmoscope. Vision acuity was measured using a logarithm of the minimum angle of resolution (logMAR) chart for distance, as well as for near. Spectacles and LVAs were dispensed after refraction and LVA trial. Follow?up was performed to assess the vision using the LV Prasad Functional Vision Questionnaire (LVP?FVQ) along with compliance with use after 6 months. Results: Of the 456 students examined from six schools, 188 (41.2%) were female; 147 (32.2%) were <10 years of age. In all, 362 (79.4%) were blind since birth. The students dispensed only LVAs were 25 (5.5%), only spectacles were 55 (12.1%), and both spectacle and LVAs were 10 (2.2%). The vision improved using LVAs in 26 (5.7%) and using spectacles in 64 (9.6%). There was a significant improvement in LVP?FVQ scores (P < 0.001). Also, 68/90 students were available for follow?up, of whom 43 (63.2%) were compliant to use. Causes of not wearing spectacles or LVA in 25 were left somewhere or lost 13 (52%), broken 3 (12%), uncomfortable to use 6 (24%), not interested to use 2 (8%), and got operated 1 (4%). Conclusion: Although the dispensing of LVA and spectacles improved the visual acuity and vision function of 90/456 (19.7%) students, nearly a third were not using them after 6 months. Efforts need to be taken to improve the compliance of use

Visual impairment and refractive errors in school children in Andhra Pradesh, India

Purpose: Addressing childhood vision impairment (VI) is one of the main goals of the World Health Organization’s (WHO) combating blindness strategies. The primary aim of this study was to estimate the prevalence of VI, causes, and its risk factors in school children in Krishna district, Andhra Pradesh, India. Methods: Children aged 4–15 years were screened in schools using the 6/12 Snellen optotype by trained community eye health workers, and those who failed the test and those reported or found to have obvious eye conditions were referred to primary (VC), secondary (SC), or tertiary (TC) care centre appropriately, where they underwent a complete eye examination including cycloplegic refraction and fundus examination. Results: A total of 56,988 children were screened, of whom 51.18% were boys. The mean age was 9.69 ± 3.26 years (4–15 years). Overall, 2,802/56,988 (4.92%) children were referred to a VC, of which 632/56,988 (1.11%) required referral to SC/TC. PVA of <6/12 was found in 1.72% (95% confidence interval [CI]: 1.61–1.83). The prevalence of refractive error (corrected and uncorrected) was 2.38% (95% CI: 2.26–2.51) and myopia was 2.17% (95% CI: 2.05–2.29). In multivariable analysis, older children, those in urban schools, private schools, and children with a disability had an increased risk of VI and myopia. Additionally, the risk of myopia was higher among girls than boys. Of those referred and reached SC/TC, 73.64% were due to avoidable causes. Conclusion: Childhood VI prevalence was 1.72% in this region. Uncorrected refractive error (URE) was the major cause of VI in children. Older age, schools in urban locations, private schools, and the presence of disability were associated with the risk of VI among children

Clinical patterns of congenital ocular anomalies in the pediatric age group (0 to 5 years) and its association with various demographic parameters

Purpose: Congenital ocular anomalies are rare but important cause of childhood blindness. This study aimed to observe the clinical patterns of congenital ocular anomalies in the pediatric age group (0 to 5 years) and its association with various demographic parameters. Methods: Hospital?based cross?sectional study done on all pediatric patients in the 0?to?5?year age group presenting with congenital ocular anomalies to the Ophthalmology department of a tertiary care hospital in Eastern India between October 2018 and October 2020. Thorough clinical history was obtained, and comprehensive ocular examination was done in each case. Results: A total of 5686 patients in the 0 to 5 years age group attended the eye OPD during the study period. Congenital ocular anomalies were seen in 140 patients. The prevalence of ocular anomalies was 2.46%. Average age of patients was 3.32 ± 1.42 years. There were 74 (52.9%) males and 66 (47.1%) females. Unilateral and bilateral involvement was seen in 100 (71.45%) and 40 (28.6%) cases, respectively. Antenatal period was uneventful in 92.14% cases. Decreased vision was the most common presentation (40%). Congenital nasolacrimal duct obstruction was the most common anomaly seen in 29 (20.71%) cases followed by congenital cataract in 21 (15%) cases. Conclusion: Few of the congenital ocular anomalies can be prevented by increasing community awareness. Findings of the study can act as a reference guide for clinicians and health professionals for counseling and health planning.

Cost analysis of pediatric cataract surgery in a tertiary eye care hospital in Western India

Purpose: To assess the cost of pediatric cataract surgery in a tertiary eye care hospital from a provider’s perspective. Methods: Retrospective review of direct costs incurred for pediatric cataract surgery for the financial year April 1, 2018, to March 31, 2019. The cost analysis was done by standard costing methods. The fixed cost included the cost of land, buildings, construction, maintenance, personnel, operation theater (OT), and Out patient department (OPD) equipment. The variable cost included the cost of consumables used during surgery. The indirect costs were not considered. Results: The per?patient fixed facility cost was INR 1.52 ($0.02), maintenance cost was INR 39.06 ($0.55), OPD equipment and consultation were INR 19.64 ($0.28), OT equipment was INR 467.95 ($6.61), the cost for personnel was INR 5,300.33 ($74.92), and the cost of consumables varied between INR 16,418 ($314.44) and INR 22,313 ($397.76), with the choice of intraocular lenses (IOL) being the main determining factor. The net average cost for a pediatric cataract surgery varied between INR 22,246.50 ($ 314.44) and INR 28,141.50 ($ 397.76). Conclusion: Pediatric cataract surgeries are cost?intensive. High?volume surgeries and an increase in the number of patients in OPD reduce the fixed facility cost. But there is an overall increase in human resource (HR) and consumable cost owing to economic and technological reforms. However, the impact of operating a child, thereby, increasing his/her blindness?free years probably outweighs the cost and justifies it. High patient inflow, increased number of surgeries, and bulk purchase of consumables help in decreasing the cost.

Visual impairment and blindness among children from schools for the blind in Maharashtra state, India: Changing trends over the last decade

Purpose: To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India. Methods: Children aged <16 years, enrolled in the schools for the blind in Maharashtra state, India were examined between October 2018 and December 2019. The anatomical sites and etiology for blindness were recorded using the World Health Organization’s standard reporting form. Causes of blindness were compared among different regions of the state and also by different age groups. Results: Of the 1,969 students examined from 39 schools for the blind, 188 children (9.5%) had severe visual impairment and 1,666 children (84.6%) were blind. Whole globe anomalies (794, 42.8%) were the most common anatomical site of vision loss in children, followed by corneal (289, 15.6%) and retinal abnormalities (280, 15.2%). Corneal causes were second most common in the poorer districts of Vidarbha (15.3%) and Marathwada (14.6%), whereas retinal causes were second most common in the wealthier regions of western Maharashtra (18.3%) and Khandesh (24.1%). Nearly one?third (593, 32%) of children were blind from potentially avoidable causes. Preventable blindness consisting of corneal causes and retinopathy of prematurity was seen in 281 (15.2%) cases, whereas treatable causes comprising of lens?related causes, glaucomas, refractive errors, amblyopia, and uveitis accounted for another 311 (16.8%). Among the younger children (?10 years), the proportion of corneal blindness was lower (83/623, 13.3% vs. 206/1232, 16.7%) and that of retinal blindness was higher (119/623, 19% vs. 163/1232, 13.2%) than the older children. Conclusion: Whole globe anomalies constitute a major cause of SVI and blindness in Maharashtra. There seems to be an increase in the proportion of retinal blindness, especially retinopathy of prematurity, suggesting a need for increased screening coverage

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

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

An observational study to evaluate the prevalence and pattern of refractive errors in children aged 3-17 years in Mumbai, India

Background: Refractive error is one of the most important causes of avoidable visual impairment. Early detection of refractive error in children is essential to avoid any permanent disability. The objective of the study was to determine the prevalence and pattern of refractive errors as per age, gender and educational standard in school children aged 3-17 years.Methods: This was an observational non-interventional study. 600 eyes of 300 participants in the age group of 3-17 years were evaluated. All underwent cycloplegic refraction followed by objective refraction. Participants were divided into 3 groups as follows 3-8 years, 9-12 years and 13-17 years and evaluation of type of refractive error was done age wise and gender wise.Results: The number of male and female participants was almost similar with a male:female ratio of 1.02:1. Refractive errors were most common in the age group of 9-12 years. The most common refractive error was astigmatism followed by myopia and hypermetropia. It was also found that majority of patients had bilateral refractive errors.Conclusions: The most common refractive error was astigmatism followed by myopia and hypermetropia. It was also found that majority of patients had bilateral refractive errors. The visual acuity in majority was 6/18 which according to WHO classification falls in Category 0 of Visual impairment in India.

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.

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

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

A Prospective Observational Study on Retinopathy of Prematurity in Low Birth Weight Babies at a Tertiary Care Centre of West Bengal

Aims: The aim of the study was to know the prevalence, severity, and progression of retinopathy of prematurity (ROP) amongthe screened low birth weight (LBW) and preterm babies and to determine how many of these babies require treatment.Methods: Prospective, observational study was done between August 2018 and March 2019. Screening for the presence ofROP and its severity in 588 eyes of 294 infants below 2000 g birth weight and/or period of gestation <34 weeks in SpecialNewborn Care Units. The retinal findings were documented and staging of ROP was determined, based on the InternationalClassification of ROP guidelines. Further follow-up and treatment were done accordingly.Results: In our study, 14.28% of the total numbers of babies screened were found to have different stages of ROP and 6.5%of the total number needed treatment. Among babies with birth weight above 1250 g, screening of 418 eyes of 209 babieswas done, of which 28 eyes of 14 babies were diagnosed as ROP (6.7%). Of which 12 babies received oxygen and 4 babies(8 eyes) required treatment. Among babies with ≤1250 g body weight, screening of 170 eyes of 85 babies was done, of which56 eyes of 29 babies developed ROP (33%), of which 25 babies received oxygen and 15 babies (30 eyes) required treatmentsuch as laser photocoagulation and intravitreal ranibizumab.Conclusion: ROP is emerging as one of the leading causes of irreversible childhood blindness, if not diagnosed and treatedearly. As very LBW babies are increasingly surviving because of the ever-improving perinatal care, the prevalence of ROP isalso increasing. That’s why regular ocular screening and timely intervention of those babies are to be done to prevent permanentblindness. Moreover, the magnitude of the problem in this part of our country will enable us to prepare our infrastructure to tackle it.

India to gear up to the challenge of “third epidemic” of retinopathy of prematurity in the world

Many of the causes of childhood blindness are avoidable, being either preventable or treatable. Retinopathy of prematurity (ROP) remains one of the most preventable causes of childhood blindness worldwide. Currently, India is facing the third epidemic of ROP. In India, the health system involving the mother and child health services needs to be strengthened with a policy to cover the existing inadequacies in neonatal care and implementation of program covering newborn, especially premature. The access, availability, and affordability of services related to the care of premature babies need strengthening in India. ROP-trained ophthalmologists and neonatal care pediatricians and a professional togetherness is a big issue. Inadequacies in awareness of ROP among the parents, health care workers, counsellors add up to the problem. Community-based health workers such as Accredited Social Health Activist are a good dependable force in India and are needed to be trained in awareness and establishing a proper identification for prompt referral. ROP prevention needs a multidisciplinary team approach. ROP management stands as a good example of all the strategies for prevention, which includes primary prevention (improving obstetric and neonatal care), secondary prevention (screening and treatment programs), and tertiary prevention (treating complications and rehabilitation to reduce disability). Given its demographic and cultural diversity, India faces numerous challenges, with significant rural–urban, poor–rich, gender, socioeconomic, and regional differences. So, we need to gear up to face the present challenge of the third epidemic of ROP and prevent ROP-related childhood blindness as it is the need of the hour.

Prospective study of factors influencing timely versus delayed presentation of preterm babies for retinopathy of prematurity screening at a tertiary eye hospital in India - The Indian Twin Cities ROP Screening (ITCROPS) data base report number 6

Purpose: To evaluate the factors influencing timely versus delayed presentation of preterm babies for ROP evaluation. Methods: Preterm babies (?35 weeks gestational age, ?2000 g birth weight) were prospectively included in the study. Timely presentation was defined as babies who presented for the first ROP screening within 30 days of birth and Delayed as more than 30 days of birth. An event survey to assess factors influencing timely vs delayed presentation was administered to parents/guardian of babies after obtaining informed consent. Results: Data of 278 preterm babies (n = 139 timely vs n = 139 delayed presentation) collected in the event surveys were analyzed. The delayed presenters came at a median duration of 6.3 weeks (1st and 3rd quartiles: 5.3 and 9.1) after birth. The odds of any stage of ROP was 2.6 times and the odds of sight threatening ROP was 6.8 times in those presenting delayed compared to those presenting timely. Major Reasons for delayed presentation were not asked to do so/no referral from pediatrician in 64 (46%) participants and unaware of the importance by 46 (33%) participants. Conclusion: Deviation from screening protocol is an important modifiable risk factor in ROP screening. The study findings suggest the need for creating awareness about timely screening and referral guidelines among the pediatricians involved in “care” of preterm infants at risk of developing ROP.

Clinical profile of childhood blindness and inappropriate enrolment of children in schools for visually impaired in Uttar Pradesh, India

Purpose: To assess major causes of severe visual impairment (SVI)/blindness (BL) in children studying in schools for the blind in western Uttar Pradesh, India and the extent of inappropriate enrolment of children in blind schools. Methods: Students of five schools for the blind were examined in a tertiary care eye hospital. The anatomical sites and etiology for SVI/BL were recorded using the World Health Organization/Prevention of Blindness standard reporting form. Categorical variable were summarized using frequencies and percentages. Results: A total of 93 students were examined. Male/Female ratio was 3.4:1. The most common anatomical sites of SVI/BL were the whole globe (40.3%) and the cornea (26.4%). Postnatal or childhood causes were noted in 13.8% cases. Forty-one (56.9%) students had hereditary diseases which was most likely caused by chromosomal abnormalities. Three students were having an associated disability, one was deaf and mute, one was physically handicapped, and one was intellectually challenged. Fifty-four (58%) children were blind and 21 (22.6%) children had no visual impairment but were studying in schools for the blind. Conclusion: Schools for the blind should be screened routinely to reduce the incidence of misdiagnosed visual impairment. This will prevent inappropriate enrolment and will definitely help in reducing the social and economic burden of society and of the schools of blind too.

Ocular morbidity among school aged children in Indian scenario.

Background: Vision is the most important special sense in human being. Normal vision is essential for normal physical, mental, psychological development and education. About 30% of blind population of India lose their eyesight before the age of 20 years and many of them are under 5 when they become blind. Methods: The present study is a cross sectional study of children aged 6 to 15 years from Schools in the rural area within 30 kilometers surrounding Khammam, India during september 2012 to March 2014. Results: Conjunctival abnormalities had the highest prevalence rate (4.36%) followed by Refractive errors (2.04%), Lid Abnormalities (1.35%), Corneal Abnormalities (1.02%), Squint (0.70%), Posterior segment abnormalities (0.51%), Amblyopia (0.32%), Colour vision abnormalities (0.28%) and lens abnormalities (0.23%). Conclusion: Our study is one of the few studies to be conducted in this rural setup. This Study gives us benchmark data for comparing future studies in Khammam district and also helps in providing valuable information for proper planning and conduction of future school based health programs.

Causes of blindness and severe visual impairment among children enrolled in an early intervention and preschool program of a school for the blind in the Philippines

@#<p style="text-align: justify;"><strong>OBJECTIVE:</strong> To identify the avoidable causes of childhood blindness and visual impairment in a school of the blind in the Philippines.</p> <p style="text-align: justify;"><strong>METHODS:</strong> The medical records of students enrolled at the Resources for the Blind early intervention and preschool program from 1999 to 2012 were reviewed. Demographic characteristics and causes of visual disability were abstracted and tabulated.</p> <p style="text-align: justify;"><strong>RESULTS:</strong> A total of 90 records were included in the study. Eighty six (76.7%) had visual acuity classified as blind (<20/400) or severe visual impairment (<20/200 - 20/400, 18.9%). Majority (69.8%) were below 6 years of age and most (44.2%) were below 1 year. Retinopathy of prematurity was the most common cause (47.7%), followed by retinablastoma (11.6%). Perinatal factors accounted for most of the etiologic causes (58.1%) of visual loss.</p> <p style="text-align: justify;"><strong>CONCLUSION:</strong> More than half of the causes of severe visual impairment and blindness were potentially avoidable, with retinopathy of prematurity as the leading etiology.</p>

Impact of the day-30 screening strategy on the disease presentation and outcome of retinopathy of prematurity. The Indian twin cities retinopathy of prematurity report number 3.

Context: Outcomes of various screening strategies in retinopathy of prematurity are not well reported. Aim: To assess the impact of a city-wide, ROP screening strategy, on the disease presentation and treatment outcome. Materials and Methods: A retrospective case-control study from a prospectively collected ROP data-base was analyzed. Cases (group 1a) included ROP babies that were screened directly in neonatal intensive care units, and controls (group 1b) were babies referred directly to the institute from other neonatal centers during the same period. Historical controls (group 2) were ROP cases seen in the years preceding establishment of this ROP program and database. Primary outcome measure was the risk of eyes presenting with stage 4 or worse ROP, and main secondary outcome measure was the fi nal anatomic outcome. Results: Of the 643 cases screened, 322 eyes of 161 babies had ROP. The median age of 7.19 months at presentation for the 46 patients (92 eyes) in group 2 was higher than the median age of 1.29 months for the 115 patients (230 eyes) in group 1. Within the group 1, group 1a had lower median age at presentation than group 1b (0.91 months versus 2.30 months). The relative risk of an eye presenting in the stage 4 and 5 in group 2 was 4.7 times higher (95% confi dence interval 3.07 - 7.32) than in group 1. Eyes that could be given treatment in group 2 were signifi cantly less (P < 0.0005) than in group 1. The relative risk of poor outcome in group 2 was 3.83 times higher (95% confi dence interval 2.75 - 5.34) than in group 1. Group 1a eyes had the best outcomes. Conclusion: Early screening before one month of age in neonatal centers detects the disease early where prompt treatment can lead to favorable outcomes. The study provides early results of a model strategy for ROP screening.

Visual outcomes of bilateral congenital and developmental cataracts in young children in south India and causes of poor outcome.

Context: Bilateral pediatric cataracts are important cause of visual impairment in children. Aim: To study the outcome of bilateral pediatric cataract surgery in young children. Setting and Design: Retrospective case series in a tertiary center. Materials and Methods: Records of pediatric cataracts operated between January 2001 and December 2003, with a minimum follow-up of 3 months, were reviewed retrospectively. Statistical Methods: Independent sample t-test, Fisher's exact test, and logistic regression using SPSS (Statistical Package for Social Science, Chicago, USA) version 12. Results: 215/257 (83.7%) patients had a minimum follow-up of 3 months. The mean age of presentation to the hospital was 53 months (range: 0-168 months). Congenital cataract was present in 107 patients (58.2%) and developmental cataract in 77 patients (41.8%). The mean age at surgery was 55.2 months (range: 1-168 months). Out of 430 eyes, 269 (62.6%) had an intraocular lens implanted. The mean duration of follow-up was 13.1 months (range: 3-38 months). Pre-operatively, 102 patients (47.3%) had visual acuity <6/60, in the better eye, compared to 37 patients (17.2%) post-operatively (P < 0.001). Eighty-five patients (39.5%) had visual acuity >6/18. The most common early post-operative complication was fibrinous uveitis in 57 eyes (13.3%) and the most common delayed post-operative complication was posterior capsular opacification in 118 eyes (27.4%). The most important prognostic factor for poor outcome was congenital cataract (odds ratio [OR]: 26.3; 95% confidence interval [CI], 4.4-158.5) and total cataract (OR: 4.8; 95% CI, 1.3-17). Conclusion: Nearly half of the eyes had visual acuity>6/18. The outcome was poorer in congenital cataracts, especially those operated after >1 year of age.

A study protocol on the situational analysis on the current practice of screening and treatment of Retinopathy of Prematurity (ROP)

Objective@#The study protocolaims to provide an overview of the current practice of screening and treatment of ROP in the selected, to estimate the proportion of childhood blindness due to ROP and assess the number of premature babies at risk for ROP.@*Methods@#The study protocol is a descriptive, cross sectional study design using survey questionnaire to be sent out to pediatric ophthalmologists, vitreo-retina specialists and division heads of the neonatal intensive care units of different hospitals in a selected area. Student records and medical abstracts from local schools for the blind will be obtained and will be reviewed. All qualitative data will be reported by frequency distribution and percentages. Extrapolation on the proportion of ROP in the area will be done. @*Conclusion@#Results from the study can show an overview of the current situation of ROP in a selected area and provide the framework for recommendations for programs aimed providing criteria for timely screening and treatment of ROP to prevent complications such as childhood visual impairment and blindness in the country.

Eye conditions and blindness in children: Priorities for research, programs, and policy with a focus on childhood cataract.

The major causes of blindness in children encompass intrauterine and acquired infectious diseases, teratogens and developmental and molecular genetics, nutritional factors, the consequences of preterm birth, and tumors. A multidisciplinary approach is therefore needed. In terms of the major avoidable causes (i.e., those that can be prevented or treated) the available evidence shows that these vary in importance from country to country, as well as over time. This is because the underlying causes closely reflect socioeconomic development and the social determinants of health, as well as the provision of preventive and therapeutic programs and services from the community through to tertiary levels of care. The control of blindness in children therefore requires not only strategies that reflect the local epidemiology and the needs and priorities of communities, but also a well functioning, accessible health system which operates within an enabling and conducive policy environment. In this article we use cataract in children as an example and make the case for health financing systems that do not lead to ‘catastrophic health expenditure’ for affected families, and the integration of eye health for children into those elements of the health system that work closely with mothers and their children.

Clinical Profile of Paediatric Cataract and Surgery in a Tertiary Eye Care Centre Nepal.

Introduction: Paediatric cataract is the opacification of lens and its capsule in children below 14 years of age. The management of paediatric cataract is lens aspiration with or without anterior vitrectomy, with or without intra-ocular lens implantation. The objective was to present the profile of pediatric cataract of operated eyes in children ≤14 years. Materials and Methods: This was a descriptive study in a hospital setting. A review of pediatric cataract cases operated between November 2007 and June 2009 in Tilganga Institute of Ophthalmology (TIO), a tertiary eye care centre in Nepal was carried out. The personal profile, preoperative and intra-operative details were noted. In the statistical analysis p value less than 0.05 is considered as significant. Results: A total of 175 eyes of 132 children had presented during study. The sex ratio was 1.6 male per female with mean age of 6.7 years (SD ±4.3). About one-third (32%) presented within the age of three years where as more than two-fifths (46%) presented at the age eight years and above. Seventy two cases were collected through door to door enumeration and screening clinics for children. The proportion of cataract was higher in males than in females (P>0.05). Visual acuity ranged from 6/18 to follows light. Conclusion: Nearly half of the paediatric cataract had presented after the age of eight years mainly from hilly region through the screening program. Most of the pediatric cataract cases presented with the whitish pupillary reflex with more than two-thirds of visual acuity of less than 3/60. The most common type of the cataract surgery performed was lens aspiration with anterior vitrectomy with lens implantation. The earlier the surgery better is the visual prognoses. Hence, community screening through as door to door screening and one day screening clinics will help for early referral and earlier surgery to reduce visual disabilities due to paediatric cataract.