Global perspective- Pediatric blindness leading to morbidity

The global prevalence of childhood blindness is approximately 1.4 million. Nearly 500,000 children become blind every year - nearly one per minute. Thus, the control of childhood blindness has been identified as a priority of the World Health Organisation’s (WHO) global initiative for the elimination of avoidable blindness by the year 2020.

Effects of childhood blindness in the society:

Blindness in children leads to a deep impact on psychological, emotional, and socioeconomic growth to the family. A child with blindness is more likely to have delays in developmental milestones. Blindness in childhood has far reaching implications for the affected child and family, and throughout life profoundly influences educational, employment, personal, and social prospects.

Causes of blindness in children:

Childhood blindness results from a number of causes that range from genetically determined and congenital conditions to micronutrient deficiency (vitamin A) and infective conditions (measles, ophthalmia neonatorum, rubella) to conditions requiring specialized surgical treatment such as childhood cataract, glaucoma, and retinopathy of prematurity.

These causes can broadly be divided into 

A) Preventable causes:

• Vitamin A deficiency

• Retinopathy of Prematurity

• Ocular complications following maternal TORCH group pf infections (can be prevented using safe delivery practices)

• Ophthalmia neonatorum

• Ocular trauma (thermal and chemical injuries)

B) Treatable/ Curable causes:

• Refractive errors

• Amblyopia

• Squinting (lazy eye)

• Ophthalmia neonatorum

• Optic neuritis 

• Corneal opacities

• Congenital cataracts

• Congenital glaucoma

C) Diseases causing Ocular morbidity & requiring rehabilitation:

• Cortical blindness

• Ocular complications arising from various syndromic disorders

• Congenital ocular defects like aniridia, nanophthalmos, enophthalmos etc.

In the age group <2 years, most commonly encountered childhood eye disorders include ocular tumours like Retinoblastoma, Retinal dystrophies and other congenital associations.

Among children aging 3-10 years, the majority of ocular concerns include refractive errors, ocular trauma (physical, thermal or chemical injuries) and retinal and corneal dystrophies.

Early identification and the prompt treatment of various preventable and curable causes of childhood blindness can help us negate their detrimental effects and save the visual potential of children.

Need for screening by primary caregivers of the child:

A) Who performs vision screening?

A vision screening is an efficient eye exam. A child is “screened” for eye problems and referred to an ophthalmologist for a comprehensive  exam if needed. Your child’s vision can be screened by a:

• Parent 

• Family physician

• Paediatrician

• Ophthalmologist

• or other properly trained health care provider

B) How to diagnose blindness in children?

If you suspect that your kid may be losing their vision, make an appointment with a doctor as soon as possible. To halt or reverse the problem, you need a diagnosis immediately. You should take your kid to the pediatrician or general practitioner so that the doctor may examine your child's eyes. You may then be sent to a pediatric ophthalmologist or a children's eye specialist. 

Visual cues for parents to be aware of:

(i) <1 year age:

• Fixation of eyes by the child

• Ability to identify objects

(ii) 2-4 year olds:

• Squinting (the eyes don’t seem to be aligned)

• White reflex 

• Frequent rubbing of eyes (particularly in children of parents with high powered spectacles)

• Swelling or redness of the eyes

(iii) 4 years and older:

• Excessive blinking

• Headaches and eye strain

• Holding books or other reading items close to face

• Close proximity to the TV 

C) Screening by health care providers: 

Almost all newborns under the age of two have regular eye examinations at their physician appointments. However, a complete eye exam should be performed frequently for your kid.

(i) Newborns:

A doctor or other trained health professional should examine a newborn’s eyes to check for basic indicators of eye health. It may include testing for:

• a “red reflex” (like seeing red eyes in a flash photograph). If the bright light shone in each eye does not return a red reflex, more testing may be needed.

• blink and pupil response

An ophthalmologist should do a comprehensive exam if the baby is:

• born prematurely

• has signs of eye disease

• or a family history of childhood eye disease

(ii) 6 to 12 months

A second screening should be done during the child’s first year of life. This screening is usually done at a well-child exam between 6 and 12 months. Your child’s pediatrician or other health care professional should:

• visually inspect the eyes

• check for healthy eye alignment and movement

(iii) 12 to 36 months

Between 12 and 36 months, a child is checked for healthy eye development and any refractive error development, more so in children born to parents suffering from myopia ( near-sightedness). 

(iv) 3 to 5 years

Between 3 and 5 years, a child’s vision and eye alignment should be checked. This may be done by a pediatrician, family doctor or ophthalmologist.

Visual acuity (sharpness of vision) should be tested as soon as the child is old enough to read an eye chart. Many children are somewhat farsighted (hyperopic), but can also see clearly even at a distance. Most children will not require glasses or other vision correction. If the child struggles with the eye chart, photoscreening may be used to test vision.

An ophthalmologist should see your child if the screening shows signs of:

• misaligned eyes (strabismus)

• "lazy eye” (amblyopia)

• refractive errors (myopia, hyperopia, astigmatism)

• or another focusing problem

Begin treatment for these problems as soon as possible—getting early treatment for your child is the best thing you can do to protect their vision.

(v) 5 years and older

At 5, children should be screened for visual acuity and alignment.  Nearsightedness (myopia) is the most common problem in this age group. It is corrected with eyeglasses. An ophthalmologist should examine a child with misaligned eyes or signs of other eye problems. 

Children treated with growth hormone therapy should have their eyes tested before and during treatment.

Looking for the right way to treat childhood blindness?

In most situations, partial blindness may be remedied with glasses or laser surgery, so parents needn't be alarmed. It might be challenging to raise a kid who is completely blind since the ailment is typically untreatable. Remember that your kid has no other difficulties in life or growth, and you must support them, and you only need to be a bit more attentive to your child's needs.

Blindness is a severe disease, thus, you should always consult the doctor immediately if you sense anything wrong. The second consult will be your best support system here. Our doctors handle such cases with the utmost sensitivity, they will suggest a nutritious diet, corrective lenses, and surgery as per the condition.

Release your burden with us.

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