CHILDHOOD BLINDNESS

Definition :
A child is defined by UNICEF as individual aged less
than 16 years
Blindness is defined as corrected visual acuity of less
than 3/60 in the better eye
Severe visual impairment as a corrected visual acuity in
the better eye of < 6/60 3/60
 Prevalence of blindness in
children
0.3/1000 - 1.5/1000 children

0.4/1000 children in high income region

0.7/1000 children in middle income region
0.9/1000 children in low income region
INCIDENCE of BLINDNESS
Incidence of blindness
A few data , suggest of 6-11/100.000 children/year
Estimation : 500.000 become blind each year
( 1 /minute) but 50%-60% die within one or two years
mainly as a result of the condition causing blindness

MAGNITUDE of BLINDNESS
Estimation : 1.400.000 blind children world wide
(73% in low income countries)
 Causes of blindness in children
Anatomical clasisification Etiological categories
Retina* 380.000 Unknown 560.000
Cornea * 260.000 Hereditary 420.000
Whole globe 250.000 Childhood 280.000
Lens 190.000 Perinatal 100.000
Optic nerve* 140.000 Intrauterine
Glaucoma* 90.000
Other 50.000
Uvea 40.000
Total 1400.000 Total 1400.000
Trends in the major causes of childhood blindness

Levels socioeconomic development and health care

provision
ROP important cause of blindness in middle-income
countries introduce intensive care services

CHILDHOOD BLINDNESS
IN THE CONTEX OF VISION 2020
The five priorities problems are :
Cataract
Trachoma
Childhood blindness
Onchocerciasis
Refractive errors
Preventable : Corneal scarring ( VAD,Measles inf, oph neonat,
traditional practices, inf corneal ulcers
Intra uterine factors (rubella,toxoplasmosis,teratogen)
Perinatal ( ROP, birth hypoxia)
Hereditary diseases (risk counselling)

Treatable : Cataract
Glaucoma
ROP
Uveitis
Corneal diseases
Main priorities for action in the field :
- elimination of VAD
- treatment of : congenital cataract
glaucoma, ROP
- serious refractive errors
This will achieve through :
- Promotion of Primary Health Care
- Developing specialist childrens eye services
including surgery and low vision clinics
- School screening
 Congenital cataract
Etiology : Congenital Rubella, Genetic

Management Cataract in children : more complex, severe

intraocular inflammation, secondary cataract

Correction of aphakia : ASAP after surgery is essential

(Spectacles, Contact lenses, IOL)

When surgery should be done ?

Early intervention and early rehabilitation increase
probability of good Visual Out Come
What surgery should be done?
Type of surgery : Lensectomy, combined with PPC,PC
and anterior vitrectomy clear visual axis in one
operation

Who should do the surgery?

Surgeon : should have the skill and commitment
necessary to supervise the child until visual development is
complete

Where should surgery be done ?

Should be carried out in specialist center (paediatric
anaesthesia, automated vitreous cutting machine, good
refraction and low vision services`
 RETINOPATHY OF PREMATURITY

Definition : ROP occurs in pre term babies because the

normal process of vascularization is not complete at the time
of birth
Prevention :
Primary prevention : preventing pre term babies,
excellent intensive neonatal care of premature, LBW
including blood gas monitoring and control
Secondary prevention : screening programmes to identify
ROP stage
REFRACTIVE ERRORS AND SCREENING NING
REFRACTIVE ERRORS AND SCREENING
Screening by teacher , ONA, at school, not one time but
continuous process

LOW VISION SERVICES

Low Vision < 6/18 - NLP and/or visual field less than 100 from
the point fixation after treatment and / or standard refractive
correction
 Component of Intervention

Primary level : Community

Secondary level : Screening RE

Tertiary level : Treatment, ROP Screening,

LV Services, Training.
Pediatric Services
 Primary Intervention

Public awareness : out side the domain of

Ophthalmic Community
Preventive education
Immunization, screening in school entry
Training of local practitioners in treatment of
corneal injuries
Secondary interevention
Principles of social marketing

Tertiary intervention
Pediatric Unit
Pediatric Ophthalmologic team
Child friendly set up
Linkages with LV and Rehabilitation services