Childhood Blindness: Causes & Prevention

Rabindran 1, Gedam DS 2

1Dr. Rabindran, Consultant Neonatologist, Billroth Hospital, Chennai, 2 Dr D Sharad Gedam, Professor of Pediatrics, L N Medical college, Bhopal, MP, India

Address for correspondence: Dr Rabindran, E mail: rabindranindia@yahoo.co.in

Abstract

The global prevalence of childhood blindness is approximately 1.4 million. Nearly 500,000 children become blind every year - nearly one per minute.Worldwide, vitamin A deficiency is the commonest single cause of childhood blindness. Childhood blindness can be categorized as preventable & curable. Preventable causes include corneal scars due to vitamin A deficiency, infections & injuries; whereas curable cause includepediatric cataract, glaucoma, retinopathy of prematurity & refractive errors. Of late childhood blindness has been identified as a priority in WHO’s global initiative to eliminate avoidable blindness by the year 2020.Immunization, maternal & child health care, health education, good nutrition, provision of essential drugs, clean water supply & good sanitation, control of endemic diseases & treatment of common ailments, sufficient personnel trained in primary eye care are essential for control of childhood blindness.

Keywords: Childhood blindness, Vitamin A deficiency, Prevention of blindness

Childhood blindness can be defined as visual acuityless than 3/60 in the eye with better vision among children below 16 years of age [1].The global prevalence of childhood blindness is approximately 1.4 million &nearly 75% of the world’s blind children live in Africa & Asia.Prevalence varies from approximately 0.3/1000 children in developed countries to 1.2/1000 in developing countries [2]. India has an estimated 3,20,000 blind children [3].Recent analysis show that nearly 500,000 children become blind every year - nearly one per minute [4]. Most of them are either born blind or become blind before their fifth birthday out of which nearly 40% are preventable or treatable. Worldwide, vitamin A deficiency is the commonest single cause of childhood blindness accounting for an estimated 350,000 new cases each year.

Childhood blindness can be categorized as preventable & curable. Preventable causes includecorneal scars due to vitamin A deficiency, infections & injuries; whereas curable cause includepediatric cataract, glaucoma, retinopathy of prematurity &refractive errors. Hereditary factors include familial cataract, retinoblastoma or retinal dystrophies; maternal factors include maternal infection with rubella &toxoplasmosis; perinatal factors include retinopathy of prematurity; childhood factors include vitamin A deficiency, measles, external eye infections, harmful traditional eye medicines & eye injuries [5]. However corneal scarring due to measles & vitamin A deficiency is declining in many developing countries due to child survival programmes & proportion due to cataract is increasing.Surprisingly Refractive errorcontributes to about 19% of total blindness worldwide [6]. Analysing childhood blindness, the frequently affected parts of the eyes include whole globe (36%), cornea (36%), lens (11%), retina (6%), optic nerve (5%), uvea (2%) [3,7].

Of late childhood blindness has been identified as a priority in WHO’s global initiative to eliminate avoidable blindness by the year 2020 [2]. VISION 2020 programme has formatted an integrated approach based on three core strategies - Human Resource Development, Infrastructure Development& Disease Control.Immunization, maternal &child health care, health education, good nutrition,provision of essential drugs, clean water supply & good sanitation, control of endemic diseases& treatment of common ailments,sufficient personnel trained in primary eye care are essential for control of childhood blindness.

Pregnant woman with night blindness or Bitot’s spot should take 10,000 IU of vitamin A orally for 2 weeks & after delivery she should receive 3 doses of vitamin A 200,000 IU on Day 1, Day 2 & Day 8 to ensure adequate supply in her breast milk. Weaning foods should be rich in vitamin A. Vitamin A capsules 200,000 IU may be given every 3-6 months to children aged 1-6 years of age who are at high risk. Conjunctivitis can be prevented by antenatal screening of pregnant women for gonococcal& chlamydial infections & use of topical antibiotics or antisepticsfor infected babies [8]. Cataracts caused by congenital rubella can be prevented by immunisation. Prevention of blindness from ROP depends on preventing preterm birth & intensive neonatal care of premature babies with early detection ofROP. Visual loss in children due to trauma can be minimisedby legislation to restrict dangerous toys & fireworks.Child eye health practices should be instituted at community as well as at primary, secondary& tertiary health care levels with direct engagement of other social public sectors.

There is need for awareness among community about ocular healththrough mass media, awareness campaigns, rallies, posters & exhibitions. Vision testing must be added in child health programme. Annual school health check-ups must focus their attention towards vision impairment.

Funding: Nil, Conflict of interest: None initiated.
Permission from IRB: Yes

References

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2. Gilbert C E, Foster A. Childhood blindness in the context of VISION 2020 – The Right to Sight. Bull World Health Organ. 2001;79(3):227-32.

3. Gilbert C, Rahi J, Quinn G. Visual impairment and blindness in children. In: Johnson ,Minassian,Weale,West , editors. Epidemiology of eye disease. 2nd ed. UK: Arnold Publishers; 2003.

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8.  Isenberg SJ, Apt L, Wood M. A controlled trial of povidone-iodine as prophylaxis against ophthalmianeonatorum. N Engl J Med 1995: 332:562-66. [PubMed]
  

How to cite this article?

Rabindran, Gedam DS. Childhood Blindness: Causes & Prevention. Ophthal Rev: Int J ophtha & Oto. 2016;1(1):1-2. doi: 10.17511/jooo.2016.i1.01.