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 Retina* Cornea * Whole globe Lens Optic nerve* Glaucoma* Other clasisification 380.000 260.000 250.000 190.000 140.000 90.000 50.000 Etiological Unknown Hereditary Childhood Perinatal Intrauterine categories 560.000 420.000 280.000 100.000

Uvea
Total

40.000
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