Epidemiology of childhood blindness

Profile of Newly Diagnosed Childhood Glaucoma in India: Indian Childhood Glaucoma Study (ICGS) Group 1

OBJECTIVE

To report the profile of newly diagnosed childhood glaucoma using the Childhood Glaucoma Research Network (CGRN) classification, presenting over 1 year from across centers in India.

DESIGN

Prospective observational multicentric study.

SUBJECTS

Newly diagnosed children aged < 18 years diagnosed with childhood glaucoma according to CGRN criteria presenting between January and December 2019 to 13 centers across India.

METHODS

All children underwent a comprehensive ocular examination, including examination under anesthesia for younger children, and were diagnosed with childhood glaucoma as per CGRN. Data were entered in a standard Excel chart. Refraction and visual acuity assessments were done when feasible.

MAIN OUTCOME MEASURES

The profile of newly diagnosed childhood glaucoma in different parts of India and the severity of glaucoma at presentation.

RESULTS

A total of 1743 eyes of 1155 children fulfilled the definition of glaucoma and were analyzed. Primary congenital glaucoma (PCG) comprised the single largest group (34.4%), most of which were infantile onset (19%). Neonatal-onset PCG comprised 6.2% of all glaucoma. Secondary glaucoma constituted 53.4% of all glaucoma, one-half of which were acquired conditions (28%), followed by isolated ocular anomalies (14.7%), glaucoma after cataract surgery (6.7%), and glaucoma with nonacquired systemic diseases (4.5%). Of the 1743 eyes with glaucoma, all 3 parameters for severity grading were available in 842 eyes, of which 501 (59.5%) eyes presented with mild, 320 (38%) with moderate, and 21 (2.5%) with severe glaucoma. Nearly one-third of the children (28.5%) were not brought back for follow-up after the initial treatment given.

CONCLUSIONS

Our study has one of the largest numbers of consecutive children with glaucoma classified according to the CGRN classification. Despite a widely diverse population, the profile of childhood glaucoma was relatively uniform across India. Childhood glaucoma is a significant problem in India, primarily treated in tertiary care hospitals. The data presented may be the tip of the iceberg because we have only reported the children who reached the hospitals offering treatment for this challenging disease.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Assessment of parental awareness about pediatric visual problems by Knowledge-Attitude-Practice survey in South India

Purpose

To find out parents' knowledge, attitude, and treatment practice (KAP) toward pediatric eye problems and to assess the effect of demographic factors such as gender, age, educational status, and number of children on KAP.

Methods

A cross-sectional descriptive study was conducted in a hospital setting. Two hundred parents were randomly selected for the questionnaire. All parents had children who were included in Systematic Pediatric Eye Care Through Sibling Screening Strategies (SPECSSS) study. A survey with 15 questions on KAP of pediatric eye diseases was prepared and administered to parents coming to a tertiary eye hospital with varied experience and education qualifications.

Results

The mean age of 200 patients was 9.6 (3.4) years, with the majority of them male (n = 110; 55.0%). The majority of the children (n = 91, 45.5%) were between the age group of 6-10 years. Knowledge of visual problems among parents was of a good grade in 9% only. The attitude of the parents toward the visual problem was positive at 17%, and the responses regarding the practice were of excellent grade at 46.5% and good at 26.5%. Analysis suggests that the level of knowledge and practice were not significantly associated with the demographic factors (p > 0.05). The positive attitude toward the visual problems of the children was associated with education of the parents (p < 0.05) and the father occupation (p < 0.05).

Conclusion

Knowledge about pediatric eye diseases was poor among parents and it was significantly affected by education and occupation of parents. The parents have positive attitude toward enhancing their attitude in treatment.

Morphogenetic events influencing corneal maturation, development, and transparency: Light and electron microscopic study

The development of the cornea is a fascinating process. Its dual origin involves the differentiation of surface ectoderm cells and the migration of mesenchymal cells of neural crest origin. This research aimed to demonstrate the morphogenesis of the rabbit cornea from fetal to postnatal life using light- and electron microscopy, and immunohistochemical analysis. There were 27 rabbit embryos and nine rabbits used. The rabbit cornea begins its prenatal development on the twelfth day of gestation. The surface ectoderm differentiates into the corneal epithelium on day 13. Intriguingly, telocytes were visible within the epithelium. The secondary stroma develops on the sixteenth day of gestation by differentiation of keratocytes. At the age of 2 weeks, the lamellae of collagenous fibers become highly organized, and the stroma becomes avascular, indicating that the cornea has become transparent. Bowman's membrane appears on day 23 of pregnancy and disappears on day 30. The Descemet's membrane appears at this time and continues to thicken postnatally. The corneal endothelium appears on the twentieth gestational day as double layer of flattened cells and becomes a single layer of cuboidal cells on day 30. The spaces between the endothelial cells resemble craters. VEGF immunohistochemical expression increases over the course of development, reaching its peak in the first week after birth before decreasing in all corneal layers and becoming negative in the stroma. In conclusion, numerous morphogenetic events contribute to corneal maturation and transparency, allowing the cornea to perform its vital functions.

Exome sequencing identifies a novel GUCY2D mutation in an Iranian family with Leber congenital amaurosis-1: a case report

Background

Leber congenital amaurosis (LCA), the severe form of inherited retinal degenerative disorder, is a prevalent disorder in the first year of life. Recently, genetic studies discovered that different gene mutations are responsible for LCA clinical manifestations.

Case presentation

In this study, we applied whole exome sequencing (WES) to identify probable gene defects in an Iranian girl with LCA-1. We found a novel disease-causing GUCY2D gene mutation (c.2348T > C; p.L783P), located in exon 12 (NM_000180), causing a missense mutation that has been changed the coding protein. The WES-identified variant was confirmed by Sanger sequencing for the patient and her healthy parents. Submitted to genetic counseling that the patient was 1-year old and blindness from birth.

Conclusions

Our findings establish that this detected GUCY2D-p.L783P mutation is the pathogenic variant for LCA-1. This is the first genetic study indicating that c.2348T > C missense mutation in the homozygous state in GUCY2D gene is responsible for the LCA-1 phenotype.

OUP accepted manuscript

Cataract is a leading cause of blindness in children worldwide. Blindness can be treated with effective surgery, but in low-resource settings this treatment can be difficult to access. In addition, positive outcomes of the surgery are heavily dependent on comprehensive postoperative care. To date in Nigeria and many other low-resource countries, robust electronic data-management systems that help facility teams to manage their patient data, especially when it comes to tracking children for follow-up visits after surgery, have either yet to be put into place or are in place but have yet to be refined to respond to the specific needs of eye care programs. Sightsavers has worked with multiple state ministries in Nigeria to set up and test a system that responds to those needs.

Knowledge, Attitudes and Practices of Postnatal Mothers on Ophthalmia Neonatorum in the Central Region, Ghana

Health education is key in the prevention of Ophthalmia Neonatorum (ON). However, health education in relation to eye care in Ghana is very low. To determine the knowledge, attitudes and practices (KAPs) of mothers on Ophthalmia Neonatorum (eye infection in newborns), a descriptive cross-sectional design was adopted, using a standardised interviewer-administered questionnaire to collect data. Using a consecutive sampling technique, we enrolled 407 mothers to participate in the study. The overall KAPs of the study participants were assessed using the sum score of each outcome based on Bloom’s cut-off point. Completed data was then analysed using descriptive statistics with SPSS version 22.0 at the level of P < .05. Out of the 407 participants, 321 (78.9%) had not heard about Ophthalmia Neonatorum with nearly 93% having low levels of knowledge on the neonatal infection. We found a significant association between formal education (P = .001), skilled occupation (P = .008) and a high level of knowledge on Ophthalmia Neonatorum. The study highlights the need to find improved and alternative methods of educating mothers on Ophthalmia Neonatorum in the bid to reduce blindness attributed to the condition.

Assessment of quality of life, mental health and ocular morbidity in children from schools for the blind in North-East India

Purpose:

The aim of this study was to describe causes of severe visual impairment and blindness (SVI/BL), and assess the mental health and quality of life of children in schools for the blind in North-East India in two phases.

Methods:

A total of 515 children were examined in 17 schools for the blind in the first phase of study across eight states in North-East India, 6 in Assam, 2 each in Meghalaya, Manipur, Mizoram, and Tripura, 1 each in Arunachal Pradesh, Nagaland, and Sikkim. WHO/PBL eye examination record was used to document findings. In the second phase of study, mental health and quality of life were objectively measured using depression anxiety stress scales (DASS) and low-vision quality of life (LVQOL) questionnaires in 442 children.

Results:

Approximately 3.1% of children had SVI and 71.84% of children were blind. Anatomical sites of SVI/BL were the whole globe in 44.85%, cornea in 17.66%, and retina in 11.65% of children. The underlying cause of visual loss was undetermined in 55% of children. Hereditary pattern was observed in 1.35% of cases. Approximately 74.94% of children were either blind or severely visually impaired since birth. DASS score revealed that 56.56% of children manifested some levels of anxiety and stress while 85.52% had some reduction in quality of life.

Conclusion:

A large significant number of these children suffered from potentially preventable and/or treatable cause of SVI/BL. Though nonvisual factors such as physical and mental health were strong predictors of quality of life, this study proves that visual impairment also plays a considerable role in one's quality of life in a population with low vision.

EyeDiseases: an integrated resource for dedicating to genetic variants, gene expression and epigenetic factors of human eye diseases

Eye diseases are remarkably common and encompass a large and diverse range of morbidities that affect different components of the visual system and visual function. With advances in omics technology of eye disorders, genome-scale datasets have been rapidly accumulated in genetics and epigenetics field. However, the efficient collection and comprehensive analysis of different kinds of omics data are lacking. Herein, we developed EyeDiseases (https://eyediseases.bio-data.cn/), the first database for multi-omics data integration and interpretation of human eyes diseases. It contains 1344 disease-associated genes with genetic variation, 1774 transcription files of bulk cell expression and single-cell RNA-seq, 105 epigenomics data across 185 kinds of human eye diseases. Using EyeDiseases, we investigated SARS-CoV-2 potential tropism in eye infection and found that the SARS-CoV-2 entry factors, ACE2 and TMPRSS2 are highly correlated with cornea and keratoconus, suggest that ocular surface cells are susceptible to infection by SARS-CoV-2. Additionally, integrating analysis of Age-related macular degeneration (AMD) GWAS loci and co-expression data revealed 9 associated genes involved in HIF-1 signaling pathway and voltage-gate potassium channel complex. The EyeDiseases provides a valuable resource for accelerating the discovery and validation of candidate loci and genes contributed to the molecular diagnosis and therapeutic vulnerabilities with various eyes diseases.

Precision of bag-in-the-lens intraocular lens power calculation in different age groups of pediatric cataract patients: Report of the Giessen Pediatric Cataract Study Group

PURPOSE

To evaluate the precision of bag-in-the-lens intraocular lens (BIL IOL) power calculation in different age groups of pediatric cataract patients.

SETTINGS

Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany.

DESIGN

Retrospective nonrandomized consecutive case series.

METHODS

Pediatric patients diagnosed with cataract and operated with BIL IOL implantation were divided into 4 age groups: Group 1 (0 to 3 months), Group 2 (>3 months, <12 months), Group 3 (12 to 36 months), and Group 4 (>36 months to 17 years). BIL IOL power was calculated with the SRK/T formula. The prediction error (PE) was defined as the absolute difference between the preoperative selected target and postoperative achieved refraction. The impact of age at the time of surgery, axial length (AL), keratometry, and corneal astigmatism on PE was analyzed.

RESULTS

The study comprised 87 eyes of 56 pediatric patients. The mean and median PEs for the entire group were 1.79 diopters (D) and 1.23 D, respectively. The mean PE in each age group was: 3.43 D in Group 1, 2.14 D in Group 2, 1.60 D in Group 3, and 1.33 D in Group 4. The mean PE in eyes with ALs shorter than 20 mm was 2.67 D, and 1.44 D in eyes with an AL of 20 mm or longer. The mean PE in eyes with corneal radii less than 7.3 mm was 2.45 D, and 1.66 D in eyes with corneal radii of 7.3 mm or more. In the age and AL subgroups, the PE differences were statistically significant (P < .05).

CONCLUSIONS

The PE was larger in the youngest study group, and it decreased gradually with age and in eyes with ALs shorter than 20 mm. The PE has to be considered during BIL IOL power calculation in children.

Analysis and management of intraoperative and early postoperative complications of bag-in-the-lens intraocular lens implantation in different age groups of paediatric cataract patients: report of the Giessen Paediatric Cataract Study Group

PURPOSE

To report the rate and management of intra- and early postoperative complications of bag-in-the-lens intraocular lens (IOL) implantation technique for cataract treatment in paediatric patients of different age groups.

SETTINGS

Department of Ophthalmology, Justus-Liebig-University Giessen, University Hospital Giessen and Marburg GmbH, Campus Giessen, Giessen, Germany.

DESIGN

Retrospective non-randomized consecutive case series.

METHODS

Ninety eyes of 60 paediatric cataract patients were enrolled to this retrospective non-randomized observational consecutive case series single-centre study. All patients underwent cataract surgery with bag-in-the-lens IOL implantation between January 2008 and December 2018, performed by two experienced surgeons. The entire cohort was divided into four age groups: first - 0-<3 months, second - 3-<12 months, third - 12-<36 and fourth - >36 months-17 years of age. The intra- and postoperative complications were based on the clinical records. The description of management of complications related specifically to bag-in-the-lens IOL technique was based on the 39 consecutive cases operated since 1 Jan 2016 by one single surgeon that were all video documented. The early postoperative period was defined as 12 months after surgery.

RESULTS

Overall, there were 27 unilateral and 33 bilateral surgical cases of 24 female and 36 male children. The mean age at surgery was 45.25 months (range 1-200 months). The most common intraoperative events were vitreous prolapse and anterior capsule rupture with 28.9% and 13.3%, respectively. Within 12 months of follow-up, five eyes (5.6%) were re-operated because of visual axis reo-pacification (VAR). Intraocular hypertension was diagnosed in seven eyes (7.8%), including two cases that required surgical treatment. In all cases with intra- and early postoperative complications related specifically to bag-in-the-lens technique, it was possible to manage them and successfully implant bag-in-the-lens IOL.

CONCLUSIONS

Implementation of bag-in-the-lens technique in the treatment of paediatric cataract was associated with a relatively low rate of intra- and postoperative complications, including rare cases of VAR. The correct management of complications related specifically to bag-in-the-lens IOL implantation technique shall to be considered during the learning curve.

The genetic aetiology of retinal degeneration in children in Finland - new founder mutations identified

PURPOSE

To study the genetic aetiology and phenotypes of retinal degeneration (RD) in Finnish children born during 1993-2009.

METHODS

Children with retinal degeneration (N = 68) were investigated during 2012-2014 with a targeted gene analysis or a next-generation sequencing (NGS) based gene panel. Also, a full clinical ophthalmological examination was performed.

RESULTS

The cohort covered 44% (68/153) of the Finnish children with inherited RD born 1993-2009. X-linked retinoschisis, retinitis pigmentosa, Leber congenital amaurosis and cone-rod dystrophy were the most common clinical diagnoses in the study group. Pathogenic mutations were found in 17 retinal genes. The molecular genetic aetiology was identified in 77% of the patients (in 77% of the families) analysed by NGS method. Several founder mutations were detected including three novel founder mutations c.148delG in TULP1, c.2314C>R (p.Gln772Ter) in RPGRIP1 and c.533G>A (Trp178Ter) in TYR. We also confirmed the previous tentative finding of c.2944 + 1delG in GYCU2D being the most frequent cause of Leber congenital amaurosis (LCA) in Finland.

CONCLUSIONS

Globally, RD is genetically heterogeneous with over 260 disease genes reported so far. This was shown not to be the case in Finland, where the genetic aetiology of RD is caused by a small group of genes, due to several founder mutations that are enriched in the population. We found that X-chromosomal retinoschisis constitutes the major group in Finnish paediatric RD population and is almost exclusively caused by two founder mutations. Several other founder mutations were detected including three novel founder mutations. All in all, the genetic aetiology of 77% of families was identified which is higher than previously reported from other populations, likely due to the specific genomic constitution of the Finns.

Prevalence And Associated Factors Of Visual Impairment Among School-Age Children In Bahir Dar City, Northwest Ethiopia

INTRODUCTION

Visual impairment (VI) is one of the major public health problems in the world. It is highly prevalent among children in sub-Saharan countries, including Ethiopia. Worldwide, the magnitude of VI among school-age children is 1%-10%. However, there was limited information regarding the prevalence and associated factors of VI among school-age children in the study area, which is essential to plan and implement appropriate interventions.

OBJECTIVE

The aim of this study was to determine the prevalence and associated factors of VI among school-age children livin g in Bahir Dar city, northwest Ethiopia.

METHODS

A community-based cross-sectional study was done on a sample of 632 school-age children selected by multistage sampling in Bahir Dar from April 30 to May 15, 2018. Data were collected through interviews and physical examinations. Face-to-face interviews were done with a pretested semistructured questionnaire. Physical examinations were done with visual acuity measures and assessment of ocular pathology by optometrists. Data were entered into Epi Info 7 and exported to and analyzed with SPSS 20. Binary logistic regression was fitted, and variables with P<0.05 in the multivariate model were considered statistically significant.

RESULTS

A total of 601 study subjects were included in this study, giving a response rate of 95.2%. The median age was 13 (IQR 11-16) years, and 303 (50.3%) were male. Prevalence of VI was 52 (8.7%, 95% CI 6.2%-10.7%). In multivariate analysis, prematurity [AOR 2.8 (95% CI 1.19-6.83)], admission to a neonatal intensive-care unit (AOR 5.5, 95% CI 2.01-15.15), having a parent with VI (AOR 1.8, 95% CI 0.13-0.97), watching television from <2 m (AOR 8.7, 95% CI 1.49-18.24), and mobile-phone exposure >4 hours per day (AOR 1.6, 95% CI 1.32-4.45) were factors significantly associated with VI.

CONCLUSION

The prevalence of VI among school-age children in Bahir Dar was significant. Premature birth, admission to a neonatal intensive-care unit, having a parent with VI, watching television from <2 m, and mobile exposure >4 hours per day were significantly associated.

The prevalence of uncorrected refractive error in urban, suburban, exurban and rural primary school children in Indonesian population

Uncorrected refractive error (URE) is a major health problem among school children. This study was aimed to determine the frequency and patterns of URE across 4 gradients of residential densities (urban, exurban, suburban and rural). This was a cross-sectional study of school children from 3 districts in Yogyakarta and 1 district near Yogyakarta, Indonesia. The information regarding age, sex, school and school grader were recorded. The Snellen's chart was used to measure the visual acuity and to perform the subjective refraction. The district was then divided into urban, suburban, exurban and rural area based on their location and population. In total, 410 school children were included in the analyses (urban=79, exurban=73, suburban=160 and rural=98 school children). Urban school children revealed the worst visual acuity (P<0.001) and it was significant when compared with exurban and rural. The proportion of URE among urban, suburban, exurban and rural area were 10.1%, 12.3%, 3.8%, and 1%, respectively, and it was significant when compared to the proportion of ametropia and corrected refractive error across residential densities (P=0.003). The risk of URE development in urban, suburban, exurban, and rural were 2.218 (95%CI: 0.914-5.385), 3.019 (95%CI: 1.266-7.197), 0.502 (95%CI: 0.195-1.293), and 0.130 (95%CI:0.017-0.972), respectively. Urban school children showed the worst visual acuity. The school children in urban and suburban residential area had 2 and 3 times higher risk of developing the URE.

Profile of paediatric low vision population: a retrospective study from Nepal

BACKGROUND

Childhood blindness and low vision have become major public health problems in developing countries. The purpose of this study was to categorise the causes of visual impairment according to aetiology and provide detailed local information on visually impaired children seeking low-vision services in a tertiary eye centre in Nepal.

METHODS

A retrospective study was conducted of all visually impaired children (visual acuity of less than 6/18 in the better eye), aged less than 17 years seen in the low-vision clinic at the Sagarmatha Chaudhary Eye Hospital in Lahan between January 1, 2012 and December 31, 2013.

RESULTS

Of the 558 visually impaired children, the majority were males, 356 (63.7 per cent). More than half (56.5 per cent) of the children were in the 11 to 16 years age group. Many of the low-vision children (52.9 per cent) were identified as having moderate visual impairment (visual acuity less than 6/18 to 6/60). Most children were diagnosed with childhood (36.2 per cent) or genetic (35.5 per cent) aetiology, followed by prenatal (22.2 per cent) and perinatal (6.1 per cent) aetiologies. Refractive error and amblyopia (20.1 per cent), retinitis pigmentosa (14.9 per cent) and macular dystrophy (13.4 per cent) were the most common causes of paediatric visual impairment. Nystagmus (50.0 per cent) was the most common cause of low vision in the one to five years age group, whereas refractive error and amblyopia were the major causes in the six to 10 and 11 to 16 years age group (17.6 and 22.9 per cent, respectively). Many of the children (86.0 per cent) were prescribed low-vision aids and 72.0 per cent of the low-vision aid users showed an improvement in visual acuity either at distance or near.

CONCLUSION

Paediatric low vision has a negative impact on the quality of life in children. Data from this study indicate that knowledge about the local characteristics and aetiological categorisation of the causes of low vision are essential in tackling paediatric visual impairment. The findings also signify the importance of early intervention to ensure a better quality of life.

Establishing a surgical outreach program in the developing world: pediatric strabismus surgery in Guatemala City, Guatemala

PURPOSE

To report our experince in establishing a sustainable pediatric surgical outreach mission to an underserved population in Guatemala for treatment of strabismic disorders.

METHODS

A pediatric ophthalmic surgical outreach mission was established. Children were evaluated for surgical intervention by 3 pediatric ophthalmologists and 2 orthoptists. Surgical care was provided at the Moore Pediatric Surgery Center, Guatemala City, over 4 days. Postoperative care was facilitated by Guatemalan physicians during the second year.

RESULTS

In year 1, patients 1-17 years of age were referred by local healthcare providers. In year 2, more than 60% of patients were prescreened by a local pediatric ophthalmologist. We screened 47% more patients in year 2 (132 vs 90). Diagnoses included congenital and acquired esotropia, consecutive and acquired exotropia, congenital nystagmus, Duane syndrome, Brown syndrome, cranial nerve palsy, dissociated vertical deviation, and oblique muscle dysfunction. Overall, 42% of the patients who were screened underwent surgery. We performed 21 more surgeries in our second year (58 vs 37), a 57% increase. There were no significant intra- or postoperative complications.

CONCLUSIONS

Surgical outreach programs for children with strabismic disorders in the developing world can be established through international cooperation, a multidisciplinary team of healthcare providers, and medical equipment allocations. Coordinating care with local pediatric ophthalmologists and medical directors facilitates best practice management for sustainability.

Hypoxia-induced retinal neovascularization in zebrafish embryos: a potential model of retinopathy of prematurity

Retinopathy of prematurity, formerly known as a retrolental fibroplasia, is a leading cause of infantile blindness worldwide. Retinopathy of prematurity is caused by the failure of central retinal vessels to reach the retinal periphery, creating a nonperfused peripheral retina, resulting in retinal hypoxia, neovascularization, vitreous hemorrhage, vitreoretinal fibrosis, and loss of vision. We established a potential retinopathy of prematurity model by using a green fluorescent vascular endothelium zebrafish transgenic line treated with cobalt chloride (a hypoxia-inducing agent), followed by GS4012 (a vascular endothelial growth factor inducer) at 24 hours postfertilization, and observed that the number of vascular branches and sprouts significantly increased in the central retinal vascular trunks 2-4 days after treatment. We created an angiography method by using tetramethylrhodamine dextran, which exhibited severe vascular leakage through the vessel wall into the surrounding retinal tissues. The quantification of mRNA extracted from the heads of the larvae by using real-time quantitative polymerase chain reaction revealed a twofold increase in vegfaa and vegfr2 expression compared with the control group, indicating increased vascular endothelial growth factor signaling in the hypoxic condition. In addition, we demonstrated that the hypoxic insult could be effectively rescued by several antivascular endothelial growth factor agents such as SU5416, bevacizumab, and ranibizumab. In conclusion, we provide a simple, highly reproducible, and clinically relevant retinopathy of prematurity model based on zebrafish embryos; this model may serve as a useful platform for clarifying the mechanisms of human retinopathy of prematurity and its progression.

Pediatric cataract surgery in National Eye Centre Kaduna, Nigeria: outcome and challenges

PURPOSE

To assess the outcomes of congenital/developmental cataract from a tertiary eye care hospital in Northwest Nigeria.

MATERIALS AND METHODS

A retrospective chart review was performed of all patients diagnosed with congenital or developmental cataract who underwent surgery from January 2008 to December 2009. Data were collected on patient demographics, preoperative characteristics, intraoperative complications, and postoperative outcomes as well as complications.

RESULTS

A total of 181 eyes of 102 patients underwent surgery. There were 95 (52.5%) right eyes. There were 64 (62.7%) males. The mean age of the patients was 6.88 ± 7.97 years. Fifty-four (51.3%) patients were below 3 years old. Most (62%) patients had congenital cataract with a history of onset within the first year of life [39 (62.9%) patients]. Amblyopia, nystagmus, and strabismus were the most frequent ocular comorbidities accounting for 50.3%, 36.5%, and 35.4% of eyes respectively. The majority (84.3%) of the patients had surgery within 6 months of presentation. All patients underwent manual small incision cataract surgery (MSICS). Seventy-nine (77.5%) patients underwent simultaneous bilateral surgery. Intraocular lens implantation was performed in 83.4% eyes. The most common early and late postoperative complication was, posterior capsular opacity which occurred in 65 eyes of 43 children. In these cases, moderate visual acuity was predominant visual outcome.

CONCLUSION

Treatment of pediatric cataract in our setting is complicated by demographic factors which results in late presentation and consequently, late treatment of children. Short-term visual outcome is fair. Data on long term postoperative outcomes could not be acquired due to poor follow-up.

A comparative analysis of avoidable causes of childhood blindness in Malaysia with low income, middle income and high income countries

To determine the avoidable causes of childhood blindness in Malaysia and to compare this to other middle income countries, low income countries and high income countries. Data were obtained from a school of the blind study by Patel et al. and analysed for avoidable causes of childhood blindness. Six other studies with previously published data on childhood blindness in Bangladesh, Ethiopia, Nigeria, Indonesia, China and the United Kingdom were reviewed for avoidable causes. Comparisons of data and limitations of the studies are described. Prevalence of avoidable causes of childhood blindness in Malaysia is 50.5 % of all the cases of childhood blindness, whilst in the poor income countries such as Bangladesh, Ethiopia, Nigeria and Indonesia, the prevalence was in excess of 60 %. China had a low prevalence, but this is largely due to the fact that most schools were urban, and thus did not represent the situation of the country. High income countries had the lowest prevalence of avoidable childhood blindness. In middle income countries, such as Malaysia, cataract and retinopathy of prematurity are the main causes of avoidable childhood blindness. Low income countries continue to struggle with infections such as measles and nutritional deficiencies, such as vitamin A, both of which are the main contributors to childhood blindness. In high income countries, such as the United Kingdom, these problems are almost non-existent.

Causes of severe visual impairment and blindness in children in the Republic of Suriname

Aims

To determine the causes of severe visual impairment and blindness (SVI/BL) in children in Suriname (Dutch Guyana) and to identify preventable and treatable causes.

Methods

4643 children under 16 years of age were recruited from two locations: 33 children attending the only school for the blind were examined and 4610 medical records were analysed at an eye clinic. Data have been collected using the WHO Prevention of Blindness Programme eye examination record for children.

Results

65 children were identified with SVI/BL, 58.5% were blind and 41.5% were severely visually impaired (SVI). The major anatomical site of SVI/BL was the retina in 33.8%, lens in 15.4% and normal appearing globe in 15.4%. The major underlying aetiology of SVI/BL was undetermined in 56.9% (mainly cataract and abnormality since birth) and perinatal factors 21.5% (mainly retinopathy of prematurity (ROP)). Avoidable causes of SVI/BL accounted for 40% of cases; 7.7% were preventable and 32.3% were treatable with cataracts and ROP the most common causes (15.4% and 12.3%, respectively).

Conclusions

More than a third of the SVI/BL causes are potentially avoidable, with childhood cataract and ROP the leading causes. Corneal scarring from vitamin A deficiency does not seem to be a continuing issue in Suriname.

An overview of a UK paediatric visual impaired population and low vision aid provision

A retrospective study was carried out to evaluate the paediatric visual impaired population attending the Low Vision Clinic at Sheffield Teaching Hospitals NHS Foundation Trust, over a period of 14 years. Data were collected and analysed for children less than 17 years for prevalence, demographics, registration status, aetiologies, and types of low vision aids issued. The total number of children identified was 204. Of these, 19 percent of the children were registered blind, 45 percent were registered partially sighted, and 36 percent were not registered. The four diagnostic groups were genetic (29%), prenatal (36%), perinatal (23%), and childhood (12%). Describing local characteristics of paediatric visual impairment is a useful measure of current low vision service provision. This information can further inform educational, social, and health needs for the visually impaired children to ensure adequate service provision.

A survey of visual impairment and blindness in children attending four schools for the blind in Cambodia

PURPOSE

To identify the causes of blindness and severe visual impairment (BL/SVI) in children attending four schools for the blind in Cambodia and to provide spectacles, low vision aids, orientation and mobility training and ophthalmic treatment.

METHODS

Children < 16 years of age were recruited from all 4 schools for the blind in Cambodia. Causes of visual impairment and blindness were determined and categorized using World Health Organization methods.

RESULTS

Of the 95 children examined, 54.7% were blind (BL) and 10.5% were severely visually impaired (SVI). The major anatomical site of BL/SVI was the lens in 27.4%, cornea in 25.8%, retina in 21% and whole globe in 17.7%. The major underlying etiologies of BL/SVI were hereditary factors (mainly cataract and retinal dystrophies) in 45.2%, undetermined/unknown (mainly microphthalmia and anterior segment dysgenesis) in 38.7% and childhood factors in 11.3%. Avoidable causes of BL/SVI accounted for 50% of the cases; 12.9% of the total were preventable with measles being the commonest cause (8.1% of the total); 37.1% were treatable with cataracts and glaucoma being the commonest causes (22.6% and 4.8% respectively). More than 35% of children required an optical device and 27.4% had potential for visual improvement with intervention.

CONCLUSION

Half of the BL/SVI causes were potentially avoidable. The data support the need for increased coverage of measles immunization. There is also a need to develop specialized pediatric ophthalmic services for the management of surgically remediable conditions, to provide optometric, low vision and orientation and mobility services. Genetic risk counseling services also may be considered.

Incidence of retinopathy of prematurity in a neonatal intensive care unit in Nepal

PURPOSE

To determine the incidence of retinopathy of prematurity (ROP) in low birth weight premature infants admitted to the neonatal intensive care unit of a children's hospital in Kathmandu.

METHODS

A hospital-based prospective study was performed in neonates with a gestational age of less than 36 weeks or birth weight of less than 2,000 g during 1 year. Ophthalmologic examination was performed 2 to 4 weeks after birth and patients were observed until the retinal vascularization was complete. ROP was classified using the revised International Classification of Retinopathy of Prematurity.

RESULTS

A total of 78 infants fulfilled the screening criteria. ROP was detected in 29.5% (n = 23) of neonates. Thirteen infants (16.7%) had stage 1 disease and 5 each (6.4%) were found to have stage 2 and stage 3 ROP. Threshold disease was present in 3.8% (n = 3) of infants with a gestational age of less than 32 weeks and birth weight less than 1,500 g who required laser treatment per Early Treatment of ROP criteria. Low birth weight (P < .01) and low gestational age (P < .01) were significantly associated with the incidence of ROP.

CONCLUSION

Prematurity and low birth weight were found to be major risk factors for ROP. ROP screening should be performed in such infants for early detection because its incidence is likely to increase as more premature infants survive with improved neonatal care.

Cost of pediatric cataract surgery in Maharashtra, India

AIM

To calculate the direct cost of pediatric cataract surgery, from the provider's perspective.

METHODS

The direct cost was calculated using standard costing methods in a pediatric ophthalmology department of a comprehensive community eye care center in western India. Fixed costs included those of the building, interior decoration, out patient department's equipment, operation theater equipment, personnel, administration and hospital maintenance. The consumable costs included materials used during surgery. Only direct costs were considered.

RESULTS

The average direct costs were Indian rupees (Rs.) 69 ($1.77) for an outpatient department consultation, Rs.606 ($15.53) for operation theater equipment use, and Rs. 2 427($62.23) for personnel. The consumable costs ranged from Rs.1 452 ($37.23) to 15 267 ($391.46), depending on the protocol used. The net average cost of pediatric cataract surgery ranged from Rs. 4 722 ($122) to Rs. 18 537 ($475) per eye.

CONCLUSION

Cataract surgery is cost intensive for children with cataract. Pediatric ophthalmologists should decide about most cost effective standards of care to rationalize consumable cost.

National Registry for the Blind in Israel: Estimation of prevalence and incidence rates and causes of blindness

OBJECTIVE

To describe the population registered as blind in Israel and estimate the prevalence and incidence of blindness, by age, sex and the causes of blindness.

METHODS

Israel has maintained a Registry for the Blind since 1987. Patients are identified by ophthalmologists and registered if they have a visual acuity of < or = 0.05 (20/400) or a visual field of < 20 degrees radius in their better eye. The Registry consists of all eligible citizens living in Israel at the time of registration. This report includes prevalence data on 18,891 persons enrolled in the Registry from 1987-1999 and still alive and living in Israel in 1999, and incidence data on 2,511 persons newly registered in 1999. Data were collected on visual acuity and visual field loss, cause of blindness, and patient demographics.

RESULTS

In 1999, the estimated prevalence rate of blindness nationwide was 0.31% and the estimated incidence rate was 0.037%. The major causes of blindness in the complete Registry were age related macular degeneration (AMD) and glaucoma (14%), followed by diabetic retinopathy (11%), cataract and myopic maculopathy (10%), and optic atrophy (8.4%). The leading causes of newly diagnosed blindness were age-related macular degeneration (AMD) (20%), glaucoma (14%), diabetic retinopathy (12%), myopic maculopathy (11%), and optic atrophy and cataract (10%).

CONCLUSIONS

Israel has one of the few nationwide blindness registries in the world. The prevalence and incidence of blindness in Israel appear to be comparable to other western countries. Comparisons are difficult because of different definitions of blindness, age distributions, and the uniqueness of the Israeli Registry.

Visual impairment secondary to congenital glaucoma in children: visual responses, optical correction and use of low vision AIDS

INTRODUCTION

Congenital glaucoma is frequently associated with visual impairment due to optic nerve damage, corneal opacities, cataracts and amblyopia. Poor vision in childhood is related to global developmental problems, and referral to vision habilitation/rehabilitation services should be without delay to promote efficient management of the impaired vision.

OBJECTIVE

To analyze data concerning visual response, the use of optical correction and prescribed low vision aids in a population of children with congenital glaucoma.

METHOD

The authors analyzed data from 100 children with congenital glaucoma to assess best corrected visual acuity, prescribed optical correction and low vision aids.

RESULTS

Fifty-five percent of the sample were male, 43% female. The mean age was 6.3 years. Two percent presented normal visual acuity levels, 29% mild visual impairment, 28% moderate visual impairment, 15% severe visual impairment, 11% profound visual impairment, and 15% near blindness. Sixty-eight percent received optical correction for refractive errors. Optical low vision aids were adopted for distance vision in 34% of the patients and for near vision in 6%. A manual monocular telescopic system with 2.8 x magnification was the most frequently prescribed low vision aid for distance, and for near vision a +38 diopter illuminated stand magnifier was most frequently prescribed.

DISCUSSION AND CONCLUSION

Careful low vision assessment and the appropriate prescription of optical corrections and low vision aids are mandatory in children with congenital glaucoma, since this will assist their global development, improving efficiency in daily life activities and promoting social and educational inclusion.

Keratitis in children as seen in a tertiary hospital in Africa

BACKGROUND

Blindness studies have shown that keratitis complicated by the use of traditional eye medications is a major factor of childhood blindness in developing countries. Most cases of such keratitis were presumably due to nutritional causes or bacterial infection. The patterns of outcome that are seen in hospitals may be different.

OBJECTIVE

To determine the clinical types of keratitis seen in children at a tertiary hospital and compare with other reports.

METHOD

A retrospective analysis was conducted using the records of children who presented with keratitis to the eye unit of the University College Hospital, Ibadan, Nigeria, over a three-year period from January 2003 to December 2005. Information obtained were the demographic data, the etiological type of keratitis and visual outcome of management.

RESULT

Ninety-five patients with keratitis seen during this three-year period were children. Of these, 47 (49.5%) patients had presumed herpes simplex keratitis; 78.9% of children with herpes simplex keratitis presented with combined epithelial and stromal disease; 21 (22.1%) had keratitis that was associated with a recent measles infection and protein calorie malnutrition. Fifteen (15.8%) had keratitis associated with phlyctenular keratoconjunctivitis, eight (8.4%) patients had bacterial/fungal keratitis, while four (4.2%) had vernal ulcers. Both the right and left eyes were affected in 47.6% and 52.4% of cases, respectively. Bilateral keratitis occurred in eight of the children with measles, and six patients with herpes simplex keratitis. Fifty-nine eyes had visual acuity recorded after the keratitis healed. Of these, the visual outcome was very poor in six (20.0%) eyes with herpes simplex keratitis and eight (100%) eyes with bacterial/fungal keratitis. All eyes with suppurative keratitis associated with measles developed dense corneal scars or were perforated.

CONCLUSION

Herpes simplex keratitis was the leading cause of keratitis in children seen at this tertiary hospital, and clinical presentations do not differ from those reported in other populations. Very poor visual outcome was associated with all types of keratitis except those with herpes keratitis. Blindness studies may underrepresent the burden of herpes simplex keratitis in the location of this study.

Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project

PURPOSE

To determine the feasibility in a middle-level human development country of onsite training, image collection, Internet transfer, and remote grading of digital retinal images from babies screened for retinopathy of prematurity (ROP).

METHODS

Two experienced nurses in a neonatal nursery in Lima, Peru, were trained to take posterior pole (30 degrees ) digital retinal images. Nurses obtained posterior pole retinal images from babies undergoing routine ROP screening and selected images for uploading via Internet for remote evaluation by five masked ROP experts. Results of gradings were compared with same-day clinical diagnostic examinations by an experienced ophthalmologist. Success rates for image acquisition and transfer for grading by expert readers were calculated.

RESULTS

Serial image sets from 26 of the 28 babies enrolled in this study were obtained; two babies were too unstable for imaging. Fifty-six of 58 (96.6%) imaging sessions were successful in obtaining retinal images. Three hundred thirty of 336 (98.2%) images obtained were successfully uploaded to an interactive database. Remote graders judged 93.6% to 97.3% of image sets suitable for ROP grading. Preliminary results indicate sensitivities for detection of serious ROP from 45.5% to 95.2% among individual readers, with specificities of 61.7% to 96.2% when images were gradable.

CONCLUSIONS

A telemedicine approach for ROP screening using digital retinal images obtained by nonophthalmologists is feasible in rapidly developing countries that lack ROP-trained ophthalmologists. If remote grading of digital images is validated as an effective method for identifying referral-warranted ROP (RW-ROP), images obtained by nonphysicians may provide a means of identifying babies who require a diagnostic examination by an ophthalmologist.

Causes and temporal trends of childhood blindness in Indonesia: study at schools for the blind in Java

AIMS

To ascertain the causes of blindness and severe visual impairment (BL/SVI) in schools for the blind in Java, to identify preventable and treatable causes and to evaluate temporal trends in the major causes.

METHODS

From a total of 504 students, 479 were examined. Data was collected using a modified World Heath Organization Prevention of Blindness (WHO/PBL) eye examination record for children.

RESULTS

The majority of the students (95%) were blind and 4.6% were severely visually impaired. The major anatomical site of BL/SVI was whole globe in 35.9%, retina in 18.9%, lens in 16.4% and cornea in 16.1%. The major underlying aetiology of BL/SVI was undetermined/unknown in 32.7% (mainly microphthalmia, anterior segment dysgenesis and cataract), hereditary factors 31.9% (mainly retinal dystrophies), and childhood disorders 28.5%. Avoidable causes of BL/SVI accounted for 59.9% of the total students, whereas measles blindness was the underlying condition for 23.1% of the preventable causes; cataract and glaucoma accounted for 15.5% and 8.2% of the treatable causes, respectively. Exploration on trends of SVI/BL among two different age groups <16 years and > or = 16 years suggested that childhood disorders and corneal factors have declined, while hereditary disorders have increased. Optic nerve disorder, although not counted as a major cause of blindness, seems to be on the increase.

CONCLUSIONS

More than half of the BL/SVI causes are potentially avoidable. Cataract and corneal disorders related to measles or vitamin A deficiency were the major treatable and preventable causes. Declining proportions of childhood factors and corneal disorders over a period of 10-20 years could reflect improved vitamin A supplementation and measles vaccination coverage in Indonesia. This finding, and the increased proportion of hereditary disease causes, could suggest improving levels of socioeconomic development and health care services.

Incidence and risk factors for retinopathy of prematurity in very low and in extremely low birth weight infants in a unit-based approach in southern Brazil

AIMS

To analyse the incidence and risk factors for retinopathy of prematurity (ROP) and survival rates among extremely low birth weight (ELBW) and very low birth weight (VLBW) preterm infants.

METHODS

A prospective cohort study of 352 infants admitted at a teaching hospital, Hospital de Clinicas de Porto Alegre, Brazil, between October 2002 and December 2006, was screened for ROP. The ELBW group comprised infants whose birth weight (BW) was < or = 1000 g and the VLBW group comprised those infants whose BW were > 1000 g and < or = 1500 g. Perinatal risk factors for ROP were assessed using univariate and multivariate analysis.

RESULTS

Of the 352 neonates screened, 88 were ELBW babies. Survival rates among ELBW and VLBW were 47.8 and 88.7%, respectively. ROP affected 48.9% of ELBW infants and 18.2% of VLBW babies. Threshold disease occurred in 21 patients, 15 of whom were born weighing < 1000 g. Only 2.3% of the neonates born with more than 1000 g developed treatable disease. Univariate analysis showed that gestational age (GA), BW, use of indomethacin and erythropoietin, blood transfusions, and intraventricular haemorrhage were associated with ROP. After logistic regression, the most important adjusted risk factors were BW (OR: 1.002;95% CI: 1.001-1.003; P=0.003), GA (OR: 1.254;95% CI: 1.082-1.455; P=0.003), and use of erythropoietin (OR: 2.486;95% CI: 1.182-5.231; P=0.016).

CONCLUSION

This study showed reduced survival rates, high incidence of ROP, and a greater need of treatment among ELBW infants as compared to VLBW babies admitted in this institution.

Causes of visual impairment in children: a study of 3,210 cases

PURPOSE

To determine causes of visual impairment in children at the Low Vision Service of the Ophthalmic Clinic at the University of São Paulo and at the Brazilian Association for the Visually Impaired People (Laramara), located in São Paulo, Brazil.

PATIENTS AND METHODS

This study evaluated 3,210 visually impaired children (49% female, 51% male; average age, 5.9 years). Visual impairment was present in 57% (visually impaired group) and 43% presented another associated disability (multiple disability group).

RESULTS

The main causes of visual impairment in the visually impaired group were toxoplasmic macular retinochoroiditis (20.7%), retinal dystrophies (12.2%), retinopathy of prematurity (11.8%), ocular malformation (11.6%), congenital glaucoma (10.8%), optic atrophy (9.7%), and congenital cataracts (7.1%). The main causes of visual impairment in the multiple disability group were optic atrophy (37.7%), cortical visual impairment (19.7%), toxoplasmic macular retinochoroiditis (8.6%), retinopathy of prematurity (7.6%), ocular malformation (6.8%), congenital cataracts (6.1%), and degenerative disorders of the retina and macula (4.8%). The retina was the most frequently affected anatomic site in the visually impaired group (49.2%) and the optic nerve in the multiple disability group (39%).

CONCLUSION

Primary, secondary, and tertiary prevention efforts for childhood blindness and visual rehabilitation must be considered in Latin America.

Investigação do reflexo vermelho em recém-nascidos e sua relação com fatores da história neonatal

O teste do reflexo vermelho é parte importante do exame ocular do recém-nascido. Buscou-se investigá-lo em recém-nascidos prematuros (RNPT) e sua relação com fatores da história neonatal. Estudo descritivo, exploratório, quantitativo, realizado numa maternidade pública, em Fortaleza-CE, em março, abril e maio de 2004, com 114 RNPTs. Para o registro dos dados, utilizou-se um formulário próprio e para a realização do exame, um oftal-moscópio direto. Considerou-se pertinente os seguintes achados da história neonatal: 68% dos RNPTs obtiveram Apgar inferior a sete no primeiro minuto; 112 utilizaram oxigenoterapia e 68, fototerapia. Quanto ao reflexo vermelho, 13 (11%) apresentaram alteração, com associação estatística significativa entre este e o Apgar no primeiro minuto de vida (p= 0,041). Os achados preocuparam, pois, dez dos 13 RNPTs, com alteração no reflexo vermelho, tinham retinopatia da prematuridade.

Changes in refraction and ocular dimensions after cataract surgery and primary intraocular lens implantation in infants

PURPOSE

To study refraction and axial length changes after cataract extraction and primary intraocular lens (IOL) implantation in children younger than 1 year of age.

SETTING

Two regional hospitals.

METHODS

After determining the IOL power for emmetropia, 80% of the value was used to choose the IOL for implantation to counter anticipated myopic shift with age. The main outcome measures were changes in refraction and axial length 3 years after surgery.

RESULTS

Thirty-four eyes of 20 children (mean age 6.7 months +/- 3.9 [SD]) were studied. Refraction in the immediate postoperative period was +4.53 +/- 1.45 diopters (D). Three years after surgery, the mean refraction was -2.49 +/- 3.08 D (P<.001). Twenty-two eyes (64.7%) had surgery during the first 6 months of life (group 1) and had a shorter axial length at surgery (mean 18.92 +/- 1.32 mm) compared with 12 eyes (35.3%) that received surgery between 7 and 12 months (group 2, mean 20.29 +/- 1.00 mm) (P = .007). However, the final axial length was greater in group 1 (mean 22.67 +/- 1.04 mm) than in group 2 (mean 21.23 +/- 0.26 mm) (P = .019).

CONCLUSIONS

Primary IOL implantation is an option for children having cataract surgery in the first year of life. Significant myopic shifts occurred, and this seemed to be more pronounced in younger children. It appears that rethinking current strategies for IOL power calculation may be required to achieve more optimal refractive outcomes.

Updates on the Surgical Management of Paediatric Cataract with Primary Intraocular Lens Implantation

With the advent of modern surgical techniques, paediatric cataract has become much more manageable. Intraocular lens (IOL) implantation is the standard of care for patients over the age of 2 years. The use of IOL in young infants is still controversial. In addition, there are still unresolved issues, such as the minimum age at which IOL can be safely implanted, IOL power selection and IOL power calculation. The current trends in the management of the above challenges are discussed. Although numerous reports on the prevention and management of posterior capsule opacification have been published, there are ongoing intensive debates and research. Long-term postoperative complications like glaucoma and rhegmatogenous retinal detachment are problems that cannot be overemphasised and these issues are also reviewed. Key words: Congenital cataract, Intraocular lens, Posterior capsule opacification

Pediatric and adolescent population with visual impairment: study of 385 cases

OBJECTIVE

To analyze data on the pediatric population attending the Ophthalmologic Clinic's Low Vision Service at the São Paulo University Medical School.

METHODS

Low vision ophthalmologic assessment, from April 1998 to December 2003, of 385 children and adolescents with mean age of 7 years; 51.7% males and 48.3% females. The main data analyzed were age, diagnosis, anatomic site of the ocular injury, visual acuity, and prescription of optical aids.

RESULTS

45.4% were below 6 years, and 54.6% were between 6 and 16 years. 35.5% experienced moderate visual impairment, 26% had severe visual impairment, 8.6% had profound visual impairment, 10.6% were near blind, and 1.6% were blind. The main causes of visual impairment included congenital glaucoma (30.6%), macular retinochoroiditis due to congenital toxoplasmosis (16.7%), congenital cataract (12.8%), retinal and macular inherited disorders (11.7%), and optic atrophy (9.8%). Among school-age children, 52.9% received a prescription of optical aids. The most widely used optical aids for distance were 2.8 X 26 (34.4%); 4.2 X 12 (30.3%); and 6 X 17 (26.8%) telescopic systems. The most frequently prescribed optical aid for near vision was the 2x magnifying bar (33.3%).

CONCLUSIONS

There is a need for prevention of primary (congenital infections), secondary (congenital glaucoma and retinopathy of prematurity), and tertiary (congenital cataract) visual impairment. The prescription of optical aids for school-age children will help them perform better at school and contribute to their social inclusion.

25-Gauge transconjunctival sutureless vitrectomy system in the surgical management of children with posterior capsular opacification

PURPOSE

To evaluate the safety and efficacy of the 25-gauge transconjunctival sutureless vitrectomy (TSV) system in the surgical management of posterior capsular opacification (PCO) in pseudophakic children.

METHODS

Pars plana membranectomy was performed for PCO in 10 pseudophakic eyes of six children (mean age 35.1 +/- 37.8 months; range 6-93 months) using the TSV system. Surgical technique, intraoperative problems and postoperative complications including wound leakage, hypotony and the need for suturing were recorded.

RESULTS

Wound leakage and other intraoperative problems were not noted in any of the eyes. All eyes showed improvement of visual acuity from a mean of 6/67 before to 6/29 after surgery (P = 0.001). Mean postoperative intraocular pressure (IOP) was 7.8 +/- 3.1 mmHg (range: 3-10 mmHg). Four eyes (40%) had hypotony on the first postoperative day (IOP: 3-5 mmHg), which was transient in three eyes. One eye in a patient with uveitis had persistent hypotony, but hypotony was also present preoperatively, and the postoperative IOP returned to preoperative levels. This eye also developed recurrent PCO and a second capsulotomy was performed using the 25-gauge TSV system.

CONCLUSIONS

Posterior capsulotomy using the 25-gauge TSV system appears to be a safe and effective approach in the management of PCO in pseudophakic children. Advantages include easier manipulation with the smaller instruments in these small eyes, and it can be considered in appropriate cases.

Retrospective Analysis of Refractive Errors in Children With Vision Impairment

PURPOSE

Emmetropization is the reduction in neonatal refractive errors that occurs after birth. Ocular disease may affect this process. We aimed to determine the relative frequency of ocular conditions causing vision impairment in the pediatric population and characterize the refractive anomalies present. We also compared the causes of vision impairment in children today to those between 1974 and 1981.

METHODS

Causes of vision impairment and refractive data of 872 children attending a pediatric low-vision clinic from 1985 to 2002 were retrospectively collated. As a result of associated impairments, refractive data were not available for 59 children. An analysis was made of the causes of vision impairment, the distribution of refractive errors in children with vision impairment, and the average type of refractive error for the most commonly seen conditions.

RESULTS

We found that cortical or cerebral vision impairment (CVI) was the most common condition causing vision impairment, accounting for 27.6% of cases. This was followed by albinism (10.6%), retinopathy of prematurity (ROP; 7.0%), optic atrophy (6.2%), and optic nerve hypoplasia (5.3%). Vision impairment was associated with ametropia; fewer than 25% of the children had refractive errors < or = +/-1 D. The refractive error frequency plots (for 0 to 2-, 6 to 8-, and 12 to 14-year age bands) had a Gaussian distribution indicating that the emmetropization process was abnormal. The mean spherical equivalent refractive error of the children (n = 813) was +0.78 +/- 6.00 D with 0.94 +/- 1.24 D of astigmatism and 0.92 +/- 2.15 D of anisometropia. Most conditions causing vision impairment such as albinism were associated with low amounts of hyperopia. Moderate myopia was observed in children with ROP.

CONCLUSIONS

The relative frequency of ocular conditions causing vision impairment in children has changed since the 1970s. Children with vision impairment often have an associated ametropia suggesting that the emmetropization system is also impaired.

Visual impairment in children born at full term from 1972 through 1989 in Finland

OBJECTIVE

To investigate the incidence, prevalence, and causes of visual impairment in children born at full term and to determine conditions and factors associated with visual impairment.

DESIGN

Retrospective, cross-sectional, population-based study.

PARTICIPANTS

All visually impaired individuals from 0 to 17 years of age who were born at full term from 1972 through 1989 in Finland and recorded in the Finnish Register of Visual Impairment (n = 556) were eligible for this study.

METHODS

Data in the Finnish Register of Visual Impairment relating to 556 subjects were supplemented with data from hospital records and other national registers (Register of Births, Register of Congenital Malformations, Finnish Care Register, and Finnish Cancer Register). Data relating to the children born at full term were compared with Finnish perinatal and vital statistics and with data concerning children born prematurely. The chi-square test (Mantel-Haenszel) and stepwise logistic regression analysis were used in statistical analysis of the data.

MAIN OUTCOME MEASURES

Visual acuity, time of onset of visual impairment, ophthalmic diagnosis of visual impairment, systemic disease, multiple handicap, 5-minute Apgar score, prenatal disorders, perinatal disorders, disorders arising during infancy and childhood, and treatment.

RESULTS

Four hundred thirty-one of the 556 individuals with visual impairment (78%) had been born at full term. Visual impairment was predominantly associated with genetic (53%) and prenatal (34%) factors. Ocular malformations (34%), retinal diseases (31%), and neuro-ophthalmologic disorders (26%) were the main ophthalmic diagnoses. Optic nerve atrophy (20%) and congenital cataract (13%) were the most common single diagnoses. The occurrence of blindness, systemic disease, and multiple handicap was 40%, 43%, and 45%, respectively.

CONCLUSIONS

The incidence of visual impairment in children born at full term did not decline during the 2 decades covered by this study. The findings reflected the lack of treatment for genetic eye diseases. The results also confirmed an obvious need for further understanding of mechanisms underlying congenital anomalies of the human visual system.

Causes of blindness at the "Wiyata Guna" School for the Blind, Indonesia

AIM

To determine the anatomical site and patterns of cause of blindness in one of the biggest schools for the blind in Indonesia with a view to determining potentially preventable and treatable causes.

METHODS

165 students in one school for the blind in Bandung, Indonesia, were examined clinically and data reported using the WHO/PBL childhood blindness assessment form.

RESULTS

Most of the students (96.4%) were blind (BL); 3% were severely visually impaired (SVI). The major causes of SVI/BL in this study were: (1) corneal staphyloma, corneal scar, and phthisis bulbi (mainly attributed to infection) in 29.7%; (2) retinal dystrophies (mainly Leber congenital amaurosis, early onset retinitis pigmentosa) in 20.6%; (3) congenital and familial cataract (13.3%); (4) microphthalmus, anophthalmus (10.9%). The whole globe was the major anatomical site of visual loss (32.7%), followed by the retina (26.0%), cornea (17.6%), lens (13.3%), optic nerve (6.1%), and uvea (4.3%).

CONCLUSIONS

This is a small study in a selected population and the results should be interpreted with caution. This blind school study, adopting the WHO/PBL eye form for data analysing, is the first reported for Indonesia. Hereditary disease and infective causes of blindness are the predominant causes of blindness, accounting for 42.4% and 29.7%, respectively. This pattern of causes is a mixed pattern which lies in an intermediate position between the patterns seen in developing countries and those seen in developed countries. The importance both of preventive public health strategies and of specialist paediatric ophthalmic and optical services in the management of childhood blindness in Indonesia are therefore strongly suggested to cover the problems that exist.

Primary open-angle glaucoma in blacks: a review

Glaucoma is one of the leading causes of blindness worldwide. Primary open-angle glaucoma (POAG) is the most prevalent form of glaucoma and has a particularly devastating impact in blacks. In the black American population, POAG prevalence is estimated to be six times as high in certain age groups compared to whites. POAG is more likely to result in irreversible blindness, appears approximately 10 years earlier and progresses more rapidly in blacks than in whites. Racial differences in optic disk parameters have been reported and show that blacks have larger optic disks than whites. This finding is robust and may account for the reported differences in other optic disk parameters. The existence of racial differences in intraocular pressure remains to be demonstrated, as conflicting findings are reported in the literature. Intraocular pressure may actually be underestimated in blacks, perhaps because they have thinner corneas. The prevalence of diabetes and hypertension is higher in blacks than in whites, and although no causal relationship has been established between POAG and each of these systemic diseases, some reports suggest that they often occur together, perhaps through an indirect relationship with intraocular pressure. Compounding the problem, there is evidence that blacks are less responsive to both drug and surgical treatment for POAG. Finally, they often have reduced accessibility to treatment and are less aware of the risks of having POAG. This article provides a comprehensive review of the current knowledge pertaining to POAG in blacks.

Paediatric cataract blindness in the developing world: surgical techniques and intraocular lenses in the new millennium

Paediatric cataract blindness presents an enormous problem to developing countries in terms of human morbidity, economic loss, and social burden. Managing cataracts in children remains a challenge: treatment is often difficult, tedious, and requires a dedicated team effort. To assure the best long term outcome for cataract blind children, appropriate paediatric surgical techniques need to be defined and adopted by ophthalmic surgeons of developing countries. The high cost of operative equipment and the uneven world distribution of ophthalmologists, paediatricians, and anaesthetists create unique challenges. This review focuses on issues related to paediatric cataract management that are appropriate and suitable for ophthalmic surgeons in the developing world. Practical guidelines and recommendations have also been provided for ophthalmic surgeons and health planners dealing with childhood cataract management in the developing world.

Measuring the burden of ocular morbidity

This hospital-based study highlights the spectrum of eye ailments in 35,273 patients who attended the Department of Ophthalmology at the B P Koirala Institute of Health Sciences, Eastern Nepal, during a 5-year period with varied clinical diagnosis. The attendance each year showed a progressive increase with a male preponderance. More than 13% of the patients were children. Cataract was the most common problem for which patients needed ophthalmic advice; diabetic and hypertensive retinopathy were frequent occurrences and infection was a common problem. Over 21% of the eyes examined had a refractive error: as high as 2.54% were amyblyopic caused by non-correction of refractive errors. Allergic conjunctivitis was frequently encountered. As shown by the magnitude of the problem, the existing eye care facilities must be enhanced and new strategies developed.