Childhood blindness and severe visual impairment in Malaysia: a nationwide study

Knowledge, attitude and practice of Ethiopian pediatricians concerning childhood eye diseases

BACKGROUND

Eye examination and vision assessment are vital for the detection of conditions that result in blindness. Childhood blindness seriously impacts the development, education, and future employment opportunities of affected children. Pediatricians' knowledge of eye diseases is critical for the prevention of blindness through early diagnosis, allowing proper treatment and identification of conditions requiring referral to an ophthalmologist to preserve or restore vision. This study aimed to assess the knowledge, attitude, and practice of Ethiopian pediatricians concerning childhood eye diseases.

METHODS

We carried out a cross-sectional descriptive study of pediatricians working in various hospitals and clinics in Ethiopia. Participants were selected via a convenient sampling technique. Data were collected using both closed and open-ended semi-structured questionnaires. Responses were entered into EpiData 3.1 and transferred to SPSS version 21.0 software for analysis.

RESULTS

A total of 79 pediatricians participated in the study. Our findings showed that the attitude of all but 2 participants towards improving the management of childhood eye diseases was positive, even though this was not reflected in actual knowledge or practice. Even though attitudes were positive, knowledge was often poor and practice inadequate owing to barriers such as inadequate undergraduate training, lack of ophthalmology options during pediatric residency, and unavailability of ophthalmic equipment.

CONCLUSIONS

Participants' attitudes towards improving treatment for childhood eye diseases are positive, but their insufficient knowledge of eye diseases makes their practice poor in this respect.

Knowledge, attitude and practice of Ethiopian pediatricians concerning childhood eye diseases

BACKGROUND

Eye examination and vision assessment are vital for the detection of conditions that result in blindness. Childhood blindness seriously impacts the development, education, and future employment opportunities of affected children. Pediatricians' knowledge of eye diseases is critical for the prevention of blindness through early diagnosis, allowing proper treatment and identification of conditions requiring referral to an ophthalmologist to preserve or restore vision. This study aimed to assess the knowledge, attitude, and practice of Ethiopian pediatricians concerning childhood eye diseases.

METHODS

We carried out a cross-sectional descriptive study of pediatricians working in various hospitals and clinics in Ethiopia. Participants were selected via a convenient sampling technique. Data were collected using both closed and open-ended semi-structured questionnaires. Responses were entered into EpiData 3.1 and transferred to SPSS version 21.0 software for analysis.

RESULTS

A total of 79 pediatricians participated in the study. Our findings showed that the attitude of all but 2 participants towards improving the management of childhood eye diseases was positive, even though this was not reflected in actual knowledge or practice. Even though attitudes were positive, knowledge was often poor and practice inadequate owing to barriers such as inadequate undergraduate training, lack of ophthalmology options during pediatric residency, and unavailability of ophthalmic equipment.

CONCLUSIONS

Participants' attitudes towards improving treatment for childhood eye diseases are positive, but their insufficient knowledge of eye diseases makes their practice poor in this respect.

Causes of severe visual impairment in infants and methods of management

OBJECTIVES

To examine the causes of severe visual impairment (SVI) in infants below the age of 2 years and to review management methods.

METHODS

The data of 2657 patients followed between January 2014 and July 2019 were reviewed, and 148 (5.6%) infants who had SVI were enrolled. Data including age, gender, affected anatomical site, diagnosis, presence of any non-ophthalmological deficiencies, and methods of management were reviewed. The diagnoses were investigated in the categories of avoidable and unavoidable basis. The methods of management were analysed from the perspective of low vision habilitation.

RESULTS

The mean age at first eye examination was 6.61 ± 5.25 months, and 84 (56.7%) infants were male. Of the 148 infants, 69 (46.6%) were premature. Cerebral visual impairment (CVI) was the most common diagnosis in both preterm (39.1%) and term (11.4%) infants. Delayed visual maturation, optic nerve pathologies, oculocutaneous albinism, and congenital cataract were the other frequent causes. The rate of multiple disabilities was 30% in the whole group and 94% in infants with CVI. Most of the babies had a normal-appearing globe (43.3%). Retina was affected in 23.7% of the infants. Avoidable causes were identified in 79.7% of the infants. The used methods of management were optic interventions, visual stimulation therapy, medical and/or surgical treatment.

CONCLUSIONS

CVI was found the most common cause of SVI in both preterm and term-born infants, and the higher rate of multiple disabilities in these infants was remarkable. Optic interventions and visual stimulation therapy were the most common methods of management.

Emerging trends in childhood blindness and ocular morbidity in India: the Pavagada Pediatric Eye Disease Study 2

AIM

To discuss the aims, methods, and results of a population-based cross-sectional prevalence survey of children ≤15 years, in South India and compare it with a study conducted earlier, in the same area. We also discuss the changing trends in the domain of childhood blindness in India.

METHODS

A population-based cross-sectional prevalence survey of children ≤15 years, in Pavagada and Madhugiri taluks of Tumkur district in Karnataka state in south India, was conducted in 2 phases. One trained medical-social-worker and one field-investigator identified eligible children and brought them to a makeshift clinic in the village school, where they were examined by an ophthalmologist. Children with minor problems were treated on the field and those with major conditions were referred to the pediatric ophthalmologist in the tertiary hospital. The prevalence of specific diseases were calculated in percentages.

RESULTS

The prevalence of childhood ocular morbidity (COM) was 6.54%. Refractive errors (2.77%) constituted the major cause of COM. The prevalence of blindness (best corrected visual acuity of <3/60 in the better eye) was 0.09%. Whole-globe anomalies (25%) and uveal coloboma (25%) constituted the main cause of blindness.

CONCLUSION

A major proportion of the blindness was due to unavoidable causes. Unlike several earlier studies, corneal blindness is no longer the main cause of blindness. This shows that there is a changing trend in the pattern of childhood blindness in India. The current data demonstrate the need for low vision rehabilitative services and a review of public health strategy in India.

Visual function of children with visual and other disabilities in Oman: A case series

Background:

We assessed the visual functioning of the children with special needs in Oman between 2009 and 2012. We present the methods of assessing different visual functions, outcomes, and interventions carried out to improve their functioning.

Methods:

Optometrists assessed visual functions of children of “Day care centres” in Oman. Experts further assessed them and provided low vision care. Ocular movements, refractive corrections, near, distance, contrast color, motion, field of vision, and cognitive visual function test results were noted. Feedback to caregivers was given to improve visual functioning of these children.

Results:

We grouped 321 participants, (196 [61.1%] boys, age range of 3–18 years) into 61; Down syndrome (DS), 72 with intellectual disabilities (IDs), 67; hearing impaired and 121 with other conditions. Refractive error and lag of accommodation were 26 (42.6%) and 14 (22.6%) among children with DS. Contrast sensitivity was impaired in 8 (12.7%) among hearing impaired children. Defective distant and near vision was in 162 (70%) and 104 (42%) of our cohort. Children with ID were most difficult to assess. Children in a group of other disabilities had a higher proportion of impaired visual functioning. They were given low vision aids (telescopes [22], filters [7], and magnifiers [3]) in large numbers compared to those in other groups.

Conclusions:

Visual functioning of children with other disabilities show great variation and difficult to group. The care, therefore, should be at individual level. All visual functions cannot be assessed at one time.

Visual function of children with visual and other disabilities in Oman: A case series

Background:

We assessed visual functioning of the children with special needs in Oman between 2009 and 2012. We present the methods of assessing different visual functions, outcomes and interventions carried out to improve their functioning.

Materials and Methods:

In this case series type of study, optometrists assessed visual functions of children of “day care centers” in Oman. Experts further assessed them and provided low vision care. Ocular movements, refractive corrections, near, distance, contrast color, motion, field of vision and cognitive, visual function test results were noted. Feedback to caregivers was given to improving visual functioning of these children.

Results:

We grouped 321 participants, (196 (61.1%) boys, age range of 3-18 years) into 61; Down syndrome (DS), 72 with intellectual disabilities, 67; hearing impaired and 121 with other conditions. Refractive error and lag of accommodation was 26 (42.6%) and 14 (22.6%) among children with DS. Contrast sensitivity was impaired in 8 (12.7%) among hearing impaired children. Defective distant and near vision was in 162 (70%) and 104 (42%) of our cohort. Children with intellectual disability were most difficult to assess. Children in group of other disabilities” had a higher proportion of impaired visual functioning. They were given low vision aids (telescopes (22), filters (7) and magnifiers (3)) in large numbers compared to those in other groups.

Conclusions:

The outcomes of assessment of visual functioning of children with other disabilities show great variation and difficult to group. The care therefore should be individual. All visual functions cannot be assessed at one time.

Causes of Severe Visual Impairment and Blindness: Comparative Data From Bhutanese and Laotian Schools for the Blind

PURPOSE

To determine and compare the major causes of childhood blindness and severe visual impairment in Bhutan and Laos.

DESIGN

Independent cross-sectional surveys.

METHODS

This survey consists of 2 cross-sectional observational studies. The Bhutanese component was undertaken at the National Institute for Vision Impairment, the only dedicated school for the blind in Bhutan. The Laotian study was conducted at the National Ophthalmology Centre and Vientiane School for the Blind. Children younger than age 16 were invited to participate. A detailed history and examination were performed consistent with the World Health Organization Prevention of Blindness Eye Examination Record.

RESULTS

Of the 53 children examined in both studies, 30 were from Bhutan and 23 were from Laos. Forty percent of Bhutanese and 87.1% of Laotian children assessed were blind, with 26.7% and 4.3%, respectively, being severely visually impaired. Congenital causes of blindness were the most common, representing 45% and 43.5% of the Bhutanese and Laotian children, respectively. Anatomically, the primary site of blinding pathology differed between the cohorts. In Bhutan, the lens comprised 25%, with whole globe at 20% and retina at 15%, but in Laos, whole globe and cornea equally contributed at 30.4%, followed by retina at 17.4%. There was an observable difference in the rates of blindness/severe visual impairment due to measles, with no cases observed in the Bhutanese children but 20.7% of the total pathologies in the Laotian children attributable to congenital measles infection.

CONCLUSIONS

Consistent with other studies, there is a high rate of blinding disease, which may be prevented, treated, or ameliorated.

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.

The gender issue in congenital and developmental cataract surgery

PURPOSE

To describe the demographic pattern of congenital cataract surgery at a referral ophthalmology center in Iran and to evaluate any possible difference between the genders.

METHODS

Subjects aged 15 years or less scheduled for cataract surgery were enrolled in this cross-sectional study. Data was retrieved from the electronic medical records according to the ICD-10 coding system. Age and proportion of operations by sex were the main parameters of interest. We employed analysis of covariance to compare age at surgery and logistic regression to obtain the trend for the number of cataract procedures in boys and girls.

RESULTS

Overall, 314 congenital cataract procedures were performed during the study period, 55 (17.5%) of which were related to second eye surgery. Operated eyes belonged to male subjects in 172 (54.8%) cases and female subjects in 142 (45.2%) cases. Mean age at operation for both first and second eyes was 3.2±3.0 years overall, and 3.1±2.9 versus 3.4±3.0 years in girls and boys, respectively (P= 0.62). Surgery was performed before one year of age in 33.2% and before 5 years in 75% of cases. Among patients undergoing second eye surgery, girls presented significantly later than boys (at 4.2±3.3 vs. 2.6±1.7 years, P= 0.012).

CONCLUSION

The rate of congenital/infantile cataract surgery in boys was almost 10% higher than girls. We observed a significant difference only regarding age at second eye surgery which comprised 17.5% of all operations. One third and two thirds of the procedures were performed under the age of one and five years, respectively.

An update on progress and the changing epidemiology of causes of childhood blindness worldwide

PURPOSE

To summarize the available data on pediatric blinding disease worldwide and to present current information on childhood blindness in the United States.

METHODS

A systematic search of world literature published since 1999 was conducted. Data also were solicited from each state school for the blind in the United States.

RESULTS

In developing countries, 7% to 31% of childhood blindness and visual impairment is avoidable, 10% to 58% is treatable, and 3% to 28% is preventable. Corneal opacification is the leading cause of blindness in Africa, but the rate has decreased significantly from 56% in 1999 to 28% in 2012. There is no national registry of the blind in the United States, and most schools for the blind do not maintain data regarding the cause of blindness in their students. From those schools that do have such information, the top three causes are cortical visual impairment, optic nerve hypoplasia, and retinopathy of prematurity, which have not changed in past 10 years.

CONCLUSIONS

There are marked regional differences in the causes of blindness in children, apparently based on socioeconomic factors that limit prevention and treatment schemes. In the United States, the 3 leading causes of childhood blindness appear to be cortical visual impairment, optic nerve hypoplasia, and retinopathy of prematurity; a national registry of the blind would allow accumulation of more complete and reliable data for accurate determination of the prevalence of each.

The trend of retinopathy of prematurity in Malaysia from 1992 to 2001 based on a nationwide blind schools study

Retinopathy of prematurity (ROP) is one of the most important causes of childhood blindness worldwide. The trend of ROP in Malaysia was unclear because there was no national registry before 2002. The purpose of this study is to analyze ROP students of different ages in the schools for the blind in Malaysia in order to evaluate the trend of ROP from 1992 to 2001. Data were obtained from a previous survey of 24 blind schools. It was found that 78 students or 17.4% were blind/severely visual impaired as a result of ROP. There was a significant surge in the number of ROP students who were born in 1994 when the use of synthetic surfactants was first introduced in Malaysia; otherwise there was no increasing trend in the number of students with ROP. However, the percentage of ROP in total was increasing, which indicates that ROP is becoming a more important cause of childhood blindness in this country.