Will Bilkis see again? Bilkis revisited Her suffering could have been avoided.

Will Bilkis see again?

Bilkis revisited

Her suffering could have been avoided

Childhood BlindnessRarer than blindness in adultsTotal number of blind-years suffered by blind

children is second only to that due to cataract in adults

Reliable data is not available from all geographic regions

Childhood BlindnessPossible sources of dataAvailable data on childhood blindness in

India - prevalence & causesChange in the trend over time

Prevalence - Sources of dataBlindness RegistrationBirth cohort studiesSurveillancePopulation based surveyCommunity Based Rehabilitation (CBR)

programme

Community Based RehabilitationPrevention and treatment of preventable and

treatable visual impairmentRehabilitation of incurably blind individuals

CBRBaseline door-to-door surveys of whole

populationVisual screening by qualified

ophthalmologists and optometristsIncludes all age groups

Estimation of Prevalence of blindness using U5MRs

U5MR/1000

Estimatedprevalence

Example countries

0-19 0.3 UK, Sweden

20-39 0.4 Argentina, Thiland

40-59 0.5 Honduras, Vietnam

60-79 0.6 South Africa, Brazil

80-99 0.7 Zimbabwe, Papua New Guinea

100-119 0.8 Kenya, Nepal

120-139 0.9 Sudan, Laos

140-159 1.0 Tanzania, Albania

160-179 1.3 Nigeria, Central AfricanRepublic

180+ 1.5 Niger, Bhutan

Prevalence of Childhood Blindness in India0.61/1000 children(95% CI0.51-0.82) in

Andhra Pradesh (CBR)0.51/1000 children(95% CI 0.37-0.65) in West

Bengal (CBR)1/1000 children(95% CI 0.094 - 0.106) in

Orissa (Survey)1/1000 children (East Delhi)1.06/1000 children (Karnataka)

Prevalence of Childhood Blindness in some countries

Country Categoryof visualimpairment

Prevalence/1000

Agegroup inyears

Source ofdata

Year

Scandinavia

<3/60 0.15 –0.41 0-15 Registration

1992

Iceland variable 0.36 0-14 Survey 1980

UK <6/60 0.34 10 Cohortstudy

1988

India <3/60 0.51 -0.65 0-15 CBR 1998

Nepal <3/60 0.63 0-16 Survey 1980

Nigeria <3/60 1.00 5-14 Survey 1994

Distribution of Severely Visually Impaired and Blind Children in the World

Region Population(0-15yrs.) inmillion

Estimate ofprevalenceper 1000

Estimated no.of SVI/Blindchildren

Africa 240 1.1 264000

Latin America 130 0.6 78000

NorthAmerica,Europe,Japan,Oceania,former USSR

240 0.3 72000

Asia 1200 (350 inIndia)

0.9 (0.8 inIndia)

1080000(270 000 inIndia)

Total 1810 1494000

Incidence of Childhood BlindnessInsufficient informationIn industrialized countries 2/100,000

children/year due to acquired diseasesGlobally 500,000 children become blind every

year50 - 60% blind children die early in their

childhood

Classification of Causes of Blindness in ChildrenAnatomical

Classification - Takes into account the part of the eye most affected

Aetiological Classification - Takes into account the time of onset of the condition leading to blindness

Causes of Childhood Blindness - Sources of Data used in India

Blind School StudiesCBRPopulation based Survey

Causes of SVI & Blindness in children from all the reported studies in India

Causes CBRN %

Blind SchoolsN %

TotalN %

WholeGlobe

36 29 530 25 566 25

CornealOpacity

14 11 607 28 621 27

Lens 17 14 239 11 256 11

Uvea 11 9 107 118 5

Retina 23 18 467 21 490 22

Optic Nv. 16 13 122 6 138 6

Glaucoma 3 2 64 3 67 3

Others 5 4 22 1 27 1

Total 125 100 158 100 2283 100

Some recent findings from different parts of IndiaCongenital whole globe abnormality is as

high as 41% in MaharastraVAD is still a major cause of blindness in

North EastUncorrected Refractive error is major cause

of blindness among children in West Bengal in Sarva Siksha Abhiyan ( universal education drive), - unpublished . Results from surveys in Gujarat and west Bengal in 2005 also shows similar results.

Aetiological CategoriesAetiologicalCategory

CBRN %

Blind SchoolsN %

TotalN %

Hereditaryfactors

13 24 552 26 565 26

Intra-uterinefactors

4 8 35 15 39 2

Perinatalevents

2 4 35 15 37 2

Childhoodfactors

8 5 622 29 630 28

Unknowncauses

26 49 914 42 940 42

Total 53 100 2158 100 2211 100

Commonest Causes of Blindness in Children in IndiaCorneal scarring mainly due to VADCongenital anomalies of the whole globe,

usually of unknown cause, but where genetic factors may play a role

Retinal dystrophies mainly hereditaryCataract and amblyopia

Regional Variation in the major causes of blindness in schools for the blind in India

State VAD Retinal dystrophies/ Albinism

Cataract/Aphakia/Amblyopia

Congenital anomalies

No. of Children % % % % Gujarat(97) 21.6 9.2 11.3 17.3 MP(101) 26.7 11.9 3.9 18.8 Haryana(141) 15.6 25.5 5.7 20.6 UP(134) 21.6 6.7 2.9 32.8 WB(89) 24.7 11.2 16.8 19.1 Maharastra(157) 20.4 13.8 12.7 17.2 Karnataka(122) 11.5 23.7 6.5 28.7 Kerala(93) 7.5 33.2 23.6 6.5 TN(384) 18.5 25.5 9.8 20.6

Avoidable Childhood Blindness in IndiaUp to 30% Preventable20% causes treatable

Corneal Blindness among students of Blind Schools in West Bengal

0

5

10

15

20

25

30

35

40

16-19 yrs. 11-15 yrs. 0-10 yrs.

Whole GlobeCornea

Change of trend in the causes of childhood blindness in IndiaCorneal blindness is decreasingCongenital whole globe abnormalities are

becoming proportionately higherROP is likely increase in urban areasUncorrected refractive errors could be a

major cause if detected properly

How to reach children- IssuesNeed vs. availability of serviceNeed vs. uptake of serviceAvailability of service vs. affordability

Ways to reach childrenSchool health programmeThrough health workers working in MCHICDS – helps early detectionCBROutreach campsKey informantsPublic education in various formsNetworking with physiciansUtilising Immunisation daysSensitising all levels of workers even

priests

Motivating ICDS workers

Training ICDS Workers

Childhood blindness survey

Why Early Rehabilitation?When a mother brings a visually impaired

child to a doctor she doesn’t know whether the disease is curable or incurable. She needs help.

All our efforts to restore vision may fail, but we should not fail to give proper guidance to parents about the child’s overall development.

Outcome is always better if the process is started early

Low vision devices have greater role to playExhaust maximum medical management and

continue follow-upFind out suitable LVD (optical and non

optical) at the earliest opportunityGive overall training

Low Vision Assessment in camps

Practical approachAwareness generationActive Case finding utilising all sourcesEarly interventionIndividualised approachMaking devices affordable

Computer Braille training centre (2002), VMA School for the Blind

Integrated Education for a Blind child

Sakera at Victory Stand

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