ALI F. AHRABI, MD PGY-3 PEDIATRICS BLINDNESS IN CHILDREN.

ALI F. AHRABI, MDPGY-3 PEDIATRICS

BLINDNESS IN CHILDREN

Blindness in Children

DefinitionPrevalenceCommon CausesHow can you helpResources

Definition

In North America and most of Europe, legal blindness is defined as: Visual Acuity of 20/200 (6/60) or less in the better eye

with best correction possible This means that a legally blind individual would have

to stand 20 feet (6.1 m) from an object to see it with the same degree of clarity as a normally sighted person could from 200 feet (61 m)

Visual Field of less than 20 degrees (normal: 180 degrees) is also classified as being legally blind.

“Low Vision” is used to describe visual acuities from 20/70 to 20/200.

10% of legally blind have no vision (nlp)

Rest from 20/200 to light perception (lp)

Prevalence

7-14/10,000 children globallyApproximately 1/1000 in US (93,000 school-

aged in 2002)45 million registered blind globally, 1.3

million children (2.8%)75% of blind children live in developing

countries500,000 children become blind every year“Vision 2020—the Right to Sight,” is a global

initiative for the elimination of avoidable blindness (www.v2020.org)

Prevalence

About ½ (56%) of blind children have at least one other chronic medical condition

Most common co-morbid condition is Deafness

Cerebral palsy, behavioral problems, anxiety disorder, language and speech impairment, autism are other common co-morbidities

Ethiology

Globally: Corneal Ulceration (Vitamin A deficiency, Measles,

Trachoma, Local Remedies, etc.) Congenital Cataracts (Hereditary, Rubella, etc.) Congenital Glaucoma Optic Atrophy, Ambliopia

Developed Countries: ROP Traumatic Hereditary/Syndromic (Anophthalmia,

microphthalmia, Albinism,etc.) Congenital Cataracts/Glaucoma

LocallyStudy of 98 visually impaired children enrolled in a specialized school in the Bronx, NY

N %

Albinism 23 23

ROP 19 20

Glaucoma 4 4

RB 6 6

Others 46 44

Total 98 100

Rare Causes Multiple Sclerosis Cong. Retinal Detachment Chronic Uveitis Chronic Increased ICP Aniridia Craniosynostosis Osteopetrosis Tay-Sachs Disease Vascular Thrombosis Retinitis Pigmentosa Leber’s Amaurosis Hydrancephaly / Anencephaly Toxins/Meds: methanol, 

streptomycin, quinine, isoniazid, thallium, arsenic, penicillamine

Blinded by Law!?

In 2003, a Pakistani anti-terrorism court sentenced a man to be blinded after he carried out an acid attack against his fiancée that resulted in her blinding.

The same sentence was given in 2009 in Iran for Majid Mohavedi, the man who blinded Ameneh Bahrami with acid after she refused his romantic advances.

How can we help?

Adaptive Techniques

Adaptive computers and mobile phones: allow people with visual impairment to interact with their computers and/or phones via screen readers or screen magnifiers

Adaptations of coins and banknotes so that the value can be determined by touch

Mobility

Many people with serious visual impairments can travel independently, using a wide range of tools and techniques

Orientation and mobility specialists are professionals who are specifically trained to teach people with visual impairment how to travel safely, confidently, and independently in the home and the community

These professionals can also help practice travelling on specific routes which they may use often

“Cane” is basic, Guide Dog with training

Reading & Magnification

Most visually impaired people who are not totally blind read print, either of a regular size or enlarged by magnification devices.

Many also read large-print, which is easier for them to read without such devices. A variety of magnifying glasses, some handheld, and some on desktops, can make reading easier

Some people access these materials through agencies for the blind, such as the National Library Service for the Blind and Physically Handicapped

Reading & Magnification

The rest read Braille (or Moon type)or talking books and readers or reading

machines, which convert printed text to speech or Braille Computers with special hardware such as scanners

and refreshable Braille displays Software written specifically for the blind, such as

optical character recognition applications and screen readers

Braille

Braille was devised in 1821 by Louis Braille, a blind Frenchman

Each Braille character or cell is made up of six dot positions, arranged in a rectangle containing two columns of three dots each. A dot may be raised at any of the six positions to form sixty-four (26) possible subsets

Braille

In 1960, 50% of legally blind, school-age children were able to read Braille in the US

In 2007, only 10% use Braille as their primary reading medium

Currently, among the estimated 85,000 blind adults in the United States, 90% of those who are Braille literate are employed. Among adults who do not know Braille, only 1 in 3 is employed

Reading and Magnification

Closed-circuit televisions, equipment that enlarges and contrasts textual items, are a more high-tech alternative to traditional magnification devices

Modern web browsers, which can increase the size of text on some web pages through browser controls or through user-controlled style sheets

There are also over 100 radio reading services throughout the world that provide people with vision impairments with readings from periodicals over the radio

Computers

Access technology such as screen readers and Screen magnifiers enable the blind to use mainstream computer applications

Later versions of Microsoft Windows include an Accessibility Wizard & Magnifier for those with partial vision

A large number of websites use adaptive technology, making the web a more inviting place for visually impaired surfers

Other Aids

Talking equipment such as thermometers, watches, clocks, scales, calculators

They may also enlarge or mark dials on devices such as ovens and thermostats

First Hand Experience

14 y/o boy, ex 24 weeker premie, BW: 550 grams

s/p ROP with multiple laser surgeriesVision: nlp-R, lp-LCo-morbidities: PDD, ADHDResidential weekdays in special school, started

high-school this yearVery interested in computers, writing simple

programsWants to become a software program specialistUses computer and internet through “screen

readers”

First Hand Experience

Receiving special training for: Job training Job application and interviews Independent living skills (including cooking)

Independence: Makes own bed Dresses & undresses with no help Prepares food with no/little help Getting around familiar places

First Hand Advice

Early Intervention (vision treatment and all other services), great source of support

The Lighthouse (lighthouse.org)Jewish Guild for Blind (jgb.org)Visions (visionsvcb.org)

Student advocacy (rep will attend CSE meeting with parent)

Parental Support

NAPVI (National Association for Parents of Children with Visual Impairment) Excellent source of information Support Share experiences Meet others Links and resources

Questions?