Childhood Blindness.pptx

The current scenario of childhood blindness in India

1. CHILDHOOD BLINDNESS PRESENTER: DR.MAITHRI B.A MODERATOR: DR.VASUDHA.K

2. OVERVIEW TERMS AND DEFINITIONS THE BURDEN OF BLINDNESS CAUSES OF CHILDHOOD BLINDNESS APPROACH TO CHILDHOOD BLINDNESS

3. BLINDNESS WHO: “Best Corrected Visual acuity of less than 3/60 or a corresponding visual field loss of less than 10 degrees in the better eye with best possible correction.” NPCB: (old) “Best Corrected Visual acuity less than 6/60 in the better eye or a corresponding visual field loss of less than 10°.”

4. NPCB: (new) “ Presenting distance VA less than 20/200 in the better eye. A limitation of field of vision to under 20° from central point of fixation in the better eye is also considered blindness” Does this change anything? Severe visual impairment considered as blindness Prevalence of blindness overestimated Will need to change the govt programs as per new definition so more people can benefit Vashist P, Senjam SS, Gupta V, Gupta N, Kumar A. Definition of blindness under National Programme for Control of Blindness: Do we need to revise it?. Indian J Ophthalmol 2017;65:92-6.

5. THE BURDEN DISABILITY ADJUSTED LIFE YEARS (DALY) 11.2 5.5 Murthy GVS. Magnitude and temporal trends in avoidable blindness in Children (ABC) in India. Indian J Pediatr 2017;84:924‑9

6. “Restoring the sight of one child blind from cataract is equivalent to restoring the sight of 10 older adults blind from cataract” Gilbert C,Foster A. Blindness in children: control priorities and research opportunities. Br J Ophthalmol 2001; 85:1025-1027

7. Deep impact on Also effects Lack Of Employment Privilege LIVING WITH BLINDNESS

8. Blindness from birth can also cause Delays in developmental milestones Frequent Trauma Frequent hospitalization Early death Wadhwani M, Vashist P, Singh SS, Gupta V, Gupta N, Saxena R. Prevalence and causes of childhood blindness in India: A systematic review. Indian J Ophthalmol 2020;68:311-5

9. Global Estimates 1.42 Million 17.52 Million Blindness Impairment 1.5/1000 0.3/1000 Low-income High income World Health Organization. Cummulative official updates to ICD–Feb 2009.Available from: http://www.Who.int/clasificationd/ icd /Official updates Combined 1996‑2008 VOLUME1.pdf In the pediatric age group, the prevalence in India is estimated to be 0.8/1,000 in the 0-15 year age group with around 280,000 blind children Saxena R, Vashist P, Singh D, Tandon R. Preventing childhood blindness: Synergy between ophthalmology and community medicine. Indian J Community Med 2015;40:149-51

10. Magnitude of blindness in India Murthy GVS. Magnitude and temporal trends in avoidable blindness in Children (ABC) in India. Indian J Pediatr 2017;84:924‑9

11. WHO/PBL Eye Examination Record The International Centre for Eye Health, London (ICEH) in collaboration with WHO developed a standardized protocol – a comprehensive form For ease of recording cause of blindness For collection of database To prognosticate and formulate appropriate control measures

12. A 2-sided form that includes: History Complaints General systemic assessment Visual acuity and refractive correction including LVA Anterior and posterior examination findings Primary eye involved Etiological and anatomical cause for blindness Diagnosis and Prognosis Treatment Options Education Coding and database for analysis

13. CAUSES OF CHB Prevalence and Causes of childhood blindness can be assessed by studies that are

14. Population Based Accurate picture – gold standard Large sample Time consuming Resource intensive Blind School Based Time saving Easy access Inaccurate Biased

15. Key Informant Method: Small, well defined geographic area Informants: approachable, literate and well known in social circles Teachers, health workers, NGO staff, Govt staff, local leaders, traditional healers Informants to be trained to identify signs of poor vision/blindness To be followed up by ophthalmology team to diagnose/treat/rehabilitate Muhit MA, Shah SP, Gilbert CE, Hartley SD, and Foster A. The key informant method: a novel means of ascertaining blind children in Bangladesh. Br J Ophthalmol .

16. Under-5 Mortality Rate: Causes of childhood blindness can also cause increased mortality under 5 (pre-maturity, malnutrition, infections,etc ) Serves as a proxy estimate Can give a clue on avoidable causes – Vit A defiency Murthy GVS. Magnitude and temporal trends in avoidable blindness in Children (ABC) in India. Indian J Pediatr 2017;84:924‑9

17. Source: Dr.Vasudha

18. Studies from schools for the blind showing causes of CHB according to anatomical site of the lesion (1995-2020)

19. Aetiological: Hereditary: Genetic and/or chromosomal disorders Intrauterine: TORCH related conditions Perinatal: ROP, Birth injury, Ophthalmia neonatorum, CVI Childhood: Trauma, Vitamin A, Cataract Unknown/Undetermined

20. Anatomical: Whole Globe: Anophthalmos , Microphthalmos, Cryptophthalmos Cornea: Scarring, Xerosis, Dystrophy Lens: Cataract, Aphakia Uvea: Coloboma, aniridia Retina: Dystrophy, ROP, Retinoblastoma Optic nerve: Atrophy, Hypoplasia Glaucoma Normal appearing eye: Refractive amblyopia, CVI

21. Unavoidable: Whole globe anomalies Retinal Dystrophies Hereditary/Genetic disorders

22. Avoidable

23. Pavagada Pediatric Eye Disease Study -1 Population Based, Cross sectional survey Rural children in Karnataka Screened 23,100 children Blindness – 0.08% Nearly 50% unavoidable blindness

24. Pavagada Pediatric Eye Disease Study -2 Population Based, Cross sectional survey Rural children in Karnataka 8,553 Children screened Blindness – 0.09% 50% Unavoidable blindness

25. KemmanuV,HegdeK,Giliyar SK, ShettyBK,KumaramanickavelG , McCarty CA. Prevalence of childhood blindness and ocular morbidity in a rural pediatric population in Southern India. The Pavagadapediatric Eye Disease study 1. Ophthalmic Epidemiol 2016:23:3:185‑92

26. Shift in the cause of CHB: Early detection of preventable causes Vitamin A supplementation Better Screening programs Now the major causes are whole globe anomalies and retinal pathologies

27. Wadhwani M, Vashist P, Singh SS, Gupta V, Gupta N, Saxena R. Prevalence and causes of childhood blindness in India: A systematic review. Indian J Ophthalmol 2020;68:311-5.

28. Approach to Childhood Blindness

29. Classify according to etiology , anatomy and whether treatable/not, progressive/not If retinal cause suspected: Additional tests such as ERG, OCT, CT (Retinoblastoma) If cataract: Surgery and rehabilitation as early as possible If corneal cause: Decide on keratoplasty If whole globe: Decide on maintaining globe integrity If anatomically normal: Causes could be refractive error or cortical visual impairment – refraction of the normal/better eye, birth history, neuro-imaging Rule out systemic illness/genetic/chromosomal diseases

30. Explain to parents nature of condition and its prognosis Be Truthful Kindness and Empathy go a long way Give appropriate visual aids and guide on usage Counsel parent and child Help parents consider different opportunities for education of the child Assist Child to lead as independent a life as possible - Genetic counselling for parents if cause is hereditary

31. Aids for the Blind DAILY LIFE EDUCATION VOCATION

32. Thank You “Even if you cannot help the blind see, Help them be who they are And they will show you, What joy it is to simply be” ~my3

33. Based on Age Physical ability Intellectual ability Interest Economic status Family support Visual Rehabilitation

34. Assistive Technology: “any piece of equipment, product, or tool, whether it is acquired commercially, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities” For Education: For reading, writing, mathematics, science, games For Orientation and Mobility For Activities of Daily Living Senjam SS Assistive Technology for People with Visual Loss.DJO 2019;30:7-12

35. F or pre-academic learning Tactile and Light/Sound producing toys

36. Education: Braille Image source: internet

37. Refreshable Braille Display (RBD): a screen reader and enables the user to read what’s on the computer screen by touch on Braille display. Braille Translator Software (BTS): translates electronic documents into Braille codes and sends it to a Braille embosser (special Braille printer- Braille embosser) which produces a hard copy of the original text