ALBERT TOUSIF ISRAFIL (M.Optom) PARIKSHEET GOGATE (MS, FRCS) VARSHA KULKARNI (M.S)

AIM AND OBJECTIVE Aim: To evaluate the causes of blindness in children attending Schools for Blind in Pune and to record their improvement in functional vision with optical LVAs. Objectives: 1. Causes of blindness among children in schools for blind in Pune. 2. Children in school for blind, who have Low Vision. 3. Improvement in visual acuity with optical LVAs.

Prospective study 1. Poona School & Home For Blind Boys, Koregaon Park. 2. Poona School & Home For Blind Girls, Kothrud. 3. Patashibai Lunkar Blind School, Panjarpur, Bhosari. 4. NFBM Jagriti School For Blind Girls, Alandi Devachi, Khed.

Inclusion Criteria: All the candidates attending Schools for Blind between the age of 5-20 years of both the genders. Exclusion Criteria: 1. Candidates absent from school. 2. Patients not willing to participate in study.

Materials and Procedure: Materials: 1.APPASWAMI AIA11 SLIT LAMP 2. HEINE BETA 200 Ophthalmoscope (US Pat ) 3. HEINE BETA 200 Retinoscope (US Pat ). 4.UNIQUE Distance Visual Acuity Test Chart (logMAR chart) calibrated for 4 meters & reduced snellen chart for near. 5.Telescopes of 2.25x,3.5x from Unique Educational Equipments 6.Magnifiers of (i) 5x illuminated stand magnifier (ii) 7.5x illuminated stand magnifier (iii) 2.5x stand magnifier (iv) 7.5x stand magnifier (v) 1.75x bar magnifier (vi) 1.75x fresnel magnifier (vii) 10D, 15D hand held magnifiers (viii) spot magnifiers of 24D, 32D, and 40x from Unique Educational Equipments were used.

Procedure: ‘WHO/PBL Eye Examination Record For Children With Blindness And Low Vision’ Step 1: History taking of patient Step 2: Visual Acuity Assessment Step 3: Functional Vision Assessment: Step 4: General Assessment Step 5: Previous Eye Surgery Step 6: Torch light, Slit lamp Examination and Ophthalmoscopy Step 7: Refraction Step 8: Low Vision Aid Assessment Step 9: Action Needed Step10: Full Diagnosis Statistical Analysis: Microsoft Excel and SPSS software.

RESULTS I. Gender Distribution and onset of visual loss:

II. Family History and Consanguinity:

III. Visual Assessment:

VI. Functional Vision: Functional VisonNo. of Patients Can walk around192 (41.73%) Recognise face116 (25.21%) See prints82 (17.82%)

V. General Assessment:

VI. Site of Abnormality:

Whole globe: Cornea: ConditionNo. of Patient Microphthalmos88(19.13%) Anophthalmos54(11.73%) Phthisis16(3.47%) Buphthalmos3(0.43%) Removed2(0.43%) Disorganised2(0.43%) Endophthalmos2(0.43%) ConditionNo. of Patients Anterior Staphyloma48 (10.43%) Corneal Opacity23 (5%) Corneal dystrophy17 (3.69%) Keratoconus7 (1.52%) Scar6 (1.3%) Micro cornea3 (0.65%)

Retina: ConditionsNo. of Patients Retinal dystrophy17 (3.69%) Albinism10 (2.17%) Retinitis pigmentosa7 (1.52%) Retinopathy of Prematurity6 (1.30%) CRVO3 (0.65%) Lens: Number of patient with cataract and PCO were 78 students

VII. LVA Assessment: LVA for distance:

LVA for near:

VII. Improvement with LVA: Visual acuity for distance which was below 1in logMAR (unaided) in RE and LE has improved to 1.0(RE) and 0.9(LE) in logMAR with LVA for distance.

Total LVA Prescribed:

Areas Of Improvement: 1.Data collected were from starting 5 years of age. 2.Children only of 4 schools were obtained. 3. Unavailability of telescopes from the manufacturers, made the examiner bound to use only two options (2.25x and 3.5x) for the distance LVA assessment. 4. Retinoscopy and ophthalmoscopy were done in undilated pupil. 5. Only optical LVA were used.

CONCLUSIONS The major causes of blindness in children microphthalmos and anophthalmos. Avoidable blindness like cataract accounted in 78 students. Lack of follow up and ampblyopia treatment. Corneal blindness also accounted for 29% students.

Out of the 460 students, 16.74% improved with LVA. Students with Low vision were not given a chance prior to this study to improve their functional vision. Regular print rather than Braille. Visual Acuity achieved upto logMAR 1.0 and Near acuity upto N6.

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