Will Bilkis see again?

Bilkis revisited

Her suffering could have been avoided

Childhood Blindness Rarer than blindness in adults Total 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 Blindness Possible sources of data Available data on childhood blindness in India - prevalence & causes Change in the trend over time

Prevalence - Sources of data Blindness Registration Birth cohort studies Surveillance Population based survey Community Based Rehabilitation (CBR) programme

Population Based Survey

Community Based Rehabilitation Prevention and treatment of preventable and treatable visual impairment Rehabilitation of incurably blind individuals

CBR Baseline door-to-door surveys of whole population Visual screening by qualified ophthalmologists and optometrists Includes all age groups

Estimation of Prevalence of blindness using U5MRs

Prevalence of Childhood Blindness in India 0.61/1000 children(95% CI ) in Andhra Pradesh (CBR) 0.51/1000 children(95% CI ) in West Bengal (CBR) 1/1000 children(95% CI ) in Orissa (Survey) 1/1000 children (East Delhi) 1.06/1000 children (Karnataka)

Prevalence of Childhood Blindness in some countries

Distribution of Severely Visually Impaired and Blind Children in the World

Incidence of Childhood Blindness Insufficient information In industrialized countries 2/100,000 children/year due to acquired diseases Globally 500,000 children become blind every year % blind children die early in their childhood

Classification of Causes of Blindness in Children Anatomical 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 Studies CBR Population based Survey

Blind School based study

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

Some recent findings from different parts of India Congenital whole globe abnormality is as high as 41% in Maharastra VAD is still a major cause of blindness in North East Uncorrected 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error is major cause of blindness among children in West Bengal in Sarva Siksha Abhiyan ( universal education drive), - unpublished.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.

Whole Globe Abnormality

Whole globe Abnormality

Corneal blindness

Aetiological Categories

Commonest Causes of Blindness in Children in India Corneal scarring mainly due to VAD Congenital anomalies of the whole globe, usually of unknown cause, but where genetic factors may play a role Retinal dystrophies mainly hereditary Cataract and amblyopia

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

Avoidable Childhood Blindness in India Up to 30% Preventable 20% causes treatable

Corneal Blindness among students of Blind Schools in West Bengal

Change of trend in the causes of childhood blindness in India Corneal blindness is decreasing Congenital whole globe abnormalities are becoming proportionately higher ROP is likely increase in urban areas Uncorrected refractive errors could be a major cause if detected properly

How to reach children- Issues Need vs. availability of service Need vs. uptake of service Availability of service vs. affordability

Ways to reach children School health programme Through health workers working in MCH ICDS – helps early detection CBR Outreach camps Key informants Public education in various forms Networking with physicians Utilising Immunisation days Sensitising 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 play Exhaust maximum medical management and continue follow-up Find out suitable LVD (optical and non optical) at the earliest opportunity Give overall training

Low Vision Assessment in camps

Practical approach Awareness generation Active Case finding utilising all sources Early intervention Individualised approach Making devices affordable

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

Integrated Education for a Blind child

Cataract

Sakera at Victory Stand

Thank you