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Vision 2020
The World Heath Organization and the International Agency for the Prevention of Blindness in 1999 jointly launched “Vision 2020—the right to sight.” This ambitious programme, to eliminate unnecessary blindness and promote good vision throughout the world, includes the control of blindness in children as one of its first five priorities.1 Given that there are estimated to be 45 million blind people, of whom only 3% are children, this may seem to be inappropriate. However, childhood blindness is important because of “years of blindness”2: the patient with blindness due to macular degeneration will have a limited number of years of visual loss, but the child who goes blind today is likely to still be with us in 2050. The concept of “blind years saved” is useful when it comes to allocation of resources, as it can be argued that restoring the sight of one child blind from cataract is equivalent to restoring the sight of 10 elderly adults blind from cataract. Children, therefore, deserve special attention.
Magnitude and causes
The definition of childhood blindness is usually considered as a corrected visual acuity of less than 6/60 in the better eye in an individual aged 0–15 years. Reliable prevalence data are difficult to obtain for a variety of reasons but the available evidence suggests that the prevalence varies from 0.3/1000 children in economically developed communities to over 1.0/1000 children in underprivileged societies.2 This translates into approximately 80–100 “blind” children per million total population in industrialised societies and over 400 blind children/million population in the poorest areas of the world.
Mortality in blind children, particularly in developing countries, is higher than in their sighted counterparts, as many of the conditions which can lead to visual loss are also causes of child mortality (for example, measles, vitamin A deficiency, prematurity, congenital …