Jump to comment:

• Childhood blindness burden
  Vasumathy Vedantham
  Published on: 17 November 2003

• Published on: 17 November 2003

  Childhood blindness burden

  • Vasumathy Vedantham, Vitreoretinal surgeon

  Dear Editor

  I read with great interest the article by Sitorus et al.[1] on the causes of blindness at a blind school in Indonesia. I would like to supplement and clarify certain points mentioned in the article.

  It was sobering to note that Indonesia has the highest rate of blindness (1.5%) among the Asian countries, much more than India (0.7%). Incidentally, the similarities with the Indian scenario...

  Show More

  Dear Editor

  I read with great interest the article by Sitorus et al.[1] on the causes of blindness at a blind school in Indonesia. I would like to supplement and clarify certain points mentioned in the article.

  It was sobering to note that Indonesia has the highest rate of blindness (1.5%) among the Asian countries, much more than India (0.7%). Incidentally, the similarities with the Indian scenario were striking. The predominance of hereditary and postnatal infectious eye diseases; a pattern intermediate to that seen in developing and developed countries and the high proportion of autosomal recessive disorders amongst the genetic eye diseases due in turn to the high degree of consanguinity have been reported previously from India.[2,3]

  However, there is an equally striking difference as well. It was remarkable that the study found that the majority of the students in the blind school had vision that was mostly between hand movements and light perception only. In contrast, studies from the Indian subcontinent have found a high percentage of patients with correctable defective vision, despite the similar aetiologies of low vision.[4,5] The study by Hornby et al in six blind schools in India,[4] found that one in seven children could read normal print with optical support, with 15.4% of the children being able to read N10 point although they were studying Braille! Similarly, treatable refractive error was found to account for 33.3% of childhood blindness in two large population based studies in a southern Indian state.[5] Although definite conclusions cannot be drawn from these two studies alone, this could reflect the lack of awareness or access to primary eye care for correction of even a simple refractive error in India. Alternatively, it could mean that children with uncorrected refractive errors and navigational vision were not admitted to the blind schools in Indonesia and were still at large in the community.

  Thus, although the aetiologic causes are more or less similar, the intervention programmes would have to be region-specific and quite different for both the countries.

  The authors have mentioned that all the cases of phthisis bulbi were due to infection. A significant subset of these cases could be secondary to uveitis or trauma, that are also quite common in childhood. It might not be appropriate to attribute all the cases of phthisis bulbi to infection alone.

  The article mentions the disturbing fact that blind children with multiple handicaps were not accepted for admission in the blind schools in Indonesia. Similar admission criteria precluding admission of blind children with mental retardation in blind schools in Ethiopia was reported previously.[6] Such rules exist in India and China as well. In contrast, the blind schools in the United Kingdom and the United states, (where lesions of the central nervous system are the commonest cause of childhood blindness)[7] allow admission of such children. Considering that children with mental retardation could also be suffering from cortical visual impairment (due to perinatal factors such as hypoxic ischaemic encephalopathy), I wonder whether such regional differences in the admission criteria of the blind schools could account for the high prevalence of cortical blindness in the West as opposed to the developing countries! This is all the more plausible since much of the information on childhood blindness that we have today is based on studies on children in schools for the blind.[7]

  References

  (1) Sitorus RS, Preising M, Lorenz B. Causes of bindness at the "Wiyata Guna" school for the blind, Indonesia. Br J Ophthalmol 2003;87: 1065-1068.

  (2) Rahi JS, Sripathi S, Gilbert CE, Foster A. Childhood blindness in India: causes in 1318 blind school students in nine states. Eye1995;9: 545 -50.

  (3) Rahi JS, Sripathi S, Gilbert CE, Foster A. The importance of prenatal factors in childhood blindness in India. Dev Med Child Neurol 1997;39(7): 449-55.

  (4) Hornby SJ, Adolph S, Gothwal VK, Gilbert CE, Dandona L, Foster A. Evaluation of children in six blind schools of Andhra Pradesh. Indian J Ophthalmol 2000;48(3): 195-200.

  (5) Dandona R, Dandona L. Childhood blindness in India: a population based perspective. Br J Ophthalmol 2003;87(3): 263-5.

  (6) Kello A B, Gilbert C. Causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia. Br J Ophthalmol 2003; 87: 526-530.

  (7) Gilbert C, Foster A. Childhood blindness in the context of VISION 2020- the right to sight. Bull World Health Organ 2001;79(3):227-32.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top