Blindness in Childhood in Developing Countries: Time for a Reassessment?

Abstract

Paul Courtright and colleagues argue that the changing patterns of global childhood blindness suggest a need to reassess research, training, and programmatic requirements.

Strategies to improve follow-up of children after surgery for cataract: findings from Child Eye Health Tertiary Facilities in sub-Saharan Africa and South Asia

“…The body of knowledge on programmatic approaches to paediatric eye care in developing countries has significantly increased in the past 10 years, and evidence suggests that, with the reduction in vitamin A deficiency and measlesrelated blindness, childhood cataract requires increased global attention. 1 For many years, there has been considerable concern about the low levels of follow-up for distance corrections, optical low-vision devices, and educational placement for children receiving cataract and other ocular surgeries in many developing countries. 2,3 Initial work in Tanzania identified reasons for poor follow-up 4 and demonstrated strategies to address these.…”

Screening for childhood blindness and visual impairment in a secondary school in rural Malawi

“…2 Histologically, they are defects in the choroid, choriocapillaris, and RPE and usually occur in the first trimester. 3,4 This time period is also when the embryonic fissures close and the corpus callosum develops. Thus, developmental defects during this period could explain the findings in Aicardi's syndrome, but not in ROP.…”

“…2 However, data on the epidemiology of childhood blindness in sub-Saharan Africa is scant, as children are rarely included in blindness surveys. Historically, information has been obtained from schools for the blind and, more recently, the key informant method, 3 but this does not address children with milder forms of visual impairment. Screening for visual impairment in regular schools may also yield useful information, although children with debilitating visual impairment may be less likely to attend, and secondary school attendance is not universal in Africa.…”

Cataract How Important Is Age of Intervention?

“…[1,2,3,4,5]. The overall incidence of clinically significant cataracts (unilateral or bilateral) in childhood is unknown, but has been estimated to be as high as 0.4%.…”

“…[10,13] been poorer than in adults. [1][2][3], [6,12,13] This difference is due, in part, to the various types of amblyopia that develop in children with cataracts, the association of nystagmus with early onset cataracts, and the presence of other ocular abnormalities that adversely affect vision in eyes with developmental lens opacities. Since the introduction of the aspiration technique for cataract removal by Scheie in 1960 , surgical procedures for the removal of the lens in childhood have improved [14,15,16] and earlier surgery for congenital cataracts has been encouraged [17][18][19].…”