Low vision in east African blind school students: need for optical low vision services.

Abstract

Aims-There is increasing awareness of the needs of children with low vision, particularly in developing countries where programmes of integrated education are being developed. However, appropriate low vision services are usually not available or affordable. The aims of this study were, firstly, to assess the need for spectacles and optical low vision devices in students with low vision in schools for the blind in Kenya and Uganda; secondly, to evaluate inexpensive locally produced low vision devices; and, finally, to evaluate simple methods of identifying those low vision students who could read N5 to N8 print after low vision assessment. Methods-A total of 230 students were examined (51 school and 16 university students in Uganda and 163 students in Kenya, aged 5-22 years), 147 of whom had a visual acuity of less than 6/18 to perception of light in the better eye at presentation. After refraction seven of the 147 achieved 6/18 or better. Eighty two (58.6%) of the 140 students with low vision (corrected visual acuity in the better eye of less than 6/18 to light perception) had refractive errors of more than 2 dioptres in the better eye, and 38 (271%) had more than 2 dioptres of astigmatism. Results-Forty six per cent of students with low vision (n=64) could read N5-N8 print unaided or with spectacles, as could a further 33% (n=46) with low vision devices. Low vision devices were indicated in a total of 50 students (3570/o). The locally manufactured devices could meet two thirds of the need. $ e . Conclusion-A corrected distance acuity of 1/60 or better had a sensitivity of 99 lI% and a specificity of 56-7% in predicting the ability to discern N8 print or better. The ability to perform at least two of the three simple tests of functional vision had a sensitivity of 95-50/o and a specificity of 63.3% in identifying the students able to discern N8 or better. (BrJ Ophthalmol 1995; 79: 814-820)

Avoidable blindness and its correction in schools for the blind in Gujarat, India

“…12,13 Sloan et al showed that children, compared to adults, have a very high rate of successful LVD use, when aids are properly prescribed. 14 The importance of the present study is highlighted by the fact, that LVD were not available in any of the schools, emphasizing the need to improve awareness of LVD among parents and teachers involved in educating the blind in the developing countries..…”

A survey of severe visual impairment in children attending schools for the blind in a coastal district of Andhra Pradesh in South India

“…Functional vision was assessed to determine if the child had useful residual vision for independent mobility (the ability to navigate without assistance between two chairs set 2 m apart in a well-lit room), social contact (the ability to recognize known faces at a distance of 2 m), and near vision (the ability to recognize or describe the shape of three 5 mm symbols at any near distance). 10 Assessment for refraction and low vision aids was performed in all children who were able to perform the tests for functional vision. Anterior segment examination was performed using a torch, magnifying loupe, and/or slit lamp.…”

How should blindness in children be managed?

“…For example, one blind school survey from Kenya and Uganda found that 36% of children would benefit from an optical low vision device. 25 Liaison between the tertiary centres and blind schools and mainstream schools with low vision units is essential as are studies to investigate the longer-term functional and educational status of these patients.…”