Comm Eye Health Vol. 11 No. 27 1998 pp 33 - 34. Published online 01 September 1998.

How can blind children be helped?

Allen Foster FRCS FRCOphth

Medical Director, Christoffel Blindenmission, Senior Lecturer, International Centre for Eye Health, Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK

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There are an estimated 1.5 million blind children world-wide. Table 1 documents where they live and Table 2 gives the major anatomical causes. The years of blindness resulting from these diseases represent a major social and economic burden on communities, as well as individuals.

This issue specifically asks the question ‘How can blind children be helped?’ It concentrates on what can be done to help the child with significant visual loss, rather than what can be done to prevent blindness in children, which has been discussed in previous issues (see Issues 5, 8, 11, 22).

Visually impaired children, some with albinism, in Kenya. © Clare Gilbert
Visually impaired children, some with albinism, in Kenya. © Clare Gilbert

Dr Rahi discusses how to examine a child who is reported to have visual problems in order to assess the level of visual function, the cause of visual loss and the prognosis for future vision. The examination is often difficult to perform, but it is important that time is taken, if necessary over several examinations, to determine accurately visual function, aetiology and prognosis.

Surveys from around the world have demonstrated that a significant proportion of children in blind schools or special education have conditions which may be improved by surgery, specifically cataract and some cases of corneal scarring. Identification of these children, followed by surgery in the hands of an experienced ophthalmologist and follow-up to manage errors and amblyopia, is an important part of any prevention of blindness programme. Dr Vijay, in her article, gives information on the management of surgically remediable causes of childhood blindness. The role of IOLs in the management of paediatric cataract in developing countries is an important area for evaluation.

Work from West and East Africa and South America is reported in the very practical article by Lynne Ager which shows that approximately half of all children in blind schools can be helped to read normal print (and therefore avoid the need of Braille), if they are carefully refracted and supplied with the appropriate spectacles and magnifiers. This results in better educational opportunities and improved integration. A number of low vision programmes in Africa and Asia for children in blind schools and special education have now been implemented, with encouraging results.

Blind schools are good places to start such programmes as studies show that 5-10% of children can benefit by surgery and 10-15% can have improved vision with spectacles alone.

To conclude, blindness in children is important because of the numbers affected and the years of resulting disability. As well as preventive measures to avoid blindness in children, there is much that can be done surgically and optically to improve the vision of a significant proportion of children with visual loss (Table 3). It is proposed that a minimal requirement for the developing world is 1 unit specialising in ‘visual loss in children’ for every 10 million population. Such a unit requires an experienced ophthalmologist and optometrist who are willing to work as a team with educationalists to provide services and long term follow-up.

Table 1. Magnitude of blindness in children

Region No. children million No. blind Prev. /1,000 Total % Mind children
Africa 253 330,000 1.2 24
India 340 270,000 0.8 20
Rest of Asia 264 220,000 0.8 16
Middle East 336 200,000 0.6 12
China 238 190,000 0.8 14
Latin America 167 100,000 0.6 8
Eastern Europe 168 50,000 0.3 4
Western Economies 77 40,000 0.5 2
Total (approximates) 1,843 1,400,000 0.71 100%

Table 2. Causes of blindness in children

Site No. blind % Conditions
Retina 400,000 29 Retinal dystrophies and ROP*
Cornea 300,000 21 VAD, measles, ON and TEM*
Globe 200,000 14 Microphthalmos, coloboma
Lens 130,000 9 Cataract and aphakia
Other 130,000 9 Cortical blindness, amblyopia
Optic Nerve 120,000 9 Optic atrophy/hypoplasia
Glaucoma 70,000 5 Bupthalmos or glaucoma
Uvea 50,000 4 Aniridia and uveitis
Total 1,400,000 100%  

*ROP: Retinopathy of Prematurity, VAD: Vitamin A Deficiency, ON: Ophthalmia Neonatorum, TEM: Traditional Eye Medicines

Table 3. Avoidable causes of childhood blindness by region

Region Corneal Scar Cataract ROP Total
Africa 100,000 30,000 <500 130,000
India 90,000 30,000 <500 120,000
Rest of Asia 60,000 30,000 2,000 92,000
Middle East 25,000 10,000 <1,000 35,000
China 15,000 35,000 <1,000 50,000
Latin America 10,000 10,000 25,000 45,000
Eastern Europe <1,000 10,000 5,000 16,000
Western Economies <1,000 5,000 6,000 12,000
Total (approximates) 300,000 160,000 40,000 500,000