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Childhood blindness and severe visual impairment in Malaysia: a nationwide study
D K Patel1, I Tajunisah, C Gilbert
1Department of Ophthalmology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia. dpatel_72@yahoo.com
Insights
Retinal disorders, particularly retinopathy of prematurity, are the leading causes of childhood blindness and severe visual impairment in Malaysia. Many cases are preventable or treatable, highlighting the need for improved pediatric eye care services.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Childhood blindness and severe visual impairment (BL/SVI) pose a significant public health challenge globally.
- Understanding the specific causes of BL/SVI in different regions is crucial for targeted prevention and intervention strategies.
Purpose of the Study:
- To identify the primary causes of BL/SVI among children in Malaysian schools for the blind.
- To assess the proportion of potentially preventable and treatable cases of childhood visual impairment in Malaysia.
Main Methods:
- A cross-sectional study was conducted involving 469 children aged 15 years or younger in 24 schools for the blind across Malaysia.
- The World Health Organization (WHO) Prevention of Blindness Programme (WHO/PBL) eye examination record was utilized.
- Visual loss was classified according to the International Classification of Disease (ICD).
Main Results:
- A high prevalence of BL/SVI was observed, affecting 95.6% (448 children) of the study population.
- The leading causes of visual loss were retinal disorders (33%), primarily retinopathy of prematurity (17.4%), followed by cataract/pseudophakia/aphakia (17.2%) and global anomalies (19.2%).
- Undetermined etiology accounted for the largest proportion (43.1%), with hereditary (21.7%) and perinatal (20.5%) factors being significant contributors. Over 7% of cases were potentially preventable, and nearly 43% were potentially treatable.
Conclusions:
- Retinal diseases, especially retinopathy of prematurity, are the predominant causes of childhood visual impairment in Malaysia, indicating an impact of improved neonatal care for premature infants.
- Lens-related impairments highlight the need for enhanced pediatric ophthalmology services.
- A substantial number of cases are amenable to prevention or treatment, underscoring the importance of early detection and intervention programs.
Aim:
To determine the causes of childhood blindness and severe visual impairment (BL/SVI) in schools for the blind in Malaysia.
Methods:
All children ≤ 15 years attending 24 schools for the blind throughout the country were examined using the WHO Prevention of Blindness Programme (WHO/PBL) eye examination record for children, and visual loss was classified according to the International Classification of Disease (ICD).
Results:
In all, 469 children were examined, of whom 448 (95.6%) had BL/SVI. The major causes of visual loss were retinal disorders (n=148, 33%; mainly retinopathy of prematurity (n=78, 17.4%)), cataract/pseudophakia/aphakia (n=77, 17.2%), and anomalies affecting the whole globe. (n=86, 19.2%). The major underlying etiology was undetermined (n = 193, 43.1%), followed by hereditary factors, 21.7% (mainly retinal dystrophies), and perinatal factors, 20.5%. More than 34 (7.6%) cases were considered potentially preventable and 192 (42.9%) potentially treatable.
Conclusion:
Diseases of the retina are the major cause of visual impairment, with retinopathy of prematurity being an important avoidable cause. This reflects expansion of neonatal services in Malaysia, and improved survival of very low birth weight and preterm babies. Lens-related causes of visual impairment reflect the need to further improve pediatric ophthalmology services in Malaysia.
