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Xerophthalmia, keratomalacia and nutritional blindness
1Dana Center for Preventive Ophthalmology, Wilmer Eye Institute, Johns Hopkins Medical Institution.
Insights
Vitamin A deficiency causes childhood blindness and increases mortality. Prevention through supplements or dietary intake is crucial for child survival and preventing xerophthalmia.
Area of Science:
- Public Health
- Ophthalmology
- Pediatrics
Background:
- Vitamin A deficiency is a leading cause of preventable childhood blindness, affecting millions globally.
- Xerophthalmia, a severe consequence of vitamin A deficiency, leads to significant pediatric ocular morbidity and mortality.
- Measles-associated blindness, particularly in Africa, is often linked to concurrent vitamin A deficiency.
Purpose of the Study:
- To highlight the critical role of vitamin A in preventing childhood blindness and improving survival rates.
- To emphasize the importance of prevention strategies over treatment for xerophthalmia.
- To advocate for widespread vitamin A supplementation and dietary improvements.
Main Methods:
- Review of existing evidence on vitamin A deficiency, xerophthalmia, and measles-related blindness.
- Analysis of the cost-effectiveness and impact of vitamin A supplementation regimens.
- Evaluation of different prevention strategies including high-dose supplements, food fortification, and dietary enhancement.
Main Results:
- Annual incidence of over five million cases of xerophthalmia, with over 250,000 resulting in blindness.
- Effective and inexpensive treatment involves oral vitamin A (200,000 IU for two days) at a low cost.
- Prophylactic regimens (200,000 IU every 3-6 months) may reduce overall child mortality by over 35%.
Conclusions:
- Prevention of vitamin A deficiency through supplementation or improved diet is paramount for reducing childhood blindness.
- Vitamin A supplementation offers significant survival benefits, extending beyond ocular health to overall child mortality.
- Public health initiatives focusing on vitamin A intake are essential for improving pediatric health outcomes globally.
Abstract:
Vitamin A deficiency remains a major cause of pediatric ocular morbidity. Over five million children develop xerophthalmia annually, a quarter million or more becoming blind. It is also a major pathway for measles-associated blindness, particularly in Africa. Treatment is practical and inexpensive, based upon the oral administration of 200,000 IU vitamin A on two successive days, at a cost of 10 cents U.S. Given the potential rapidity of corneal necrosis (keratomalacia) and the relative inaccessibility of health services to those at greatest risk, prevention is probably more important than treatment. Oral administration of high dose supplements (2000,000 IU every 3 to 6 months), vitamin A fortification of commonly consumed items, or best of all, increased dietary intake of natural sources of vitamin A will reduce the number of needlessly blind young children. Given recent evidence that vitamin A deficiency greatly increases overall mortality, even among children without evidence of xerophthalmia, the same prophylactic regimen may improve child survival by 35% or more.