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The importance of prenatal factors in childhood blindness in India
J S Rahi1, S Sripathi, C E Gilbert
1Department of Epidemiology and Biostatistics, Institute of Child Health, London, UK.
Insights
Causes of childhood blindness in India are primarily prenatal, affecting 60% of severely visually impaired (SVI) or blind children. Strategies must address both preventable and treatable causes for effective intervention.
Area of Science:
- Ophthalmology
- Public Health
- Pediatrics
Background:
- Childhood blindness remains a significant public health issue in India.
- Understanding the etiological factors is crucial for developing targeted interventions.
- Previous studies have indicated a complex pattern of visual impairment causes in the region.
Purpose of the Study:
- To describe the causes of visual loss in a large cohort of children attending schools for the blind across India.
- To identify the prevalence of different etiological categories contributing to severe visual impairment (SVI) or blindness.
- To analyze geographical variations in the causes of childhood blindness within India.
Main Methods:
- A cross-sectional study involving 1411 children from schools for the blind in various Indian geographical areas.
- Data collection on visual acuity and etiological factors for visual loss.
- Classification of causes into prenatal, natal, and postnatal categories, with sub-analysis of known/probable factors.
Main Results:
- 93% of children were classified as severely visually impaired (SVI) or blind.
- Prenatal factors accounted for 60% of SVI/blindness, with known/definite causes in 47% and probable causes in 13%.
- Hereditary retinal dystrophies and albinism were present in 19%, and congenital ocular anomalies in 23% of SVI/blind children.
Conclusions:
- The pattern of visual loss causes in India is intermediate between industrialized and developing nations.
- Effective strategies for combating childhood blindness must concurrently address preventable and treatable causes.
- Further etiological studies, especially on anophthalmos and microphthalmos, are warranted.
Abstract:
The causes of visual loss in 1411 children attending schools for the blind in different geographical areas in India are described. Ninety-three percent (1318) of the children were severely visually impaired (SVI) or blind (i.e. corrected acuity in the better eye of <20/200 [<6/60]). In 60% of SVI/blind children vision loss was attributable to factors operating in the prenatal period, in 47% the prenatal factors were known and definite, and in 13% prenatal factors were the most probable causes. Hereditary retinal dystrophies and albinism were seen in 19% of SVI/blind children and 23% had congenital ocular anomalies. There were variations in the relative importance of different causes by state. The observed pattern of causes of visual loss is intermediate between those seen in industrialised countries and in the poorest developing countries. This suggests that strategies to combat childhood blindness in India need to address concurrently both preventable and treatable causes. The need for aetiological studies, particularly on anophthalmos and microphthalmos, is highlighted.