First Author: R.Deshpande INDONESIA
Co Author(s): M. Deshpande
Purpose:
The World Health Organization estimates 161 million people worldwide have a visual impairment. Of these, 37 million are blind and 124 million have low vision (World Health Organization, 2000). More than 90% of worlds visually impaired live in developing countries like India. The problem of low vision has come in limelight at international level attracting attention of the global initiative VISION 2020: The Right to Sight. About 90% of the world's blind live in the developing world. It is estimated that there are 9-12 million blind in India, which amounts to about one-fourth of all the blind people worldwide. More than 12 million children aged 5 15 years worldwide are visually impaired. This study is an attempt to reach out to screen and treat children with low vision so as to help them use their residual potential vision to the best and lead a better quality life.
Setting:
HV.Desai Eye Hospital,Pune,Maharashtra,India
Methods:
ThE comprehensive data was collected from children aged 0-16 years, attending schools for blind in and around Pune and those with low vision examined in a tertiary eye care centre, between November 1st 2007 and September 1st 2008. Entire examination was done by a team of ophthalmologists, low vision specialist, optometrist and retina specialist.Dry retinoscopy was done and whenever needed radical retinoscopy at reduced working distance / wet retinoscopy were performed. Visual acuity was tested using the Lea symbol charts for near and distance. Contrast sensitivity was assessed using Hand Held Low Contrast Flip Chart with Lea symbols. Contrast sensitivity measures the ability to see details at low contrast levels. Anterior segments of the eyes were examined using a torch and / or handheld slit lamp. The posterior segment was examined using a direct ophthalmoscope and indirect ophthalmoscope
Magnification = Best visual acuity / Target acuity
For near: Kestenbaum method.
Two follow up examinations were done at three months and nine months respectively from the first examination. The data was entered into a database and analyzed using SPSS (statistical package for social sciences), version 16.0 statistical software for Windows. Chi square test and t test was applied wherever applicable
Results:
out of 314 children 60(19.1%) children and in the tertiary eye care centre out of 3149 children attending the pediatric OPD over 1 year period, 53(1.7%) were found to have low vision. Majority of children from the schools for blind, i.e. 51.7%, had whole globe anomalies like microphthalmos as the determinant of low vision followed by retinal causes. In the schools for blind, 16.7% children improved to the 6/18-6/9-distance vision. All the children with vision (less than) <6/60 showed improvement in vision. Out of 52 children who had vision <6/24, 35 [58.33%] improved to equal to or (more than) >6/24 range. This is statistically significant by t-test, p value <0.01. In the tertiary eye care centre, 15.1% children improved to the 6/18 - 6/9 range. 10 of 18 children i.e. 18.86% with vision <6/60 showed improvement in vision. Out of 49 who had vision <6/24, 24 [45.28%] improved to >6/24 range which is statistically significant by t test with p value <0.05.After correction, 61.7% in blind schools and 67.9% in the tertiary eye care centre had their near vision improved to the range of 1.6M 1M [N12-N8]. This is statistically significant with p value <0.05 by t-test.
Conclusions:
Thus, Low vision/ " partial sight" can be managed well with low vision services thereby improving the quality of life of children with low vision. Thus, it is important to screen out patients of low vision from blind schools to provide them with appropriate aids. More so in children as early management and provision of aids will help them cope with their daily needs, social and educational needs as well. This will enhance their performance in school and develop their self confidence. And help in their social acceptance and thus enlighten their dark world. Our study, thus, emphasizes on the great need of proper screening of children in blind schools and tertiary eyecare centres/clinics for low vision and appropriate management with refraction and low vision services. FINANCIAL DISCLOSURE?: No
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