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By Roibeard O’hÉineacháin

GOTHENBURG — Because childhood blindness is either treatable or easily preventable in at least half of all cases, the World Health Organisation (WHO) has identified the condition as a priority area in its Vision 2020 initiative, a British ophthalmologist told the Vision 2002 meeting.

"Vision 2020 is a global initiative of the WHO to eliminate avoidable blindness by the year 2020. Globally, out of the 50 million people who are blind, 1.4 million are children.
"Childhood blindness has been selected as a priority area because it contributes hugely to overall blind years and is associated with high mortality. It also requires special training and expertise to manage properly," Mohammed Muhit MD said.
Defining blindness as visual acuity of 20/200 or worse and childhood as less than 16 years of age, the current WHO estimates of the prevalence of childhood blindness range from 0.3/1000 children in high-income countries to 1.2/1000 children or more in poorer countries.

Consequently, about 73% of blind children are living in the poor and very poor countries of Asia and sub-Saharan Africa. There is also a strong correlation between the prevalence of childhood blindness and the under-five mortality rate, he noted.
"There are an estimated 500,000 new cases of childhood blindness every year - almost one per minute. One child is going blind every minute and over 50% of them die within one year of blindness. This is because many causes of blindness, such as vitamin A deficiency, corneal diseases, rubella and measles, are also responsible for high childhood mortality," Dr Muhit said.

Dr Muhit noted that most of the blindness occurring in children in the high income economies of the world—like Europe and North America - is due to conditions which are unavoidable and/or untreatable with modern medical science.
In contrast, about over half of the childhood blindness in the rest of the world is either preventable or treatable.
In a survey of data from 10,000 blind children in 30 countries, the major cause of childhood blindness in established market economies were diseases of the retina and optic nerve, while blindness arising from disease affecting the front of the eye was very uncommon.
In middle-income countries like South America, retinal problems are very prominent because of retinopathy of prematurity (ROP) and this is emerging as a problem in big cities in Asia as well.

However, in the poorer Asian countries and those of sub-Saharan Africa, diseases of the front of the eye such as cataract, glaucoma and corneal scarring, mostly due to vitamin A deficiency or measles, were the major causes of childhood blindness.
Dr Muhit noted that while the poorer economies had the same incidence of unavoidable causes of blindness as richer countries, it was the incidence of avoidable causes that magnified their overall blindness prevalence by three to 10-fold.
"This is the take home message: About 50% of blindness with the current standard of knowledge is unpreventable and untreatable but the other 50% we can do something about.

"About 28% of blindness is entirely preventable by very easy means of primary health care and primary eye care and another 15%, mostly cataract and glaucoma, can be treated easily and ROP is also preventable," Dr Muhit said.
Strategies to prevent and treat childhood blindness will involve not only the allocation of resources but also the identification of areas where available medical resources are under-used.

Dr Muhit noted that in a large study he and his associates conducted in Bangladesh, 30% of blind children out of 2,000 were blind due to unoperated cataracts. The condition is completely treatable and the main problem is lack of resources.
On the other hand, even when surgery was provided free of charge, only 50% availed of it. Better results will require the use of mass media to dispel the popular misconception that congenital cataracts are untreatable.

Another useful strategy is to adapt modern medicine to the community traditions. For example, Dr Muhit and his associates have found that corneal scarring is less common in areas where traditional healers have been incorporated in primary eye care.
Such healers are the most acceptable service providers in many poor communities. So it is better to educate than ignore them, he pointed out.
"The interesting thing about childhood blindness is that most of the work will need to be done outside the medical community; it requires an integrated society-wide approach. The primary causes are uneducated parents, poor primary childcare, and poor primary health care systems.
"Furthermore, there are no rehabilitation services in many communities. Poor surgery and follow-up is another problem. We need to establish child eye care centres integrated with primary healthcare system," he stressed.

Over the last five or 10 years, the political leaders of many developing countries have realised the importance of primary health care and primary eye care.
However, in many countries where there is primary healthcare, primary eye care is not sufficiently integrated and is not given the priority it requires to be effective.
"Our aim is to reduce the childhood blindness prevalence from 0.75/1000 to 0.4/1000. This we may achieve through elimination of corneal scarring by rubella and measles immunisation programmes, surgery for childhood cataract and vision screening in school. If we can make that a success then there will be only the unavoidable causes of childhood blindness," Dr Muhit said.

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