Will Bilkis see again?

1. Changing pattern of Childhood blindness in India and service delivery needs Asimkumar Sil MBBS, DO, DNB, M ScNetraNiramayNiketan,Vivekananda Mission AshramChaitanyapur, West Bengal

2. Will Bilkis see again?

3. Bilkis revisited

4. Her suffering could have been avoided

5. Childhood Blindness • Rarer than blindness in adults • Total number of blind-years suffered by blind children is second only to that due to cataract in adults • Reliable data is not available from all geographic regions

6. Childhood Blindness • Possible sources of data • Available data on childhood blindness in India - prevalence & causes • Change in the trend over time

7. Prevalence - Sources of data • Blindness Registration • Birth cohort studies • Surveillance • Population based survey • Community Based Rehabilitation (CBR) programme

8. Population Based Survey

9. Community Based Rehabilitation • Prevention and treatment of preventable and treatable visual impairment • Rehabilitation of incurably blind individuals

10. CBR • Baseline door-to-door surveys of whole population • Visual screening by qualified ophthalmologists and optometrists • Includes all age groups

11. Estimation of Prevalence of blindness using U5MRs

12. Prevalence of Childhood Blindness in India • 0.61/1000 children(95% CI0.51-0.82) in Andhra Pradesh (CBR) • 0.51/1000 children(95% CI 0.37-0.65) in West Bengal (CBR) • 1/1000 children(95% CI 0.094 - 0.106) in Orissa (Survey) • 1/1000 children (East Delhi) • 1.06/1000 children (Karnataka)

13. Prevalence of Childhood Blindness in some countries

14. Distribution of Severely Visually Impaired and Blind Children in the World

15. Incidence of Childhood Blindness • Insufficient information • In industrialized countries 2/100,000 children/year due to acquired diseases • Globally 500,000 children become blind every year • 50 - 60% blind children die early in their childhood

16. Classification of Causes of Blindness in Children • Anatomical Classification - Takes into account the part of the eye most affected • AetiologicalClassification - Takes into account the time of onset of the condition leading to blindness

17. Causes of Childhood Blindness - Sources of Data used in India • Blind School Studies • CBR • Population based Survey

18. Blind School based study

19. Causes of SVI & Blindness in children from all the reported studies in India

20. Some recent findings from different parts of India • Congenital whole globe abnormality is as high as 41% in Maharastra • VAD is still a major cause of blindness in North East • Uncorrected Refractive error is major cause of blindness among children in West Bengal in Sarva Siksha Abhiyan ( universal education drive), - unpublished . Results from surveys in Gujarat and west Bengal in 2005 also shows similar results.

21. Whole Globe Abnormality

22. Whole globe Abnormality

23. Corneal blindness

24. Aetiological Categories

25. Commonest Causes of Blindness in Children in India • Corneal scarring mainly due to VAD • Congenital anomalies of the whole globe, usually of unknown cause, but where genetic factors may play a role • Retinal dystrophies mainly hereditary • Cataract and amblyopia

26. Regional Variation in the major causes of blindness in schools for the blind in India

27. Avoidable Childhood Blindness in India • Up to 30% Preventable • 20% causes treatable

28. Corneal Blindness among students of Blind Schools in West Bengal

29. Change of trend in the causes of childhood blindness in India • Corneal blindness is decreasing • Congenital whole globe abnormalities are becoming proportionately higher • ROP is likely increase in urban areas • Uncorrected refractive errors could be a major cause if detected properly

30. How to reach children- Issues • Need vs. availability of service • Need vs. uptake of service • Availability of service vs. affordability

31. Ways to reach children • School health programme • Through health workers working in MCH • ICDS – helps early detection • CBR • Outreach camps • Key informants • Public education in various forms • Networking with physicians • Utilising Immunisation days • Sensitising all levels of workers even priests

32. Motivating ICDS workers

33. Training ICDS Workers

34. Childhood blindness survey

36. Why Early Rehabilitation? • When a mother brings a visually impaired child to a doctor she doesn’t know whether the disease is curable or incurable. She needs help. • All our efforts to restore vision may fail, but we should not fail to give proper guidance to parents about the child’s overall development. • Outcome is always better if the process is started early

37. Low vision devices have greater role to play • Exhaust maximum medical management and continue follow-up • Find out suitable LVD (optical and non optical) at the earliest opportunity • Give overall training

38. Low Vision Assessment in camps

39. Practical approach • Awareness generation • Active Case finding utilising all sources • Early intervention • Individualised approach • Making devices affordable

40. Computer Braille training centre (2002), VMA School for the Blind

41. Integrated Education for a Blind child

42. Cataract

43. Sakera at Victory Stand

44. Thank you