For low vision specialists and those who consult them
Causes of visual impairment in children
January 19, 2010Posted by on
I have just read an interesting research article in Eye, the journal of the Royal College of Ophthalmologists in the UK. The authors look at the cause of visual impairment in children who have been registered as sight impaired in one specialist paediatric ophthalmology clinic in North West England.
The most common cause of vision loss was cortical visual impairment (27%) and optic atrophy (16%). These figures are very similar to other reports from Europe or the USA.
Of the 256 children who were registered as sight impaired (previously called partially sighted in the UK) or severely sight impaired (previously registered blind), only 7 cases were thought to be avoidable. These were two cases of retinopathy of prematurity (which can be treated if detected and managed early enough); two cases of amblyopia (usually treatable with glasses and/or patching if caught early enough); two cases of trauma and one case of non-accidental injury (child abuse).
Only 10 of the children (4%) had no sight at all. This is an important figure as it shows that the overwhelming majority of children registered as sight impaired in the UK could potentially benefit from a low vision assessment. I am aware that as a low vision specialist I am biased, but I would like to have seen some discussion of this in the paper (and some check on whether these children did all receive low vision intervention).
The authors show that children with visual impairment are more likely to come from deprived areas than their peers with good vision. This is not really discussed further by the authors and I would like to know why they feel this should be the case, and (more importantly) whether targeted public health education programmes in areas of greater deprivation would be wise.
This paper is most interesting when the numbers are compared to the global picture, and the authors summarise some of these data well. It is sobering to remember that 95% of sight impaired children in the world are born in Africa, Latin America or Asia, and that many of these children will have treatable or avoidable causes of visual loss such as vitamin A deficiency, corneal scarring or cataract.
The authors show a small increase in the number of children who are registered as sight impaired in their clinic although the numbers are probably too small for meaningful analysis. They do speculate that as neonatal care for premature babies improves there may be an increase in the number of children with cerebral visual impairment surviving, so it is possible that the number of children visually impaired may increase. However, the number of children with visual problems in Europe and the USA remains tiny when compared to the developing world.