Children’s eye care issues, their causes and treatment represent a speciality and niche area within the broader sector of ophthalmology. Nonetheless, it is an essential process to reduce the prevalence of avoidable blindness.
The factors primarily responsible for children’s blindness and visual impairments have strong linkages with their social, environmental and economic backgrounds. With improvements in nutritional security and the rising usage of digital devices, children’s eye care issues have substantially shifted. These causal changes have also necessitated modifications in national-level programs and their implementation.
With the COVID-19 pandemic-induced shifts in living standards and mode of education, the burden of children’s eye care will only rise in the future.
Prevalence of Visual Impairment
Dandona L. et al. (1996) published a list of the causes of childhood blindness and strategies to reduce its prevalence. The authors identified a set of factors responsible for childhood blindness like genetic/hereditary, intrauterine, neonatal, and those related to infancy and childhood. Other miscellaneous factors included cataracts, glaucoma, and retinoblastoma
Recent studies showcase that the prevalence of preventable blindness in the country has reduced compared to the earlier studies. According to Saxena, R. et al. (2015) the causes of visual impairment in children have changed since the beginning of the millennium. Due to better nutrition and improved immunization, eye conditions amenable to preventable factors such as trachoma and pediatric corneal infections have declined. Newer challenges such as refractive errors and cataracts instead have increased.
Implications of the COVID-19 Pandemic
With the advent of technology and the coronavirus pandemic, spending more time indoors and undertaking fewer outdoor activities are known risk factors that cause myopia. Excessive use of digital devices can cause dry eyes. Eyes are accustomed primarily to far-away vision. Hence, repeated usage of near-vision devices can impact children’s eyes and cause irritation and even blurred vision.
Increased usage of digital devices coupled with lack of sunlight may affect the growth and development of children’s eyes, putting them at risk of developing near-sightedness or myopia. The impact of digital devices goes beyond disrupting eye care. Blue light, emitted from digital devices, is known to disrupt the secretion of melatonin, a hormone that regulates sleep patterns.
Trends in Eye Care
The Rashtriya Bal Swasthya Karyakram (RBSK) programme of the National Health Mission, which evaluates a child’s health, includes screening for visual disorders. However, limitations of equipment and ophthalmologists allow only for a test for refractive error. The programme has been designed primarily to identify developmental delays (usually associated with a neurological deficit) in early childhood. It does not specifically identify visual impairment in children under 4-5 years of age. Identification of common visual defects such as amblyopia after the age of 7 or 8 years makes their rectification very difficult. Unlike hearing defects which need to be identified at, or soon after birth, visual defects are best identified just before a child starts school or formal education.
In anatomical causes of blindness that include various parts of the eye, there is a newer trend in the shift of causes of blindness to the whole globe that includes microphthalmos and anophthalmos; the major reason for this shift is the genetic abnormalities related to PAX 2, PAX 6, use of alcohol and drugs, and also exposure to pesticides or fertilizers during pregnancy.
As countries become developed and literacy rates increase, technology penetration improves, and the television and mobile usage of children goes up; we can expect an increase in incidences of refractive error. Efforts must be taken to address genetic diseases in children and provide genetic evaluation, counseling, and treatment at lower costs. In their study on tribal areas in Odisha, Reddy, Sandip. et. al (2018), suggest large-scale school-level screenings, investment in skilled human resources, and the use of technology in objective refraction as viable solutions.
There is no nationwide data available on child eye health problems in India. Few studies have been undertaken to study pediatric eye health problems in the country, many emanating from South India. As per studies conducted by Murthy G.V. et al. (2002) and Dandona R. et al. (2003), the prevalence of childhood blindness in India is 0.8/1000 in the 0-15 age year group. Though the prevalence of childhood blindness in India is low, the lack of large-scale surveys and data leads to unreliable information.
Due to a lack of a database that adequately captures children’s eye issues, the country will face a grave threat in this niche yet important sub-sector of ophthalmology. In a paper by Murthy et al. (2008), the authors concluded that pediatric care services were deficient in India. As of 2019, there are only an estimated 15,000 ophthalmologists in India and only 45,000 optometrists against a required 125,000.
Most of the current eye care models in India are focused on screenings and surgeries. They include school screening, consequent referral and community-based eye health programs. There is no nationwide data available on child eye health problems in India. Few studies have been undertaken to study pediatric eye health problems in the country, many emanating from South India. Since the majority of the people inflicted with visual impairment are over the age of 50 years, several policies of the government are tiling towards interventions in the adult population. Though the prevalence of childhood blindness in India is low, the lack of large scale surveys and data lead to unreliable information.
Visual impairment affects reading and invariably the learning opportunities for children. Childhood blindness can adversely impact national literacy rates. Further, if visual impairment continues to attract stigma, visually impaired individuals may suffer from psychological and mental health care problems, socially isolating themselves in the future.
Acknowledgment: Mahi Dugar is a Research Intern at IMPRI