Causes and temporal trends of blindness and severe visual impairment in children in schools for the blind in North India

Aims: To describe the causes of severe visual impairment and blindness (SVI/BL) in children in schools for the blind in north India, and explore temporal trends in the major causes. Methods: A total of 703 children were examined in 13 blind schools in Delhi. A modified WHO/PBL eye examination record for children with blindness and low vision which included sections on visual acuity, additional non-ocular disabilities, onset of visual loss, the most affected anatomical part of the eye concerning visual impairment, and the aetiological category of the child's disorder based on the timing of insult leading to visual loss was administered in all children. Results: With best correction, 22 (3.1%) were severely visually impaired ( visual acuity in the better eye of < 6/60) and 628 (89.3%) children were blind ( visual acuity in the better eye of < 3/60). Anatomical sites of SVI/BL were whole globe in 27.4% children, cornea 21.7%, retina 15.1%, and lens 10.9%. The underlying cause of visual loss was undetermined in 56.5% children ( mainly abnormality since birth 42.3% and cataract 8.3%), childhood disorders were responsible in 28.0% ( mainly vitamin A deficiency/measles 20.5%), and hereditary factors were identified in 13.4%. Study of temporal trends of SVI/BL by comparing causes in children in three different age groups - 5 - 8 years, 9 - 12 years, and 13 - 16 years - suggests that retinal disorders have become more important while childhood onset disorders ( particularly vitamin A deficiency) have declined. Conclusions: Almost half of the children suffered from potentially preventable and/ or treatable conditions, with vitamin A deficiency/measles and cataract the leading causes. Retinal disorders seem to be increasing in importance while childhood disorders have declined over a period of 10 years.