The Frequency Of Visual Impairment In Children Attending The Out- Patient Clinic Of Ain Shams University Hospital Due To Different Ocular Conditions

Abstract

Childhood vision disorders are prevalent and are a significant public health problem. Early identification, diagnosis and correction of children's vision disorders are essential parts of all child health programs. The early detection and treatment of vision disorders give the visual system and brain an opportunity to develop normally by preventing permanent vision loss; thus giving children a better opportunity to develop educationally, socially and emotionally. A study of the patterns of ocular diseases in children is very important because, while some eye conditions are just causes of ocular morbidity, others invariably lead to blindness. Also while some conditions such as refractive errors and cataract are treatable others like measles and vitamin A deficiency are largely preventable. There are few data available on the prevalence and types of refractive errors, strabismus, amblyopia, lens-related visual impairment and ocular malformation in children in developing countries. Therefore, the magnitude of the problem needs a systematic assessment. That, early ocular assessment of children can facilitate correction of ocular morbidity of the victims. Visual impairment is a major public health concern. In order to help nations combat visual impairment, it is important to determine the specific aetiologies by region.This will enable each nation to better understand its specific needs, and better ensure thatappropriate resources are efficiently allocated for prevention and treatment. Weconducted this study to determine avoidable causes of childhood blindness and visual impairment so that a nationwide intervention can be planned. 403 children had been included in this study aged 4 to 14 years,175 (43%) were males while 228 (57%) were females children. Once a child was enrolled full detailed history had been taken, medical history, presence of other disabilities, previous eye surgery and eye examination was performed, including: visual acuity, pupils,extraocular motility, intraocular pressure with Goldmann applanation tonometer asnecessary, anterior segment examination by handheld light or slit lamp and dilation of eyesfor cycloplegic refraction by retinoscopy and Fundoscopic examination with a direct orindirect ophthalmoscope. For dilation, cyclopentolate hydrochloride 1% was instilled in all children. We found that 66 children (16.50% of the total 403 children) were visually impaired (had best corrected visual acuity less than 6/18).While the other 337 children (83.50%) had normal vision (BCVA between 6/6 and 6/18).

Of those 66 visual impaired children, refractive errors were the major cause of the impairment (41 children 62% of total impaired children) then amblyopia (10 children=15%) and strabismus (6 children= 9%) and other causes such as cataract, trauma, trachoma and congenital issues (9 children=14%). In the other hand, wefound that 30% of the studied children had eye diseases. The most important eye diseases were refractive errors 105 (26.25%) of overall 403 participated children, ocular surface diseases 57 (14.25%), amblyopia 20 (5%), strabismus 11 (2.75%), congenital anomalies 4 (1%), lens-related visual impairment 2 (0.75%) and other different ocular diseases 12 (3%) including blepharitis, chalazion, stye,lid ptosis. All eye diseases were more common in low socioeconomic families. The most important significant risk factors were previous eye diseases, no early consultation for eye diseases, never received eye examination, low level of parental occupation, sibling(s) with eye diseases, last birth order child and female sex. Therefore,more studies on big number of children in rural and urban areas are recommended and focusing on early examination of children as visual impairment is a big problem that can affect the child’s performance in school and may also cause severe ocular disability in the later part of life.