ALBERT TOUSIF ISRAFIL (M.Optom) PARIKSHEET GOGATE (MS, FRCS) VARSHA KULKARNI (M.S)

AIM AND OBJECTIVE

Aim:

To evaluate the causes of blindness in children attending Schools for Blind in Pune and to record their improvement in functional vision with optical LVAs.

Objectives:

1. Causes of blindness among children in schools for blind in Pune.

2. Children in school for blind, who have Low Vision.

3. Improvement in visual acuity with optical LVAs.

Prospective study 1. Poona School & Home For Blind Boys, Koregaon Park.

2. Poona School & Home For Blind Girls, Kothrud.

3. Patashibai Lunkar Blind School, Panjarpur, Bhosari.

4. NFBM Jagriti School For Blind Girls, Alandi Devachi, Khed.

Inclusion Criteria:

All the candidates attending Schools for Blind between the age of 5-20 years of both the genders.

Exclusion Criteria:

1. Candidates absent from school.

2. Patients not willing to participate in study.

Materials and Procedure:

Materials:

1.APPASWAMI AIA11 SLIT LAMP 2. HEINE BETA 200 Ophthalmoscope (US Pat 4.963.014) 3. HEINE BETA 200 Retinoscope (US Pat.5.859.687).

4.UNIQUE Distance Visual Acuity Test Chart (logMAR chart) calibrated for 4 meters & reduced snellen chart for near.

5.Telescopes of 2.25x,3.5x from Unique Educational Equipments 6.Magnifiers of (i) 5x illuminated stand magnifier (ii) 7.5x illuminated stand magnifier (iii) 2.5x stand magnifier (iv) 7.5x stand magnifier (v) 1.75x bar magnifier (vi) 1.75x fresnel magnifier (vii) 10D, 15D hand held magnifiers (viii) spot magnifiers of 24D, 32D, and 40x from Unique Educational Equipments were used.

Procedure:

‘WHO/PBL Eye Examination Record For Children With Blindness And Low Vision’ Step 1: History taking of patient Step 2: Visual Acuity Assessment Step 3: Functional Vision Assessment: Step 4: General Assessment Step 5: Previous Eye Surgery Step 6: Torch light, Slit lamp Examination and Ophthalmoscopy Step 7: Refraction Step 8: Low Vision Aid Assessment Step 9: Action Needed Step10: Full Diagnosis Statistical Analysis: Microsoft Excel and SPSS software.

RESULTS

I. Gender Distribution and onset of visual loss: Gender Distribution

Female 46.53% Male 53.47% since birth

Onset of Visual Loss

first year of life after 1yr of birth unknown 415 90% 19 4% 17 4% 9 2%

II. Family History and Consanguinity: Family History

350 300 250 200 150 100 50 0 15% 64.34% 20.66% family hisory no family history unknown family hisory no family history unknown

Consanguinity

250 200 150 100 50 0 10.65% 42.39% 46.95% history of consanguinity no history of consanguinity unknown

III. Visual Assessment:

Unaided Visual Acuity 180 160 140 120 100 80 60 40 20 0 164 35.6% 99 21.5% 38 8.2% 20 4.3% 48 10% 34 7.3% 24 5.2% 19 4.1% 6 1.3% 4 0.9% 2 0.4% 1 0.2% 1 0.2% pl-ve pl+ve HM FCCF 1.8

1.5

1.3

Visual Acuity 1 0.9

0.8

0.7

0.6

0.3

VI. Functional Vision:

Functional Vison

Can walk around Recognise face See prints

No. of Patients

192 (41.73%) 116 (25.21%) 82 (17.82%)

V. General Assessment:

98%

General Assessment

no additional disability hearing loss mental retardation physical handicap 0.21% 1% 1%

VI. Site of Abnormality: Anatomical Site of Abnormality

Cornea 25% Lens 18% Retina 10% Uvea 5% Whole Globe 36% optic nerve 6%

Whole globe: Cornea: Condition

Microphthalmos Anophthalmos Phthisis Buphthalmos Removed Disorganised Endophthalmos

Condition

Anterior Staphyloma Corneal Opacity Corneal dystrophy Keratoconus Scar Micro cornea

No. of Patient

88(19.13%) 54(11.73%) 16(3.47%) 3(0.43%) 2(0.43%) 2(0.43%) 2(0.43%)

No. of Patients

48 (10.43%) 23 (5%) 17 (3.69%) 7 (1.52%) 6 (1.3%) 3 (0.65%)

Retina: Conditions

Retinal dystrophy Albinism Retinitis pigmentosa Retinopathy of Prematurity CRVO

No. of Patients

17 (3.69%) 10 (2.17%) 7 (1.52%) 6 (1.30%) 3 (0.65%)

Lens:

Number of patient with cataract and PCO were 78 students

VII. LVA Assessment:

LVA for distance: LVA for Distance 401; 87.17% 250 200 150 100 50 0 450 400 350 300 48; 10.43% 2.25x

11; 2.40% 3.5x

not prescribed 2.25x

3.5x

not prescribed

LVA for near: LVA for Near 40 35 30 25 20 15 34 47.2% 22 30.5% 10 5 5 6.9% 0 5x illuminated sm 7.5x

illuminated sm 2.5x sm 6 8.3% 2 2.7% 2 2.7% 1 1.38% 7.5x sm bar magnifier fresnel prism hand held mag.

5x illuminated sm 7.5x illuminated sm 2.5x sm 7.5x sm bar magnifier fresnel prism hand held mag.

VII. Improvement with LVA: VA attained with magnifiers

25 22 4.78% 20 4.34% 21 4.56% 20 15 10 5 5 1.08% 1 0.21% 1 0.21% 1 0.21% 1 0.21% 0 N6 N8 N10 N12 N14 Near vision notations N16 N18 N24  Visual acuity for distance which was below 1in logMAR (unaided) in RE and LE has improved to 1.0(RE) and 0.9(LE) in logMAR with LVA for distance.

Total LVA Prescribed: Percentage of children benifited with LVA Not prescribed 83.26% LVA prescribed 16.74%

Areas Of Improvement:

1.Data collected were from starting 5 years of age.

2.Children only of 4 schools were obtained.

3. Unavailability of telescopes from the manufacturers, made the examiner bound to use only two options (2.25x and 3.5x) for the distance LVA assessment. 4. Retinoscopy and ophthalmoscopy were done in undilated pupil. 5. Only optical LVA were used.

CONCLUSIONS

 The major causes of blindness in children microphthalmos and anophthalmos.

 Avoidable blindness like cataract accounted in 78 students. Lack of follow up and ampblyopia treatment.

 Corneal blindness also accounted for 29% students.

 Out of the 460 students, 16.74% improved with LVA.

 Students with Low vision were not given a chance prior to this study to improve their functional vision.

 Regular print rather than Braille.  Visual Acuity achieved upto logMAR 1.0 and Near acuity upto N6.

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