“Childhood blindness” describes a number of diseases and conditions that occur in childhood and early adolescence. Preventing and treating childhood blindness is a priority for ORBIS International. Most serious pediatric eye disorders can be prevented or avoided. But when they do occur, and often in spite of attempts at treatment or if left untreated — as is usually the case in developing countries — they can result in a lifetime of blindness.

Saddi Shadri, born with bilateral cataracts, was nearly blind when he attended an ORBIS patient screen- ing day in Uganda.

Reducing childhood blindness depends on the availability of primary health care. This includes a proper diet replete with vitamin A, rubella immunization for young women and infants, and a clean, hygienic environment. Also important are increasing public awareness of the harm that can arise from eye trauma, traditional medicine or home remedies for eye injuries, and marriages between blood relatives.

Because a child’s eye is very different from an adult’s — it is especially susceptible to nutritional deficiencies and infections — the diagnosis and surgical treatment of children requires specialized equipment and training in pediatric ophthalmology. Resources for pediatric ophthalmology, however, are extremely limited in developing countries, and public awareness and government initiatives are also lacking.

In developing countries, the primary causes of childhood blindness include:

• Corneal scarring from measles, vitamin A deficiency, disease transmission through the birth canal (ophthalmia neonatorum) or the use of harmful, traditional home remedies
• Cataracts from rubella
• Cataract, glaucoma and retinal dystrophies of genetic origin
• Retinopathy of prematurity (ROP) caused by premature birth
• Amblyopia, which occurs when the brain fails to learn to see as the result of strabismus (squint) or uncorrected refractive error

Arjun Kumbhar is being treated for bilateral glaucoma at an ORBIS- supported clinic in India.

How common is childhood blindness?

According to the World Health Organization, an estimated 1.4 million children are needlessly blind. Combating childhood blindness has been identified by the World Bank as the most cost-effective of health interventions. It is considered a priority area in global blindness prevention due to the number of years of blindness that will ensue — devastating families and keeping children from contributing to their communities.

Blindness prevention in childhood

The major preventable causes of childhood blindness are:

• Vitamin A deficiency
• Measles
• Disease transmission through the birth canal (ophthalmic neonatorum)

Preventive measures include the distribution of vitamin A tablets, immunizations and prenatal as well as perinatal care.

Treatment of childhood blindness

The major treatable causes of childhood blindness are:

• Retinopathy of prematurity (ROP)
• Cataract
• Glaucoma

In order to treat ROP, cataract and glaucoma, children's eye care services must be readily available and provided both early and effectively. This means that more doctors must be trained to deal full- or part-time in the subspecialty of pediatric ophthalmology.

What ORBIS is doing about childhood blindness in developing countries

ORBIS was one of the first organizations working in developing countries to make the prevention

Nguyen Thu Phong of Vietnam was cured of ROP by ORBIS- trained physicians.

and treatment of childhood blindness a priority. ORBIS is strengthening pediatric eye care capacity by offering training as well as financial and technical support to its partners.

Examples of ORBIS pediatric eye care projects include:

The Chittagong Eye Infirmary and Training Center (CEITC) project in Bangladesh
This project began in March 2001 with the objective of offering pediatric training to ophthalmologists and other professionals working in pediatric ophthalmology units. CEITC now has a separate pediatric eye care unit, trained pediatric eye care specialists and the necessary diagnostic and surgical equipment for the treatment of a child's eye. In 2005, nearly 41,000 children were examined and nearly 2,000 received surgery from the unit. With ORBIS’s support, CEITC has emerged as the first training facility of its kind in Bangladesh and is now conducting its own pediatric training programs for Bangladeshi eye care professionals.

ROP programs in Vietnam
To prevent retinopathy of prematurity in Vietnam, ORBIS first worked with its Vietnamese partners in Hanoi to screen, diagnose and treat infants for this condition. Because of the project’s success, the program is being rolled out in other parts of Vietnam.

In the past, developing countries generally focused on treating ROP rather than preventing it. In Vietnam, ORBIS is:

• Providing training to neonatologists in diagnosing, monitoring and managing the possible complications of prematurity
• Raising awareness among parents and caregivers of ROP
• Strengthening capacity to monitor and treat infants already suffering from ROP

Menelik II Hospital in Addis Ababa, Ethiopia
With ORBIS’s support, Menelik II Hospital in Addis Ababa, Ethiopia, opened its first pediatric ophthalmology unit in March 2003. Prior to the opening of this unit, the hospital didn’t have any pediatric ophthalmologists or equipment to diagnose or treat children. ORBIS has supported two Ethiopian ophthalmologists in their training in the United States for pediatric ophthalmology. Now they can provide specialized care and treatment to thousands of children in their home country. To strengthen pediatric eye care throughout Ethiopia, the Menelik II Hospital operates as a training center for Ethiopian eye care professionals.

Sadguru Nethra Chikitsalaya Hospital in Chitrakoot, India
Working with the Sadguru Nethra Chikitsalaya Hospital in Chitrakoot, India, ORBIS is developing specialties in pediatric ophthalmology through hospital-based training programs addressing environmental factors, cataract, refractive error and strabismus. School children are now screened for eye conditions and diseases, and community health workers are providing education on eye health issues.

For more information on causes of childhood blindness in developing countries, see:

• Cataract
• Corneal blindness
• Glaucoma
• Retinoblastoma
• Retinopathy of prematurity
• Strabismus