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
Onset of Visual Loss
since birth
first year of life
after 1yr of birth
415
90%
Female
46.53%
Male
53.47%
19
4%
17
4%
9
2%
unknown
II. Family History and Consanguinity:
Family History
Consanguinity
350
250
64.34%
300
46.95%
42.39%
200
200
family hisory
150
20.66%
unknown
50
15%
0
50
0
family
hisory
no family
history
unknown
history of
consanguinity
100
no family history
150
100
Students
Population
250
10.65%
no history of
consanguinity
unknown
III. Visual Assessment:
No. of Patients
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%
pl-ve pl+ve HM FCCF 1.8
34
7.3%
1.5
24
5.2%
19
4.1%
1.3
1
Visual Acuity
6
1.3%
4
0.9%
2
0.4%
1
0.2%
1
0.2%
0.9
0.8
0.7
0.6
0.3
VI. Functional Vision:
Functional Vison
No. of Patients
Can walk around
192 (41.73%)
Recognise face
116 (25.21%)
See prints
82 (17.82%)
V. General Assessment:
General Assessment
98%
no additional disability
hearing loss
mental retardation
physical handicap
1%
0.21%
1%
VI. Site of Abnormality:
Anatomical Site of Abnormality
Cornea
25%
Lens
18%
Uvea
5%
Retina
10%
Whole Globe
36%
optic nerve
6%
Whole globe:
Condition
No. of Patient
Microphthalmos
88(19.13%)
Anophthalmos
54(11.73%)
Phthisis
16(3.47%)
Buphthalmos
3(0.43%)
Removed
2(0.43%)
Disorganised
2(0.43%)
Endophthalmos
2(0.43%)
Condition
No. of Patients
Anterior Staphyloma
48 (10.43%)
Corneal Opacity
23 (5%)
Corneal dystrophy
17 (3.69%)
Keratoconus
7 (1.52%)
Scar
6 (1.3%)
Micro cornea
3 (0.65%)
Cornea:
Retina:
Conditions
No. of Patients
Retinal dystrophy
17 (3.69%)
Albinism
10 (2.17%)
Retinitis pigmentosa
7 (1.52%)
Retinopathy of Prematurity
6 (1.30%)
CRVO
3 (0.65%)
Lens: Number of patient with cataract and PCO were 78 students
VII. LVA Assessment:
LVA for distance:
LVA for Distance
450
401; 87.17%
400
350
300
250
2.25x
3.5x
200
not prescribed
150
100
50
48; 10.43%
11; 2.40%
0
2.25x
3.5x
not prescribed
LVA for near:
LVA for Near
40
35
34
47.2%
30
22
30.5%
25
5x illuminated sm
7.5x illuminated sm
2.5x sm
20
7.5x sm
bar magnifier
15
fresnel prism
6
8.3%
10
5
5
6.9%
2
2.7%
2
2.7%
1
1.38%
0
5x illuminated
7.5x
sm
illuminated sm
2.5x sm
7.5x sm
bar magnifier fresnel prism
hand held
mag.
hand held mag.
VII. Improvement with LVA:
VA attained with magnifiers
25
22
4.78%
No.of students
20
20
4.34%
21
4.56%
15
10
5
1.08%
5
1
0.21%
1
0.21%
1
0.21%
1
0.21%
N16
N18
N24
0
N6
N8
N10
N12
N14
Near vision notations
 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.
THANK YOU