Causes of severe visual impairment and blindness in students in schools for the blind in Northwest Ethiopia.

OBJECTIVES: To determine the causes of severe visual impairment and blindness (SVI/BL) among students in schools for the blind in Northwest Ethiopia and to identify preventable and treatable causes. METHOD: Students attending nine schools for the blind in Northwest Ethiopia were examined and causes assigned using the standard WHO record form for children with blindness and low vision in May and June 2015. RESULTS: 383 students were examined, 357 (93%) of whom were severely visually impaired or blind (<6/60 in their better eye). 253 (70.9%) were aged 16 years or above and 228 (63.9%) were males. 100 students aged <16 years were blind and four were SVI, total 104. The major anatomical site of visual loss among those 0-15 years was cornea/phthisis (47.1%), usually due to measles and vitamin A deficiency, followed by whole globe (22.1%), lens (9.6%) and uvea (8.7%). Among students aged 16 years and above, corneal/phthisis (76.3%) was the major anatomical cause, followed by lens (6.3%), whole globe (4.7%), uvea (3.6%) and optic nerve (3.2%). The leading underlying aetiology among students aged <16 years was childhood factors (39.4%) (13.5% measles, 10.6% vitamin A deficiency), followed by unknown aetiology (54.8%), perinatal (2.9%) and hereditary factors (2.9%). In the older group, childhood factors (72.3%) (25% measles, 15% vitamin A deficiency) were major causes, followed by unknown aetiology (24.1%), perinatal (2.4%) and hereditary factors (0.8%). Over 80% of the causes were avoidable with majority being potentially preventable (65%). CONCLUSION: Corneal blindness, mainly as the result of measles and vitamin A deficiency, is still a public health problem in Northwest Ethiopia, and this has not changed as observed in other low-income countries. More than three-fourth of causes of SVI/BL in students in schools for the blind are potentially avoidable, with measles/vitamin A deficiency and cataract being the leading causes

Outcome of paediatric cataract surgery in Northwest Ethiopia: a retrospective case series.

AIM: To assess visual acuity outcomes, and factors associated with the outcome, of paediatric cataract surgery at the Child Eye Health Tertiary Facility, Gondar, Northwest Ethiopia. METHODS: The medical records of children aged below 16 years who underwent cataract surgery between September 2010 and August 2014 were reviewed for preoperative, surgical and postoperative data. RESULTS: One hundred and seventy-six eyes of 142 children (mean age 7.9 years±4.2 SD, 66% male) who had cataract surgery were included. Twenty-five per cent (35/142) of children had bilateral cataract, 18 (13%) had unilateral non-traumatic cataracts and 89 (63%) had unilateral traumatic cataracts. An intraocular lens was implanted in 93% of eyes. Visual acuities at last follow-up: bilateral cases in the better eye: good (≥6/18 or fix and follow) in 21/34 eyes (62%), borderline (<6/18-6/60) in 4 eyes (12%) and poor (<6/60) in 9 eyes (26%). In unilateral non-traumatic cases: good in 6 eyes (33%), borderline in 3 eyes (17%) and poor in 9 eyes (50%). In unilateral traumatic cases: good in 36 eyes (40%), borderline in 20 eyes (23%) and poor in 33 eyes (37%). In bilateral cataract, worse outcomes were associated with preoperative nystagmus/strabismus. In traumatic cases, worse outcomes were associated with the preoperative trauma-related complications. CONCLUSIONS: Visual acuity improved significantly after surgery, with better outcomes in bilateral cases. Early detection and surgery by a trained surgeon with good follow-up and postoperative rehabilitation can lead to better visual outcomes

Visual Impairment among Primary School Children in Gondar Town, Northwest Ethiopia

Background. An impairment of the visual system at or shortly after birth adversely affects educational performance of children which typically occurs through vision. Limited evidence on the magnitude and causes of visual impairment is one of the reasons for the low priority given to eye care in low-income countries. Objectives. To estimate the prevalence and determine the causes of visual impairment in primary school children in Gondar town, Northwest Ethiopia. Materials and Methods. A descriptive cross-sectional study was conducted among 1289 children aged 5–15 years who were randomly selected in 9 primary schools (government and private) from May to June 2016. Visual acuity was measured at 6 m using Snellen’s chart, and children with an acuity of less than 6/18 in the better eye underwent refraction and a detailed eye examination. A cause of their impairment was determined. Data were recorded using pretested tools. . Statistical Package for Social Sciences version 16 was used to enter and analyze the data using 95% confidence intervals. Results. The prevalence of visual impairment was 1.8%. Refractive errors (nearly 70%) followed by strabismus and cataract, each contributing 4.3%, were the most frequent causes of visual impairment in the study population. Majority (87%) of the children had moderate degree of vision impairment, and 10–15-year age groups are the more affected ones. Children of age fifteen and above showed statistically significant association with visual impairment (p=0.005). Conclusion. The magnitude of visual impairment in primary school children in the study area is significant. School screening programme is recommended to minimize the burden of visual impairment in the study area