Childhood blindness remains a significant public health concern in Pakistan and causes economic burden on the family and the community. The National Committee for the Prevention of Blindness in Pakistan recently revealed a startling statistic: approximately one percent of the Pakistani population is living in darkness, with a significant portion being children i.e., approximately 1.2 per 1,000 children. Alarmingly, at least one-third of these children suffer from blindness that could have been prevented. While the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB) have launched a global initiative aimed at eliminating avoidable blindness, including childhood blindness as a key focus area, the question remains: who will translate this initiative into tangible change on the ground? This question looms large and demands urgent attention.
Children need good vision from birth until the age of seven years to ensure that their brains develop the visual pathways that will lead to healthy adult vision. Anything that obstructs their vision during this crucial time can result in lifelong visual impairment or blindness, as well as delays to their overall physical, mental, and social development; this is the case even if their eye condition is treated when they are older.
Amidst the COVID-19 pandemic, our children found themselves confined indoors for prolonged periods. Whether due to long study hours in schools and seminaries or excessive screen exposure, many developed myopia (nearsightedness), necessitating the use of eye glasses. It is imperative for parents to prioritize daily outdoor activities for their children and set limits on their own screen time before imposing restrictions on their youngsters. Moreover, incorporating simple adjustments in our daily routines and incorporating eye exercises can significantly alleviate the situation.
Vitamin-A deficiency remains a significant cause of childhood blindness. Malnutrition, poor hygiene and lack of access to healthcare exacerbate this issue particularly in rural areas. Educating parents, encouraging breastfeeding and ensuring adequate nutrition through balanced diets and vitamin-A supplementation are crucial.
Infectious diseases including measles and rubella can lead to blindness. Mothers should be screened for rubella during the first prenatal visit and after 6-12 weeks of pregnancy in the first trimester to ensure timely intervention and to prevent potential blindness in the developing fetus. Screening for vision problems should be conducted during routine pediatric visits, especially following recovery from infections like measles and rubella. High-risk children should be screened more frequently. Immunization campaigns, proper antenatal care and public health awareness are essential in combating this childhood blindness.
Regrettably, firework injuries remain the most common cause of visual loss among our children, with incidents surging during holiday seasons. It is estimated that at least one-fourth of children with firework injury suffer permanent blindness. Urgent governmental intervention is imperative to curb the accessibility of these hazardous items, which are readily available over the counter. Additionally, sharpened pencils, rulers and common household items such as knives, scissors, bleach and limestone contribute significantly to traumatic eye injuries. It is paramount for teachers and parents to maintain heightened vigilance in preventing such accidents.
Moreover, traumatic injuries resulting from child abuse are witnessing a disturbing uptick. It’s deeply distressing to witness innocent, vulnerable souls becoming victims of adult frustrations. Violent blows to the head can inflict irreversible damage to the delicate structures within the eye. Child protection units must take swift and decisive action against perpetrators of such crimes, ensuring justice and safeguarding the well-being of our children.
Children suffering from eye allergies often receive potent steroids from pharmacies without a prescription, viewed as a magic drug and quick fix for their symptoms. Alarmingly, even general practitioners may overlook the side effects of steroids that can harm vision. Misuse of steroids can lead to irreversible blinding disease known as glaucoma, and can worsen an existing infection. Shockingly, steroid-induced glaucoma accounts for nearly half of all glaucoma cases in children. Now a days, steroid-sparing agents have largely replaced the necessity for steroids in treating many ocular conditions. Hence, it’s imperative to avoid the unnecessary use of steroids. The Drug Regulatory Authority of Pakistan (DRAP) must ensure the prudent dispensing of steroids through registered pharmacists, safeguarding the ocular health of our children.
Retinopathy of prematurity (ROP) is a leading cause of avoidable childhood blindness worldwide. It affects babies born before 37 weeks of gestation requiring oxygen. Pakistan has ranked second in the globe in terms of preterm births. With the rising number of neonatal units in Pakistan, more children are likely to survive. This of course is a positive development, but the sad part is that only a few neonatal facilities get their babies screened for ROP. If untreated, severe ROP disease can result in serious vision impairment and consequently all babies at risk of sight-threatening ROP should be screened well in time. Obstetrician, pediatrician and pediatric ophthalmologist should be on board to rescue premature babies from ROP.
Congenital cataract, glaucoma and genetic anomalies also contribute to childhood blindness. Early detection and timely intervention by pediatric ophthalmologist are vital to address them. The parents, caretakers and teachers are advised to seek immediate professional help if any abnormal eye reflex or visual behavior in a child is observed.
Trachoma is another significant cause of blindness in early childhood, primarily due to poor personal and community sanitation and hygienic conditions. This infectious eye disease, caused by the bacterium Chlamydia trachomatis, spreads through direct contact with eye discharge from infected individuals or contaminated objects like towels and flies. Access to clean water, improved sanitation facilities, promoting facial cleanliness among children and implementing health education programs about good hygiene practices are helpful in trachoma prevention. Government health authorities, NGOs and community health workers should conduct regular community-based screening and treatment programs with antibiotics to control its spread.
Parents should support their visually impaired children emotionally and help them to foster their independence. Our schools and communities should promote inclusive education for visually impaired children and provide them access to educational resources. Our society should embrace diversity and celebrate the abilities of visually impaired children.
Government of Pakistan in collaboration with NGOs should raise awareness, prioritize childhood eye health in National health policy and invest in eye care facilities, training healthcare personnel and outreach programs. Parent support groups should be established where parents can share experiences and learn from each other. Government of Pakistan should develop proper mechanisms for monitoring, evaluation and supervision of the quality of care offered to visually handicapped children.
Nationwide educational campaigns should be launched to inform the public about causes and prevention of childhood blindness. Healthcare providers should implement eye screening for children in their routine practice, especially in rural and underserved areas. Collaboration with NGOs and government support is essential to enhance outreach and provide necessary resources. Integrating eye health education into school curriculum and using print, electronic and social media for awareness can also significantly contribute in reducing the childhood blindness. Close collaboration of all the stakeholders like pediatricians, sociologists, parents, family physicians, community support groups, etc., could further enhance a better eye care screening, delivery and treatment of diseases for all these children.
It is recommended that vision assessment and screening of vision abnormalities of all the children should be carried out in early school years and then annually all over Pakistan by trained primary school teachers or health personnel. Education and health departments should liaison to screen children for poor vision and bring them to hospital for treatment. Effective public health awareness programs with strong involvement of parents are required in the management of such children. General practitioners and pediatricians should be trained to screen children in their clinics for early detection, referral, diagnosis and timely management leading to better quality of life for these children. For children not attending school, community-based eye screening through lady health workers, parent’s health education and mobile health units should be organized to ensure their eye health. These measures can help detect and treat vision problems in underserved populations effectively.
Children are our collective responsibility, as parents, teachers or doctors. Even minor negligence can go a long way, affecting their career choices and shattering their dreams. Let us unite as a nation to protect our children’s eyesight.
The writer is an Associate Professor of Pediatric Ophthalmology affiliated with Sheikh Zayed Medical College, Rahim Yar Khan. He can be reached at [email protected]
