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  • Over 90 million children and adolescents have vision impairment or blindness,1 of those:
    • 2 million are blind
    • 30 million experience moderate to severe vision impairment
  • 58 million experience mild vision impairment
  • Malik et al.2 reported that children who are blind are more likely to die in childhood than a child with good vision, especially in low-income countries3
  • It is estimated that 40% of children are blind from eye conditions that could be managed if the child had access to eye care services or could be prevented4
  • The Lancet Commission5 reported that vision impairment in children is associated with lower academic outcomes,6–10 and children in LMICs are up to five times less likely to be in formal education11
  • School-based eye health programmes are cost-efficient and effective12
  • The prevalence of myopia in children is rapidly increasing in many parts of the world, and the prevalence of myopia across Southeast and East Asia is 46%.13

Early detection and treatment of eye conditions is critical, as there is an increased risk of morbidity and mortality in children due to several conditions that cause blindness, including vitamin A deficiency, metabolic syndromes and retinoblastoma.14–19   

Vision impairment in children can severely impact educational outcomes,6–10 contribute to low self-esteem,20 and future socio-economic potential.21 

The prevalence of vision impairment and blindness varies considerably within, and between countries. Refractive error is the leading cause of vision impairment (MSVI) in school-aged children.22 Other common causes of vision impairment and blindness include cataract, retinopathy of prematurity, congenital ocular anomalies, corneal scarring, and cerebral visual impairment.5,23 The most prevalent avoidable causes of blindness are corneal scarring, cataract, and retinopathy of prematurity.23 

The trends on the causes of childhood blindness have changed over the last 30 years. There has been a substantial shift in the leading causes of blindness in children in low-income countries due to the reduction of corneal blindness due to vitamin A deficiency and measles, and cataract is now the principal cause of avoidable blindness.18,24 In children, the leading causes of unavoidable blindness include genetic retinal conditions and congenital eye anomalies.4   

In school-based surveys, Uncorrected Refractive Error (URE) is the leading cause of vision impairment in children, with a prevalence range of 63-92%25  

The Lancet Commission5 reported the provision of spectacles to be one of the most effective health interventions for children, reducing the odds of failing a class by 44%, with an effect size greater than or equal to other health interventions.6–10 

The cost-effectiveness of screening and correcting refractive errors in schoolchildren has been demonstrated in a variety of settings.26,27 

The prevalence of myopia in children is rapidly increasing in many parts of the world, and varies considerably within and between regions. This is particularly so in Southeast and East Asia, where the prevalence of myopia increased from 26% prior to 2001 to 46% (2011-2015). The rapid increase in the prevalence of myopia is observed in other regions, such as Northern Ireland, where the prevalence increased from 18% to 23% between 2007 and 2017.13  

There are a number of eye conditions in children that have associated morbidity that do not cause vision impairment. Common non-vision impairing eye conditions in children include conjunctivitis (allergic and infectious), blepharitis and chalazion, which can require ongoing care and affect the quality of life of both the child and the parents.28 

Globally, over 1 billion children attend school.29 To address the eye health conditions in children, school-based eye health programmes have been adopted as they offer an effective,30–32 cost-effective model to deliver eye care to schoolchildren,27,33 and are efficient in respect to time and resources.12 School-based refraction and dispensing services increase access to spectacles.34 However, UNICEF reports gender parity is achieved in only 42% and 24% of lower secondary and upper secondary schools, respectively.35 

References

  1. Bourne R, Steinmetz JD, Flaxman S, Briant PS, Taylor HR, Resnikoff S, et al. Trends in prevalence of blindness and distance and near vision impairment over 30 years: an analysis for the Global Burden of Disease Study. The Lancet Global Health. 2021 Feb 1;9(2):e130–43. Accessed via the IAPB Vision Atlas (https://IAPB.org/learn/vision-atlas)
  2. Malik ANJ, Mafwiri M, Gilbert C. Integrating primary eye care into global child health policies. Arch Dis Child. 2018 Feb;103(2):176–80.
  3. World Health Organization. Blindness and Deafness Unit, International Agency for the Prevention of Blindness. Preventing blindness in children : report of a WHO/IAPB scientific meeting, Hyderabad, India, 13-17 April 1999. 2000;(WHO/PBL/00.77). Available from: https://apps.who.int/iris/handle/10665/66663
  4. Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020 [Supplementary appendix 1]. The Lancet Global Health. 2021 Apr;9(4):e489–551.
  5. Burton MJ, Ramke J, Marques AP, Bourne RRA, Congdon N, Jones I, et al. The Lancet Global Health Commission on Global Eye Health: vision beyond 2020. The Lancet Global Health. 2021 Apr;9(4):e489–551.
  6. Glewwe P, West KL, Lee J. The Impact of Providing Vision Screening and Free Eyeglasses on Academic Outcomes: Evidence from a Randomized Trial in Title I Elementary Schools in Florida. J Policy Anal Manage. 2018;37(2):265–300.
  7. Glewwe P, Park A, Zhao M. A better vision for development: Eyeglasses and academic performance in rural primary schools in China. Journal of Development of Economics. 2016 Sep 1;122:170–82.
  8. Hannum E, Zhang Y. Poverty and Proximate Barriers to Learning: Vision Deficiencies, Vision Correction and Educational Outcomes in Rural Northwest China. World Dev. 2012 Sep 1;40(9):1921–31.
  9. Ma X, Zhou Z, Yi H, Pang X, Shi Y, Chen Q, et al. Effect of providing free glasses on children’s educational outcomes in China: cluster randomized controlled trial. BMJ. 2014 Sep 23;349:g5740.
  10. Ma Y, Congdon N, Shi Y, Hogg R, Medina A, Boswell M, et al. Effect of a Local Vision Care Center on Eyeglasses Use and School Performance in Rural China: A Cluster Randomized Clinical Trial. JAMA Ophthalmol. 2018 Jul 1;136(7):731–7.
  11. Kuper H, Dok AM, Wing K, Danquah L, Evans J, Zuurmond M, et al. The Impact of Disability on the Lives of Children; Cross-Sectional Data Including 8,900 Children with Disabilities and 898,834 Children without Disabilities across 30 Countries. PLOS ONE. 2014 Sep 9;9(9):e107300.
  12. Minto H, Ho M. What is comprehensive school eye health? Community Eye Health Journal. 2017 Sep 1;30:21–5.
  13. Sankaridurg P, Tahhan N, Kandel H, Naduvilath T, Zou H, Frick KD, et al. IMI Impact of Myopia. Investigative Ophthalmology & Visual Science. 2021 Apr 28;62(5):2
  14. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020 — The Right to Sight. Bulletin of the World Health Organization. 2001;6.
  15. Rahi JS, Cable N, British Childhood Visual Impairment Study Group. Severe visual impairment and blindness in children in the UK. Lancet. 2003 Oct 25;362(9393):1359–65.
  16. Gilbert C. Worldwide Causes of Blindness in Children. In: Wilson ME, Trivedi RH, Saunders RA, editors. Pediatric Ophthalmology: Current Thought and A Practical Guide [Internet]. Berlin, Heidelberg: Springer Berlin Heidelberg; 2009. p. 47–60. Available from: https://doi.org/10.1007/978-3-540-68632-3_5
  17. Maida JM, Mathers K, Alley CL. Pediatric ophthalmology in the developing world. Curr Opin Ophthalmol. 2008 Sep;19(5):403–8.
  18. Kong L, Fry M, Al-Samarraie M, Gilbert C, Steinkuller PG. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2012 Dec;16(6):501–7.
  19. Courtright P, Hutchinson AK, Lewallen S. Visual impairment in children in middle- and lower-income countries. Arch Dis Child. 2011 Dec;96(12):1129–34.
  20. Rainey L, Elsman EBM, van Nispen RMA, van Leeuwen LM, van Rens GHMB. Comprehending the impact of low vision on the lives of children and adolescents: a qualitative approach. Qual Life Res. 2016 Oct;25(10):2633–43.
  21. Schneider J, Leeder SR, Gopinath B, Wang JJ, Mitchell P. Frequency, course, and impact of correctable visual impairment (uncorrected refractive error). Surv Ophthalmol. 2010 Dec;55(6):539–60.
  22. Resnikoff S, Pascolini D, Mariotti SP, Pokharel GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health Organ. 2008 Jan;86(1):63–70.
  23. Gilbert C, Vijayalakshmi P, Bhaskaran S, Udupihille T, Muhiddin HS, Windy DA, et al. Childhood Blindness and Visual Impairment. In: Das T, Nayar PD, editors. South-East Asia Eye Health: Systems, Practices, and Challenges [Internet]. Singapore: Springer Singapore; 2021. p. 169–95. Available from: https://doi.org/10.1007/978-981-16-3787-2_11
  24. Gogate P, Kalua K, Courtright P. Blindness in Childhood in Developing Countries: Time for a Reassessment? PLOS Medicine. 2009 Dec 8;6(12):e1000177.
  25. Naidoo KS, Jaggernath J. Uncorrected refractive errors. Indian J Ophthalmol. 2012;60(5):432–7.
  26. Baltussen R, Naus J, Limburg H. Cost-effectiveness of screening and correcting refractive errors in school children in Africa, Asia, America and Europe. Health Policy. 2009 Feb 1;89(2):201–15.
  27. Frick KD, Riva-Clement L, Shankar MB. Screening for refractive error and fitting with spectacles in rural and urban India: cost-effectiveness. Ophthalmic Epidemiol. 2009 Dec;16(6):378–87.
  28. Zhang S, Li J, Liu R, Lao HY, Fan Z, Jin L, et al. Association of Allergic Conjunctivitis With Health-Related Quality of Life in Children and Their Parents. JAMA Ophthalmology [Internet]. 2021 Jun 10 [cited 2021 Aug 18]; Available from: https://doi.org/10.1001/jamaophthalmol.2021.1708
  29. Education | UNICEF [Internet]. [cited 2021 Dec 9]. Available from: https://www.unicef.org/education
  30. Evans JR, Morjaria P, Powell C. Vision screening for correctable visual acuity deficits in school-age children and adolescents. Cochrane Database Syst Rev. 2018 Feb 15;2:CD005023.
  31. Rono HK, Bastawrous A, Macleod D, Wanjala E, Tanna GLD, Weiss HA, et al. Smartphone-based screening for visual impairment in Kenyan school children: a cluster randomised controlled trial. The Lancet Global Health. 2018 Aug 1;6(8):e924–32.
  32. Sheeladevi S, Seelam B, Nukella PB, Modi A, Ali R, Keay L. Prevalence of refractive errors in children in India: a systematic review. Clinical and Experimental Optometry. 2018 Jul 1;101(4):495–503.
  33. Wodon Q. LOOKING AHEAD: VISUAL IMPAIRMENT AND SCHOOL EYE HEALTH PROGRAMS. :40.
  34. Morjaria P, Evans J, Murali K, Gilbert C. Spectacle Wear Among Children in a School-Based Program for Ready-Made vs Custom-Made Spectacles in India: A Randomized Clinical Trial. JAMA Ophthalmology. 2017 Jun 1;135(6):527–33.
  35. UNICEF. Girls’ education [Internet]. [cited 2021 Dec 9]. Available from: https://www.unicef.org/education/girls-education