Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 10232

AbstractMaterial and MethodsResultsDiscussionConclusionReferences
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2009 | Month : February | Volume : 3 | Issue : 1 | Page : 1255 - 1260

Childhood Blindness In India – Regional Variations

MADGULA I Correspondence Address :
Dr.Indira Madgula.Email:indiramadgula@yahoo.co.uk

Abstract

Background: Childhood blindness (CB) has far reaching implications for the affected child in educational, employment, personal and social aspects. In India, the overall prevalence is estimated to be a dismal 0.8/1000 children, ranging from 0.3% in well-developed states (like Kerela) to 1.5% in the poorer states.
Aim: To identify and compare the aetiology of blindness in children in two geographically different areas of India and to assess the impact of the social and rehabilitative measures available to them.
Materials and Methods: A total of 254 students in three blind schools, each in Delhi and Madurai were examined and the data was analysed.
Results: No difference was noticed in age, gender and in the rehabilitative and social support system, but for increased consanguinity in the south (47%). Causes of blindness were anomalies of the globe (32.8% vs. 30.8%), Retina (20% vs. 24%), lens and cornea (15% each vs. 10% each), optic nerve (7% vs. 15%) and others (10.2%), with significant regional variation among children of similar visual status. The social acceptance of the blind was gratifying. More than 80% of the students were fluent in Braille, extracurricular activities and vocational skills training in both parts of the country.
Conclusion: This study showed significant regional variations in the patterns of childhood blindness in India that may require different strategies to tackle the problems in these areas.

Keywords

Key words: aetiology, childhood blindness, Regional variations

Background
Prevention of childhood blindness has been prioritised in the World Health Organization’s (WHO’s) VISION 2020 – The Right to Sight programme(1). It aims to reduce the incidence of childhood blindness from 0.75 per 1000 children to 0.4 per 1000 children by the year 2020 (1).
Childhood blindness (CB) has far reaching implications for the affected child in educational, employment, personal and social aspects. The numbers of blind years suffered by the child are much more than those suffered by their geriatric counterparts (2). The aetiology is multifactorial and is influenced by socio-economic status, available health care services and geographic locales (3).

Treating children with visual problems requires special expertise that is not always available in many remote areas of the developing world. Many causes of CB are avoidable or treatable, which underlines the need for more resources to meet this challenge.(2),(3).

It is estimated that there are 1.5 million blind and severely visually impaired children in the world (4). The incidence of childhood blindness varies, ranging from 1.5/1000 children in low-income countries to 0.3/1000 in high-income ones (1),(5). In India, the overall prevalence is estimated to be a dismal 0.8/1000 children, translating to a staggering 2.7 lakhs children who are blind. This ranges from 0.3% in well-developed states (like Kerala) to 1.5% in the poorer states (3).

There is significant regional and urban rural variation in the prevalence and pattern of childhood blindness in our country. This underscores a need to develop strategies that cater to the needs of that particular segment(3).

Aim Of The Study
To identify and compare the aetiology of blindness in children in two geographically separated areas of India and to assess the impact of social and rehabilitative measures available to them.

Material and Methods

Methods
The study population was derived from special schools for the blind and visually impaired. The study was approved by the ethics committee of the department and permission was obtained from the principals of the schools. They were visited by the author (IM) during Aug 2001- Jan 2003. Three schools were in the national capital of New Delhi (North India), while the other three were situated in and around Madurai (in south India). Blind schools in both cities admit children from large segments of the regional population. Delhi (national capital) admits children from various north Indian states, while similar schools in Madurai cater to a huge segment of the rural Tamil population. All children underwent an anterior segment examination with a torch and a magnifying loupe. Intraocular pressures were not measured routinely. Posterior segment examination was carried out with a direct or indirect ophthalmoscope after dilatation with 1% tropicamide. Visual acuity was assessed using the illiterate Snellen E chart, with the current spectacle correction. Navigational vision was assessed by the ability to move around chairs unaided and by the ability in recognising faces. Children requiring further examination and assessment were referred back to the respective regional ophthalmic institution.
Those with a best corrected visual acuity in the better eye, less than 3/60, were recorded as blind, those between 3/60 and 6/60 as severely visually impaired and those with 6/18 to 6/60 as visually impaired as per the WHO classification (1).Sociodemographic data, visual acuity, anatomical site of blindness/ diagnosis and rehabilitative measures were entered in a questionnaire based on the WHO/PBL form. This was later analysed using descriptive statistical methods.

Results

Sociodemographic Data
A total of 134 children (90 M, 64 F) in North India (Delhi) and another 120 (73 M, 47 F) in South India (Madurai) were examined. Their ages ranged from 5-16 years, with a mean age of 10.6 years.
In the North Indian cohort, 61.9% (n=83) hailed from urban areas as compared to 32.5% (n=39) down south, the remaining from rural communities.
The majority of the blind children were Hindus in both parts of the country (94.02% vs 87.5% in north and south respectively).

A significant number of children (47.27%) were born to consanguineous marriages in the south, as compared to the north (5%).
Social acceptance of the blind, assessed by children visiting their native place during holidays, fairs and festivals and similar visits by parents and relatives to the institution, as recorded in the school register, was gratifying (more than 92%) in both the study samples.

More than 80% of the students were fluent in Braille, extracurricular activities and vocational skills training in both parts of the country.

A total of 103 children (76.86%) in the north Indian sample and 96(80%) in the south Indian sample, were blind, 6.71% vs. 11.66% severely visually impaired, the rest being visually impaired (Table/Fig 1).

Aetiological Aspects And Anatomical Sites Affected
The major cause of childhood blindness in both the groups was globe anomalies, followed by retinal disorders. Afflictions of the lens and optic nerve anomalies were third in order in the north and south Indian populations, respectively. The anatomical site of blindness in both sections of the population has been shown in (Table/Fig 2).

Preventable causes accounted for 24.6% and 16.66% in the north and south Indian cohorts, respectively. Avoidable causes included cataracts (13.25%), glaucoma and uveitis (1.90% each) and uncorrected refractive errors.

Discussion

WHO defines blindness as less than 3/60 vision in the better seeing eye(1).UNICEF defines a child as an individual who is less than 16 years of age (1).

Data about childhood blindness in the general population is difficult to obtain, as population based surveys are time consuming, cumbersome and expensive. Surveying blind schools is more pragmatic, as a large sample of affected children can be examined in a short duration of time. This method of sampling in these regions is easier and relatively inexpensive. However, the data obtained is potentially biased. It is believed that in developing countries, only 10% of the blind children attend blind schools (1),(2).Ignorance of parents and geographical inaccessibility to the schools are major factors among those residing in remote and poor areas. A culture of mistrust and scepticism exists in some tribal and village communities regarding such centres, which further hinders access. Most blind schools do not admit children below 5 years of age and hence, preschool children are excluded from these studies.

Sociodemographic And Rehabilitative Aspects
There is a male preponderance in the study, the sex ratio being 2:1 in north India and 1.6:1 in the south. The gender bias could be explained by parents wishing to admit their sons with an aim to rehabilitate them and give them vocational training for an economically independent future. Due to the social stigma associated with blindness, a girl child is less likely to have access to blind schools.
The low percentage of rural children in residential care in north India could be due to poor parental education about rehabilitative services and lack of accessibility to special schools for the visually handicapped.

Aetiological Aspects And Changing Trends
Hereditary aetiologies were a predominant cause of childhood blindness in the present study, irrespective of the geographical location. A significantly high percentage of consanguinity (uncle/niece or first cousin) in south India, could probably explain the increased incidence of hereditary disorders in this community. A similar observation was made in a study conducted in Sri Lanka which has a significant Tamil population(6).This section needs to be a target of health and family education by social and health care workers. In north India hereditary disorders could be the result of an endogamous population in the absence of consanguinity per se.

Globe anomalies (micropthalmos, anopthalmos, cryptophthalmos) contributed to almost 1/3 of childhood blindness in both parts of the country, 32.8%(n=44) and 30.83% (n=37) in north and south India respectively. This trend was also noticed in a study in Maharashtra (Western India) where 41.3% of blind children had globe anomalies(3). They postulated that globe anomalies may be the result of interactions between genes controlling retinoic acid signalling and maternal VAD during early foetal development, exposure to pesticides, environmental factors (intrauterine infections, recreational drugs, alcohol, hyperthermia and maternal hypothyroidism) or chromosomal anomalies(3). However, such an observation cannot be explained by any single factor and requires molecular work up and extensive research to identify the cause and define effective prevention strategies.

Retinal afflictions (Retinitis pigmentosa, Retinal dystrophies, congenital rubella or syphilis) form the next important category attributing to 1/5 of the total cases. Retinopathy of Prematurity (ROP) was not observed in our series. In the developed world, ROP accounts for a significant proportion of retinal afflictions (almost half of the retinal causes of blindness)(4). A high neonatal mortality rate in the developing countries could explain the difference. However, due to improved neonatal care, more cases are being reported, which calls for effective screening of this condition(3),(5).Retinitis pigmentosa and dystrophies have an underlying hereditary cause that can be prevented by genetic counselling. Early eye screening of children for low visual aids and public education to create more awareness may help integrate these children into mainstream education.

Lens anomalies (congenital cataracts, posterior capsular opacities, uncorrected aphakia), potentially treatable causes of blindness contribute to 15.67%( n=21) of childhood blindness in the north Indian sample. In the south, the number was slightly less at 10.83%(n=13). This is indeed sad, as children in blind schools should be examined by an ophthalmologist prior to admission. These children at this stage usually develop dense amblyopia, which is refractory to treatment. Vijaylakshmi P in 1998 made a similar observation during routine screening of children in blind schools in Madurai. Congenital cataract formed a significant cause of treatable blindness while many children were blind due to surgical complications or poor post surgical visual rehabilitation (7).

Down south, optic nerve disorders comprised 15.83% of the cases, the insult mainly being due to optic nerve hypoplasia, optic atrophy, tumours or meningitis. The incidence of such disorders is almost half in the north (7.46%, n=10). Optic nerve problems account for half the cases of childhood blindness in the western world (4). This inter regional variation could again be due to the high incidence of consanguinity in the south Indian population. Dissuading consanguineous marriages by the local health care workers, religious leaders and social workers in the community may help attenuate this problem in the future. This is a daunting task as deeply ingrained customs, traditions and belief systems are resistant to change.

Corneal blindness (due to congenital dystrophies, leucomas, keratomalacia due to vitamin A deficiency) was fourth in order in both north and south India, the percentage being 14.92% and 10.8% respectively. This again is amenable to surgical correction with either keratoplasty or optical iridectomy before the development of amblyopia (7).Corneal scarring is preventable by proper immunization, maternal and child health care, health education, good nutrition, essential drugs, clean water supplies and good sanitation, control of endemic diseases and treatment of common conditions which are the essential elements of primary health care (1). The role of traditional eye medications in causation is difficult to assess due to unreliable history and poor record keeping. The regional variation reflects the success of immunization programs, vitamin A supplementation and primary health care down south. In Ethiopia, cornea was the major anatomical site of childhood blindness (62.4%of total cases). Vitamin A Deficiency (VAD) / measles accounted for 70.1% of corneal scarring/ phthisis, which reflects inadequate immunisation coverage, poor nutrition and health services for children in Africa (8).

Congenital glaucoma, uveitis, trauma and uncorrected refractive errors add up to the remaining aetiologies with an almost equal distribution in both parts of the country.

The pattern of blindness observed in the present series is midway between the patterns seen in the developed west and developing Africa. In the UK, CNS or optic nerve disorders were the commonest cause of visual impairment (50%), followed by retinal afflictions (36%) and globe anomalies (11%). Corneal opacity and congenital glaucoma was uncommon and there were no cases of congenital cataract (4). In Ethiopia, the major anatomical site of visual loss was cornea (62.4%), followed by optic nerve lesions (9.8%), cataract/ aphakia (9.2%) and lesions of the uvea (8.8%) (8).
However, VAD that was an important cause of childhood blindness and severe visual impairment in India a decade ago (9) has declined signalling the success of immunization programmes and Vitamin A supplementation programmes launched by the government.

Vijaylakshmi et al have recommended that children with vision better than counting fingers (CF) should be investigated thoroughly and refracted so that they can achieve the best-corrected visual acuity with appropriate glasses. They observed that children with high myopia, macular dystrophy, congenital nystagmus, microphthalmos, albinism, coloboma, cone dystrophies and even optic atrophies, with refraction showed improvement for distant and near vision or near vision alone(7). Pal N in North India, concluded that 35.3% of children admitted to blind schools (with afflictions like aphakia, coloboma, refractive error and microphthalmos) benefited from spectacle correction underlining the importance of low vision services in this part of the country(10).

Rehabilitative Aspects
Data collected regarding frequency of family visits and child visits to their homes during holidays and the festival seasons -revealed a high level of acceptance by families.
In the present study, Braille was the medium of communication (reading and writing) for majority of the children. The Braille code consists of about 150 shapes and over 250 rules of usage and is difficult to learn(11).Children were also being taught vocational skills like weaving baskets, sewing, candle making etc to make them economically independent when they left school. They were encouraged to participate in extracurricular activities like music, drama and physical education. However, the technology and techniques available to their counterparts in the developed world like CCTV, electronic speech output devices; Information technology and microelectronic technology are distant dream in India(11). Thus a blind child with restricted choice in our set up is more likely to have limited opportunities to fully realise his/her potential. The use of advanced technology that would tap the potential of the visually impaired child to the fullest would require large amount of funding from the central and state government – a difficult proposition. Current observation and published data suggest that provision of low visual aids to the seemingly small sector of children in both parts of the country could help them read print. Such reorganization is psychologically more superior and socially acceptable. This will facilitate integration of visually impaired children into mainstream education. It would require a dedicated, specialist and suitably trained workforce familiar with the disorders in children and a working knowledge of low visual aids. The VISION 2020 targets to ensure one paediatric ophthalmologist per 10 million people by 2020 and development of low-cost, high quality, low-vision devices that are widely available in low-income countries(1). This requires initiative and political commitment from the state and central governments in India. Opportunities, to train the required number of paediatric ophthalmologists and refractionists to tackle the challenge of vision loss in children and provision of proper infrastructure for young ophthalmologists to gain expertise have to be created. Incentives to work with children in rural areas should be high on their agenda, as most experts tend to be confined to the urban cities leaving the rural population greatly at a disadvantage. India is a pluralistic society and local teams of health care workers who understand the customs and culture of the place can probably make a difference in surmounting this problem.

Conclusion

This study showed significant regional variations in the patterns of childhood blindness in India that may require different strategies to tackle the problems in these areas. Discouragement of consanguineous marriages in the south and better primary health care (immunizations, Vitamin A supplementation) in the north may be an answer to the problem locally. A normal vision is an essential pre-requisite for the complete physical, psychological and personal development of the child. It is his fundamental right and our duty to make him/her exercise it to the fullest extent possible.

References

1.
. Gilbert C, Foster A. Childhood blindness in the context of VISION 2020 – The right to sight. Bull World Health Organ . 2001;79(3):227-32.
2.
. Kello A B, Gilbert C. Causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia. British Journal of Ophthalmology 2003; 87: 526-30.
3.
. Gogate G, Deshpande M, Sudrik S et al. Changing pattern of childhood blindness in Maharashtra, India. British Journal of Ophthalmology 2007 Jan;91(1):8-12.
4.
. Alagaratnam J, Sharma TK, Lim CS et al. A survey of visual impairment in children attending the royal Blind school, Edinburgh using the WHO childhood visual impairment database. Eye 2002. Sep;16(5):557-61.
5.
. Titiyal JS, Pal N, Murthy GVS. Causes and temporal trends of blindness and severe visual impairment in children in schools for the blind in North India. British Journal of Ophthalmology. 2003; 87:941-45.
6.
. Eckstein M B, Foster A, Gilbert C E. Causes of childhood blindness in Sri Lanka: results from children attending six schools for the blind. British Journal of ophthalmology 1995; 79:633-636.
7.
. Vijaylakshmi P. Children in Blind schools: What conditions should be treated. Community Eye Health 1998; 11(27): 35-36.
8.
. Kello AB, Gilbert C. Causes of severe visual impairment and blindness in children in schools for the blind in Ethiopia. British Journal of Ophthalmology 2003; 87: 526-30.
9.
. Rahi JS, Sripathi S, Gilbert CE et al. Childhood blindness due to Vitamin A deficiency in India : regional variations. Arch Dis Child. 1995 ; 72 (4): 330-33.
10.
. Pal N, Titiyal JS, Tandon R et al. Need for optical and low vision services for children in schools for the blind in North India. Indian Journal of Ophthalmol 2006;54:189-93.
11.
. Buultjens M, Aitken S. The challenge of new technology in Education. In:Fielder AR, Best AB, Bax M (eds). The management of visual impairment in childhood. Mac Keith Press: London; 1993. 163-72.

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com