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Approximately 500,000 children become blind worldwide each year. This figure represents one new case of pediatric blindness every minute. It has been estimated that today there are 1,400,000 blind children in the world,1 and many of these children will not survive beyond 2 years of age. While 1,000,000 are considered untreatable by current standards due to retinal dystrophy, microphthalmos, cortical blindness, and optic atrophy or hypoplasia, the remaining 400,000 cases are potentially treatable. The main avoidable causes are corneal scarring from infection or trauma (260,000), cataract (50,000), and retinopathy of prematurity (ROP; 40,000).2 Other treatable blinding conditions include amblyopia and uncorrected refractive error. Much of the data concerning causes of pediatric blindness in developing countries come from studies of children attending schools for the blind. This information may represent a bias, since data from children not attending these schools would not be included.

In developed areas, the main causes of pediatric blindness are ROP, perinatal hypoxic brain injury, optic nerve hypoplasia, inherited retinal dystrophies, congenital anomalies, cataract, and glaucoma. These disorders are largely not preventable, but some are treatable. Geographically, 90% of all pediatric blindness (1,300,000) occurs in developing countries with 24% in Africa, 20% in India, and 29% in the rest of Asia (Fig. 582-1). In these areas, the major causes of childhood blindness are vitamin A deficiency, trachoma, ophthalmia neonatorum, measles infection, harmful traditional medicines, and trauma. All these conditions are largely the result, directly or indirectly, of malnutrition, lack of sanitation, or infection, and most of these factors cause blindness primarily through corneal scarring. All of these conditions are preventable or treatable. Blindness in children due to uncorrected major refractive errors occurs in 0.6% to 2.6% of children in developing areas. In China, it is thought that nearly 6 millions children are visually impaired simply because they are in need of glasses that they may never receive.3

Figure 582-1.

Estimates of pediatric blindness by region. Top number = total number of blind children. Bottom number = number blind from avoidable causes. Below each set of numbers is the major cause of regional childhood blindness. ROP, retinopathy of prematurity.

In some areas of the world, there are more specific localized causes of blindness. For example, in Brazil, endemic toxoplasmosis is very common and often results in bilateral macular scars with resultant legal blindness. In Uganda, rubella-related congenital cataract is frequently encountered. In Sri Lanka and many areas of the Middle East, genetic diseases resulting from consanguinity can often be found, explaining the relatively high prevalence of infantile glaucoma, retinal degenerations, and infantile cataract. In other locations, especially nontropical, semideveloped areas, the major etiologies of childhood blindness are similar to developed regions.

A contributing factor to worldwide childhood blindness is an inadequate number of pediatric ophthalmologists. General ophthalmologists may not want to operate on infants. In addition, ...

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