REGIONAL VARIATIONS IN CHILDHOOD BLINDNESS

C hildhood blindness in the Eastern European region is characterised by significant regional variation and a worrying overall growth in retinopathy of prematurity (ROP) cases, according to a presentation here. 'Based on the available data there is a significant regional variation in childhood blindness in Eastern Europe, although there is a real lack of community-based data on prevalence, incidence, and causes of visual impairment in children,' Ilian Shandurkov MD told delegates attending the World Ophthalmology Congress. 'What is clear, however, is that the most important cause or preventable blindness in children in countries such as Bulgaria, Hungary, Poland and the Czech Republic is retinopathy of prematurity. It is very important to treat avoidable blindness if we are going to make a real difference in Eastern Europe,' he added.

Dr Shandurkov noted that an estimated 80 per cent of all visual impairment could be avoided or cured, according to the World Health Organization. The most common causes of vision impairment in children globally include refractive errors without amblyopia, amblyopia, strabismus, congenital anomalies, and ROP. The etiological profile for childhood blindness in Europe is somewhat different, depending on the region, noted Dr Shandurkov. Lesions of the central nervous system, congenital anomalies, retinal disorders and dystrophies are the leading causes of childhood blindness in highly industrialised countries, while congenital cataract, glaucoma and ROP figure more prominently in middle-income countries. In less developed European countries, hereditary disorders and corneal blindness top the list, he said.

One of the first community-based surveys of blindness in Eastern Europe, the Sofia Eye Survey, found a rate of visual impairment of 1.32 per cent and a blindness rate of 0.49 per cent from a sample of 6,275 persons, with cataract implicated as the main cause of blindness. A vision screening programme of 1,863 children in Bulgaria also revealed some interesting data. 'It was found that normally developed children in orphanages had a much higher frequency of amblyopia and strabismus compared to children in families, probably due to late diagnosis in the case of institutionalised children,' he said. Looking at data from other countries, a survey of 229 children in 10 primary schools for the visually impaired in the Czech Republic recorded an ROP rate of 41.9 per cent.

The data from Poland also confirmed the worrying rise in ROP-related blindness, said Dr Shandurkov. A 2001 study found that the number of visually disabled children in Poland had increased by 70 per cent in the previous decade, with optic nerve atrophy (22 per cent), retinopathy of prematurity (19 per cent), cataracts (14 per cent), high myopia (11.84 per cent), congenital abnormalities (8.65 per cent), retinal dystrophies (8.08 per cent) and glaucoma (6.42 per cent) cited as the leading causes. In Hungary, a population-based study of children aged six to 14 in 1991 found congenital cataract (17 per cent), congenital eye abnormalities (15 per cent), high myopia (13 per cent), and ROP (11 per cent) as the leading causes of visual impairment in that age group. In terms of ROP, which has been billed as a 'third epidemic' by the World Health Organization, Dr Shandurkov said that improved neonatal care in Eastern Europe has led to greater survival of premature babies and consequently an increase in retinopathy of prematurity cases. The situation in the region has been aggravated by the lack of qualified ophthalmologists for early diagnosis and treatment, with only a few centres in bigger cities providing eye screening and treatment for ROP, he concluded.