In an interview with Bharati Sud, Dr. Mukesh Garg Ophthalmology Consultant ( Centre for Sight Hospitals- Eye Care Centre) shares about childhood blindness. He talks about the various measures that can be taken during pregnancy to avoid blindness and the steps that are to be taken to detect if the foetus is blind.
All the tests in prenatal stage are able to diagnose only the structural deformities of the eyes. But their functional capabilities can not be tested in intrauterine stage. So in prenatal stage one can only conclude with great difficulty that the child’s ocular structures are being formed normally. Infections like Rubella / German Measles, Herpes Virus etc. in the mother, increase the risk of malformation of the eyes and other body parts of the child. The exposure of such infections to the expecting mother is to be avoided and in case such infection takes place, it should be treated under appropriate medical supervision. Similarly, intake of certain drugs in pregnant stage especially during second trimester can cause birth defects. So the mother should not take any medication without consulting her physician/gynaecologist. There is a misconception that if the mother is not exposed to light, the child would be born blind. Vitamin D is necessary in the development of the bones and the overall well-being of mother and child. Vitamin A is perhaps more important since it is essential in the development of retina. In cases where the mother suffers from diarrhea, there may be depletion of Vitamin A and supplements need to be taken.
The child may open the eyes but may not be able to see. The earliest tests that can be taken are ERG (Electroretinogram) and VEP (visual evoked potential) where the child is shown lights in specific patterns. The response is recorded from the electrodes placed over child’s scalp and plotted as graphs. The test shows if the response is normal/ subnormal. The reliability of these tests is much higher after 3 months, when the child starts to focus, smile and respond to colors and patterns etc. The child's visual range is developed between 2-3 months. And by the age of one year the parents can realize themselves if the child is able to respond to external visual stimuli. There are certain tell-tale signs of poor vision like inward or outward drifting or misaligned eyes (Squint), excessive blinking, greyish white color reflex in pupils, bulging eyes, frequent eye pain, redness that continues, pus or crust in eyes, watery eyes, drooping eyelids, sensitivity to light, tilting the head or reading closely and difficulty in reading/ being clumsy/lack of coordination. If poor vision is not treated in time, it can lead to permanent visual loss. After three months the baby should be able to make eye contact and track moving objects e.g. toys etc. If the parents have doubt about the vision between 3 months - 1 year they should immediately consult a specialist to find out about the different tests. These tests are both specific and sensitive. There could be several reasons with the child not being able to focus; there could be problem either with the eyes or the brain being underdeveloped or some other unknown reason. Once the other reasons are ruled out, then an eye test is conducted where the pupils of the eyes are dilated to check if it is properly formed or diseased. Once that is completed, the next test is electroretinogram. It checks the sensitivity of retina to light. Subsequently, VEP is done to check if the impulses are being conveyed to brain to induce response. Sometimes both electroretinogram and VEP test may be positive yet the child may not be able to see. This could be due to mental retardation which manifests in poor vision. In such scenario paediatrician help is sought to rule out delayed milestones or mental retardation in child.
Blindness is both preventable and non-preventable. In India 65% blindness is avoidable. If timely intervention is given to a child born visually impaired, then the child may regain partial vision. For example, if a child is born to a mother who is diagnosed with Rubella, then the child is likely to suffer from bilateral cataract. In such situation the child will have to be operated immediately; the vision could be hampered yet it can be made functional with surgery. At a later stage lenses could be implanted to improve the vision.
For the children having poor vision due to refractive error, just giving right glasses may improve vision drastically. Similarly if there is a corneal problem, this would need transplant and immediate treatment is required.
Once the parents realize the child is blind, there are challenges for both child and the parents. Parents have be counselled. They should be referred to special schools for visually handicap or integrated approach can be adopted in which the child studies and learns along with normal children under supervision. Parents can meet other parents with children having similar problem and help groups to learn from experiences. One has to stay with the child and monitor their training. Development and survival largely depends on one’s ability to see. A visually impaired child may take longer to learn since a large portion of the learning process becomes curtailed. Continuous support from the family and surrounding people is essential for the development of the child.
A congenital blind child will be able to learn faster especially if he/she accepts the reality. With family support and guided approach it is possible for even the visually handicapped children to attain normal life. It would be even more distressing for a person to lose his eyesight later in life. It becomes difficult to train them.
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