Causes and temporal trends of childhood blindness in Indonesia: study at schools for the blind in Java.
OBJECTIVE
To ascertain the causes of blindness and severe visual impairment (BL/SVI) in schools for the blind in Java, to identify preventable and treatable causes and to evaluate temporal trends in the major causes.


METHODS
From a total of 504 students, 479 were examined. Data was collected using a modified World Heath Organization Prevention of Blindness (WHO/PBL) eye examination record for children.


RESULTS
The majority of the students (95%) were blind and 4.6% were severely visually impaired. The major anatomical site of BL/SVI was whole globe in 35.9%, retina in 18.9%, lens in 16.4% and cornea in 16.1%. The major underlying aetiology of BL/SVI was undetermined/unknown in 32.7% (mainly microphthalmia, anterior segment dysgenesis and cataract), hereditary factors 31.9% (mainly retinal dystrophies), and childhood disorders 28.5%. Avoidable causes of BL/SVI accounted for 59.9% of the total students, whereas measles blindness was the underlying condition for 23.1% of the preventable causes; cataract and glaucoma accounted for 15.5% and 8.2% of the treatable causes, respectively. Exploration on trends of SVI/BL among two different age groups <16 years and > or = 16 years suggested that childhood disorders and corneal factors have declined, while hereditary disorders have increased. Optic nerve disorder, although not counted as a major cause of blindness, seems to be on the increase.


CONCLUSIONS
More than half of the BL/SVI causes are potentially avoidable. Cataract and corneal disorders related to measles or vitamin A deficiency were the major treatable and preventable causes. Declining proportions of childhood factors and corneal disorders over a period of 10-20 years could reflect improved vitamin A supplementation and measles vaccination coverage in Indonesia. This finding, and the increased proportion of hereditary disease causes, could suggest improving levels of socioeconomic development and health care services.
Sitorus
R S
RS
Department of Ophthalmology Faculty of Medicine University of Indonesia. Jakarta. Salemba 6, Jakarta-10430. Indonesia. ritasito@yahoo.com
Abidin
M Sulaiman
MS
Prihartono
Joedo
J
D000293:Adolescent; D000367:Age Factors; D001766:Blindness / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000517:prevention & control; D002386:Cataract / Q000150:complications / Q000453:epidemiology; D002648:Child; D003316:Corneal Diseases / Q000150:complications / Q000453:epidemiology; D004519:Education, Special; D005124:Eye Abnormalities / Q000150:complications / Q000453:epidemiology; D015785:Eye Diseases, Hereditary / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D008297:Male; D008457:Measles / Q000150:complications / Q000453:epidemiology; D014792:Visual Acuity
Int Ophthalmol. 1993 Aug;17(4):229-34
8112971
Dev Med Child Neurol. 1994 Apr;36(4):326-33
8157155
Br J Ophthalmol. 1995 Jul;79(7):633-6
7662624
Br J Ophthalmol. 1999 Aug;83(8):929-32
10413695
Br J Ophthalmol. 2001 Oct;85(10):1145-6
11567952
Eye (Lond). 1993;7 ( Pt 4):580-3
8253243
Br J Ophthalmol. 2003 Jan;87(1):20-3
12488255
Br J Ophthalmol. 2003 May;87(5):526-30
12714383
Br J Ophthalmol. 2003 Aug;87(8):941-5
12881329
Br J Ophthalmol. 2003 Sep;87(9):1065-8
12928266
Eye (Lond). 1992;6 ( Pt 2):173-6
1624040
Int Ophthalmol. 2001;24(1):53-9
11998890