Visual Idea: Age vs. when screened age
Pediatric blindness and visual impairment is nearly twice as common in Suriname and the Caribbean in comparison to the United States.
Blindness and visual impairment in all ages is four times higher in Suriname and the Caribbean in comparison to the United States.
In Suriname, the average figures on the prevalence of blindness and visual impairments in children aged 0-5 years are nearly double than those in the United States and four times greater in all ages.
In children 0-5 years of age, the average figures on the prevalence of blindness and visual impairment in Suriname varies from 100 to 153 per 10,000 whereas the average prevalence in the United States is 62 to 95 per 10,000
(All ages per 10,000: Caribbean – 1,778 – 1,928 / Suriname – 1,640 – 1,793 / U.S. – 386 – 423)
(<5 years per 10,000: Caribbean – 119 – 181 / Suriname – 100 – 153 / U.S. – 62 – 95)
Title of This Section
Vision assessment is an important part of the medical care of children. Some eye abnormalities that are not treated in the first few months (eg, cataracts, pronounced ptosis) or years (asymmetric refractive errors) of life can lead to irreversible vision loss. Poor vision and vision loss also may be an early indication of serious or life-threatening diseases, such as retinoblastoma, lipid storage disorders, or peroxisomal disorders.
The visual system (retina, optic nerves, and visual cortex) is immature at birth. It begins to mature during the first weeks of life. Myelination of the optic nerves, development of the visual cortex, and growth of the lateral geniculate body occur over the first two years. The fovea, the most visually sensitive part of the retina, reaches maturity at approximately four years of age.
The period of visual maturation is a critical period during which the visual system is affected by outside influences. Visual stimuli are critical to the development of normal vision. Development of the visual pathways in the central nervous system requires that the brain receive equally clear, focused images from both eyes. Ocular processes (eg, refractive error, strabismus, cataract) that interfere with or inhibit the development of the visual pathways may result in amblyopia.
Visual behavior and performance evolve with maturation of the visual system.
• Visual fixation can be demonstrated shortly after birth. The visual acuity of a newborn infant is estimated to be approximately 20/400.
• The ability to follow an object is detectable in most infants by three months of age.
• Stereopsis and binocular visual function develop between the ages of three and seven months.
• Visual acuity reaches the adult level of 20/20 by three to five years of age, though young children often will not perform formal visual acuity testing to this level.
Vision Screening
The prevalence of undetected vision problems in preschool children is estimated to be 5 to 10 percent. Amblyopia occurs in 1 to 4 percent of children and usually develops between infancy and five to seven years of
age. Early detection and treatment of amblyopia improves the prognosis for normal eye development.
In reference to the American Academy Ophthalmology (AAO), and United States Preventive Services Task Force (USPSTF), it is recommend to screen children younger than five years of age to detect amblyopia, strabismus, and other vision problems in children younger than five years of age
Why Instrument-Based Screeners?
Instrument-based vision screening devices (eg, photoscreening and autorefraction) can identify ocular risk factors that lead to vision loss in children, though they do not directly assess visual acuity. These methods are endorsed by the American Academy of Pediatrics (AAP) and the United States Preventive Task Force for screening in young children.
Photoscreening devices use optical images of the red reflex to detect refractive errors (anisometropia, high hypermetropia, high astigmatism), media opacities (eg, cataracts), strabismus, or adnexal deformities (eg, ptosis), each of which is a risk factor for amblyopia. Autorefractors use automated retinoscopy or wave-front technology to evaluate refractive error and are therefore limited in their ability to detect strabismus in the absence of refractive error.
Instrument-based screening is relatively quick and requires minimal cooperation of the child. These methods are particularly useful in preverbal, preliterate, or developmentally delayed children.
In observational studies, vision screening of preschool children with photoscreening or autorefraction has been associated with early detection of risk factors for amblyopia. In some of the studies, earlier detection was associated with improved visual acuity outcomes.
Timing of Vision Screening
“Children should have age-appropriate assessments for eye problems in the newborn period and at all subsequent health visits. Infants at risk for eye problems, such as retinopathy of prematurity, or those with family histories of congenital cataracts, retinoblastoma, and metabolic and genetic diseases should have ophthalmologic examinations. All infants should be examined by 6 months of age to evaluate fixation preference, ocular alignment, and the presence of any eye disease, These infants should continue to be checked until 3 or 4 years of age, when visual acuity in children can be evaluated and more easily.”
Quantifying the Burden of Childhood Eye Disease in Suriname
The global financial cost of blindness with an onset during childhood, in terms of loss of earning capacity (per capita GNP), is greater than the cost of adult blindness and has recently been estimated to be between $600 billion and $2.7 trillion.
The Caribbean is in an era where healthcare coverage and costs are at the forefront of public debate and concern, it is vital to understand the magnitude of the economic burden of disease. This is especially true for eye disorders and vision loss, as these conditions often lead to chronic, life-long direct and indirect costs.
Children with blindness and visual impairment endure long years of disability which severely impacts their overall development and restrains them from any meaningful participation in social and economic activities. Uncorrected refractive error is one of the major reasons for visual impairment among children, especially in young children, with Myopia leading the list of refractive errors.
In Suriname, most blind adults need to be led by either sighted children or sighted adults. When a child becomes the caretaker, that child is often unable to attend school, thus denying the child an opportunity to escape the poverty cycle1. When a sighted adult becomes the caregiver, he or she often needs to stop working. Thus, there are long-term repercussions for economics and education that extend beyond the blind individual. In fact, the social fabric of a community is impacted on a practical level.
“The physical and emotional toll impacts not just the individual and family but the social and economic fabric of communities and everyone’s existence. Sudden blindness of one individual in a family can become the tipping point for survival when they are impoverished to begin with.”