For nine years, P Vanaja's parents thought her crossed eyes were a sign of good fortune. When she cocked her head to look at something, they thought it was a childish mannerism that she would outgrow. Vanaja's vision problem was actually discovered by her schoolteacher, who noticed that the child held her book at an awkward angle to read, and did not respond as readily when the visual stimulus was on her right side. But Vanaja's parents - both daily wage earners - did not think it necessary to seek medical help for a condition that did not seem to pose any real threat to health.
In October 2002, Vanaja went with her schoolmates to an exhibition on eye health, organized on the occasion of World Sight Day (October 14). As part of the day's events, free eye screening was offered to all those who wanted it. At the screening, eye health workers found that Vanaja had a correctible squint. She was, moreover, depending mainly on one eye. She had the beginnings of a condition known as amblyopia which, if left untreated, could cause the weaker eye to become "lazy" and gradually lose vision. Vanaja was operated upon free of cost at a non-profit eye hospital in Hyderabad, L V Prasad Eye Institute (LVPEI). Now, when she looks at you, both her eyes meet yours in confidence and clarity.
World Sight Day is a worldwide event that began four years ago as a major advocacy and public awareness opportunity under a global collaborative program known as VISION 2020: The Right to Sight, which aims to eliminate all causes of avoidable blindness by the year 2020. VISION does this in three main ways: controlling disease, developing human resources and building infrastructure and appropriate technology.
The global initiative is a joint program of the World Health Organization (WHO) and the International Agency for the Prevention of Blindness (IAPB). It was formed in response to the realization that if no public health interventions are made, the number of blind and visually impaired would double by the year 2020.
Currently, WHO estimates that there are nearly 180 million people worldwide who are blind or severely visually impaired. Roughly 1.4 million of these are children. Nearly 80 per cent of this blindness is preventable or treatable. And nearly two thirds of the world's blind persons live in the developing world. Nearly 18 million Indians are blind, mostly from treatable conditions like cataract or refractive error.
Vision impairment in children is especially significant because they have to live with the disability for a longer time. Nearly 270,000 children, or one-fifth of the world's blind children, live in India. According to Dr B R Shamanna, a public health ophthalmologist at the LVPEI, it is assumed that a blind child has 33 years of blindness, which in economic terms adds up to a lifetime loss of Rs 800 billion in India alone. "This is why childhood blindness is a focus under VISION 2020," says Dr Gullapalli N Rao, President, IAPB.
The four major causes of avoidable vision loss in children are childhood cataract, developmental glaucoma, uncorrected refractive error, and Vitamin A deficiency. "Both refractive error and Vitamin A deficiency can be treated very easily with low-cost interventions," explains Rao.
Vitamin A deficiency can be treated with good nutrition and an enhancement of maternal health, while refractive error can be corrected with spectacles. The other two problems, too, can be
handled before they become vision threatening, if good quality tertiary eye care is available to all those who need it, at the right time.
In addition to these four conditions, a problem that is becoming increasingly important across the world is retinopathy of prematurity (ROP). This affects babies born preterm or those with a very low birth weight. Until recently, this was a problem restricted to the developed world, where preterm babies had a better rate of survival. But with better neonatal care, the survival rate of such babies has increased significantly in developing countries as well.
While ROP cannot be prevented, it can be managed if detected early enough - usually in the neonatal ward or within the first few months of the baby's life. "Fertility treatments have made multiple births -twins, triplets- more common, so more babies are born premature or weigh less than optimum at birth, and this increases the risk of ROP," and this increases the risk of ROP," explains Dr Subhadra Jalali, an ophthalmologist with LVPEI.
Jalali now makes the rounds of neonatal wards in the city, screening premature babies for ROP and also educating pediatricians and parents about the need for early screening in such babies. "We can operate on babies as young as a few weeks old and handle the situation before it becomes sight threatening," she says.
One of the strategies that VISION 2020 applies to the issue of vision loss in children is to aggressively target community sites where large numbers of children and parents and other adults (such as teachers) can be reached. In India, since 2001, it has helped sensitize hundreds of teachers to the issue of vision loss, and in some cities, teachers have been trained to identify some common sight threatening conditions.
In Hyderabad, at a school-based screening program on October 14, 2004, one child came out holding a prescription for glasses, and crying, "I'll look silly with glasses, my friends will tease me!" Says Rao, "These are the kinds of attitudes we need to counter, and get more people to take advantage of care - and also make care available and accessible to all, in terms of geographic reach and cost."
According to Rao, one in four schoolchildren is likely to need spectacles in India, and many go through life never having a check up, and therefore, never getting their vision corrected.
Through programmes like World Sight Day, VISION 2020 hopes to correct this, and increase public awareness so that simple problems can be managed with simple interventions. "Like spectacles," says Rao. "Of course, there are always those problems that cannot be managed, but VISION 2020 is also about rehabilitation."