1. ALI F. AHRABI, MD PGY-3 PEDIATRICS BLINDNESS IN CHILDREN

2. Blindness in Children Definition Prevalence Common Causes How can you help Resources

3. Definition In North America and most of Europe, legal blindness is defined as: Visual Acuity of 20/200 (6/60) or less in the better eye with best correction possible This means that a legally blind individual would have to stand 20 feet (6.1 m) from an object to see it with the same degree of clarity as a normally sighted person could from 200 feet (61 m) Visual Field of less than 20 degrees (normal: 180 degrees) is also classified as being legally blind. Low Vision is used to describe visual acuities from 20/70 to 20/200.

4. 10% of legally blind have no vision (nlp) Rest from 20/200 to light perception (lp)

5. Prevalence 7-14/10,000 children globally Approximately 1/1000 in US (93,000 school-aged in 2002) 45 million registered blind globally, 1.3 million children (2.8%) 75% of blind children live in developing countries 500,000 children become blind every year Vision 2020the Right to Sight, is a global initiative for the elimination of avoidable blindness (www.v2020.org)

6. Prevalence About ½ (56%) of blind children have at least one other chronic medical condition Most common co-morbid condition is Deafness Cerebral palsy, behavioral problems, anxiety disorder, language and speech impairment, autism are other common co-morbidities

7. Ethiology Globally: Corneal Ulceration (Vitamin A deficiency, Measles, Trachoma, Local Remedies, etc.) Congenital Cataracts (Hereditary, Rubella, etc.) Congenital Glaucoma Optic Atrophy, Ambliopia Developed Countries: ROP Traumatic Hereditary/Syndromic (Anophthalmia, microphthalmia, Albinism,etc.) Congenital Cataracts/Glaucoma

8. Locally Study of 98 visually impaired children enrolled in a specialized school in the Bronx, NY N% Albinism23 ROP1920 Glaucoma44 RB66 Others4644 Total98100

9. Rare Causes Multiple Sclerosis Cong. Retinal Detachment Chronic Uveitis Chronic Increased ICP Aniridia Craniosynostosis Osteopetrosis Tay-Sachs Disease Vascular Thrombosis Retinitis Pigmentosa Lebers Amaurosis Hydrancephaly / Anencephaly Toxins/Meds: methanol, streptomycin, quinine, isoniazid, thallium, arsenic, penicillamine

10. Blinded by Law!? In 2003, a Pakistani anti-terrorism court sentenced a man to be blinded after he carried out an acid attack against his fiancée that resulted in her blinding. The same sentence was given in 2009 in Iran for Majid Mohavedi, the man who blinded Ameneh Bahrami with acid after she refused his romantic advances.

11. How can we help?

12. Adaptive Techniques Adaptive computers and mobile phones: allow people with visual impairment to interact with their computers and/or phones via screen readers or screen magnifiers Adaptations of coins and banknotes so that the value can be determined by touch

13. Mobility Many people with serious visual impairments can travel independently, using a wide range of tools and techniques Orientation and mobility specialists are professionals who are specifically trained to teach people with visual impairment how to travel safely, confidently, and independently in the home and the community These professionals can also help practice travelling on specific routes which they may use often Cane is basic, Guide Dog with training

14. Reading & Magnification Most visually impaired people who are not totally blind read print, either of a regular size or enlarged by magnification devices. Many also read large-print, which is easier for them to read without such devices. A variety of magnifying glasses, some handheld, and some on desktops, can make reading easier Some people access these materials through agencies for the blind, such as the National Library Service for the Blind and Physically Handicapped

15. Reading & Magnification The rest read Braille (or Moon type) or talking books and readers or reading machines, which convert printed text to speech or Braille Computers with special hardware such as scanners and refreshable Braille displays Software written specifically for the blind, such as optical character recognition applications and screen readers

16. Braille Braille was devised in 1821 by Louis Braille, a blind Frenchman Each Braille character or cell is made up of six dot positions, arranged in a rectangle containing two columns of three dots each. A dot may be raised at any of the six positions to form sixty-four (2 6 ) possible subsets

17. Braille In 1960, 50% of legally blind, school-age children were able to read Braille in the US In 2007, only 10% use Braille as their primary reading medium Currently, among the estimated 85,000 blind adults in the United States, 90% of those who are Braille literate are employed. Among adults who do not know Braille, only 1 in 3 is employed

18. Reading and Magnification Closed-circuit televisions, equipment that enlarges and contrasts textual items, are a more high-tech alternative to traditional magnification devices Modern web browsers, which can increase the size of text on some web pages through browser controls or through user-controlled style sheets There are also over 100 radio reading services throughout the world that provide people with vision impairments with readings from periodicals over the radio

19. Computers Access technology such as screen readers and Screen magnifiers enable the blind to use mainstream computer applications Later versions of Microsoft Windows include an Accessibility Wizard & Magnifier for those with partial vision A large number of websites use adaptive technology, making the web a more inviting place for visually impaired surfers

20. Other Aids Talking equipment such as thermometers, watches, clocks, scales, calculators They may also enlarge or mark dials on devices such as ovens and thermostats

22. First Hand Experience 14 y/o boy, ex 24 weeker premie, BW: 550 grams s/p ROP with multiple laser surgeries Vision: nlp-R, lp-L Co-morbidities: PDD, ADHD Residential weekdays in special school, started high-school this year Very interested in computers, writing simple programs Wants to become a software program specialist Uses computer and internet through screen readers

23. First Hand Experience Receiving special training for: Job training Job application and interviews Independent living skills (including cooking) Independence: Makes own bed Dresses & undresses with no help Prepares food with no/little help Getting around familiar places

24. First Hand Advice Early Intervention (vision treatment and all other services), great source of support The Lighthouse (lighthouse.org) Jewish Guild for Blind (jgb.org) Visions (visionsvcb.org) Student advocacy (rep will attend CSE meeting with parent)

25. Parental Support NAPVI (National Association for Parents of Children with Visual Impairment) Excellent source of information Support Share experiences Meet others Links and resources

26. Questions?