Khushi Kansal, B.Optom

M.Optometry (Final Year Student), GD Goenka University, Gurugram, India

Any abnormalities during the formation of the eye in the human embryo can lead to congenital ocular anomalies. As literature suggests, 5 out of every 10,000 live births are affected with this kind of abnormality. It is estimated that approximately 1.4 million Children, among which 75% from Africa and Asia are suffering from vision problems.⁽¹⁾ Although, childhood blindness reports account for less than 4% of global blindness. Vitamin A deficiency, congenital cataract, conjunctivitis in the new-born infants and retinopathy of prematurity (ROP) are the most common causes of childhood visual impairment.⁽²⁾ However, congenital cataract remains a leading global cause of childhood vision impairment. ⁽²⁾ Cataract is a treatable disease, proper vision can be recovered if diagnosis and treatment is done on time, otherwise it can lead to amblyopia.

Figure 1: Congenital cataract in the left eye of new-born infant
Image courtesy: https://neoretina.com/blog/congenital-cataracts-early-diagnosis-is-the-key/

Amblyopia is an ocular condition in which one or both eyes do not develop normal vision, due to any media opacity or any functional abnormalities in the visual system or brain.⁽³⁾

Amblyopia affects the quality of life of an individual by affecting daily routine activities, social interactions, family life, behaviour, and confidence of a person.

Babies with extremely low birth weights and young gestational ages are more likely to develop retinopathy of prematurity (ROP), a proliferative vascular disorder.⁽⁴⁾

According to a study published in March 2009 by Sudha Chaudhari et al, with sample size of 552 infants with ROP, no ROP was found in infants weighing>or=2000 g or with a gestational age more than 36 weeks. After treatment 10 children developed high myopia, 1 amblyopia and 9 children developed completely normal structural and visual outcomes. Only two (9%) children were blind due to retinal detachment.⁽⁵⁾

ROP adversely affects the quality of vision in children. Awareness of the quality of life of premature children is necessary for the medical community and society because premature children require prolonged and expensive care, both during and after the neonatal period.

Naso-lacrimal duct obstruction is a blockage in the lacrimal drainage system.  In children most of the nasolacrimal duct obstruction is congenital.⁽⁶⁾

Nutritional deficiency mainly vitamin A deficiency kills and blinds thousands of children every year by making the cornea very dry and leads to a condition called Xerophthalmia.⁽⁷⁾

Microphthalmia is an eye abnormality which arises before birth. In this, one or both eyeballs are abnormally small and in some affected people, the eyeball appears to be completely absent and even in these cases some remaining eye tissue is generally present. Such severe microphthalmia should be differentiated from a condition known as anophthalmia, in this condition no eyeball forms at all.

Figure 2: This picture shows Microphthalmia in the left eye, the picture shows that the left eye is abnormally small
Image courtesy: https://healthjade.net/microphthalmia/

Figure 3: This picture shows Anophthalmia in the left eye, both the eyeball as well as ocular tissue are absent in the left eye
Image courtesy: https://eyemantra.in/eye-diseases/anophthalmia-microphthalmia-2/

Nystagmus, an involuntary rhythmic oscillation of the eye. Due to the oscillation unstable images are formed on the retina which leads to vision impairment in children.⁽⁸⁾ The prevalence of nystagmus is estimated to be 24 per 10,000 population and infantile nystagmus is 14 per 10,000 population.⁽⁸⁾

The quality of life with the nystagmus is affected due to cosmetic appearance. Nystagmus affects the individual lifestyle by deteriorating self-esteem and confidence. It can hamper the driving ability of the individual and daily routine activities.

The purpose of this study was to spread awareness among the health care practitioners, professionals, and patients about the importance of early detection and management of the disease.

Early detection of congenital disorder can prevent the children from being visually impaired. Refractive error, refractive strabismus, refractive amblyopia can be corrected by proper spectacles correction, patching and with binocular exercise. Similarly retinal disorder, glaucoma, deficiency diseases, are preventable blindness, early detection and proper treatment can prevent children from being visually impaired.

References

1. Rahi JS, Dezateaux C. Measuring and interpreting the incidence of congenital ocular anomalies: lessons from a national study of congenital cataract in the UK. Investigative ophthalmology & visual science. 2001 Jun 1;42(7):1444-8.
2. Nicholas A.V. Beare, Andrew Bastawrous, childhood blindness,International Encyclopedia of Public Health (Second Edition), 2017
3. David Turbert et al,’ Childhood eye diseases and conditions’July 15 2020, American academy of ophthalmology.
4. Bashinsky AL. Retinopathy of Prematurity. N C Med J. 2017 Mar-Apr;78(2):124-128. doi: 10.18043/ncm.78.2.124. PMID: 28420777.
5. Chaudhari S, Patwardhan V, Vaidya U, Kadam S, Kamat A. Retinopathy of prematurity in a tertiary care center–incidence, risk factors and outcome. Indian Pediatr. 2009 Mar;46(3):219-24. Epub 2009 Jan 1. PMID: 19179740.
6. Study on nasolacrimal duct obstruction, congenital by Brad H. Feldman, M.D. on May 1, 2023, from https://eyewiki.aao.org/Nasolacrimal_Duct_Obstruction,_Congenital
7. Stärk N, Zubcov AA, Kast E, Gutermuth D. Amblyopie, Refraktionsfehler und Strabismus bei kongenitaler Ptosis [Amblyopia, refractive errors, and strabismus in congenital ptosis]. Ophthalmologe. 1996 Aug;93(4):345-50. German. PMID: 8963129.
8. Sarvananthan N, Surendran M, Roberts EO, Jain S, Thomas S, Shah N, Proudlock FA, Thompson JR, McLean RJ, Degg C, Woodruff G. The prevalence of nystagmus: the Leicestershire nystagmus survey. Investigative ophthalmology & visual science. 2009 Nov 1;50(11):5201-6.