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Picture and pattern perception in the sighted and the blind: the advantage of the late blind.

Two experiments are reported on the contribution of visual experience to tactile perception. In the first experiment, sighted, congenitally blind, and late blind individuals made tactual matches to tangible embossed shapes. In the second experiment, the same subjects attempted tactile identification of raised-line drawings. The three groups did not differ in the accuracy of shape matching, but both groups of blind subjects were much faster than the sighted. Late blind observers were far better than the sighted or congenitally blind at tactile picture identification. Four of the twelve pictures were correctly identified by most of the late blind subjects. The sighted and congenitally blind performed at comparable levels in picture naming. There was no evidence that visual experience alone aided the sighted in the tactile task under investigation, since they performed no better than did the early blind. The superiority of the late blind suggests that visual exposure to drawings and the rules of pictorial representation may help tactile picture identification when combined with a history of tactual experience.

Adult↗

Causes of childhood blindness in the People's Republic of China: results from 1131 blind school students in 18 provinces.

AIMS: To determine the anatomical site and underlying causes of blindness and severe visual impairment in children under 16 years of age in special education in the People's Republic of China with a view to determining potentially preventable and treatable causes. METHODS: A national study of children attending schools for the blind in China was conducted between April and June 1998 using the WHO Prevention of Blindness Programme (WHO/PBL) eye examination record for children with blindness and low vision. Eight Chinese ophthalmologists attended a training workshop before conducting the study. 36 blind schools in 18 provinces of China were included. RESULTS: 1245 children aged between 5 and 15 years were examined, of whom 1131 (91%) were blind or severely visually impaired (visual acuity less than 6/60 in the better eye). The commonest anatomical sites of visual loss were whole globe (mainly microphthalmos) 25.5% and retina (mainly dystrophies) 24.9%. Lens was the major site in 18. 8%, optic nerve in 13.6%, and glaucoma in 9%. Corneal scarring was not a major cause of visual loss. The aetiology was unknown in 52.9%, hereditary factors were responsible in 30.7%, and childhood causes in 14%. 15% of cases were considered potentially preventable and 22. 5% potentially treatable. CONCLUSION: The pattern of childhood blindness seen in this study is likely to reflect the improved health and socioeconomic status of China but may partly reflect bias in admission to, and location of, blind schools, with higher socioeconomic groups overrepresented. Nutritional and infective causes of blindness are uncommon, and hereditary and unknown factors are now the predominant causes.

Adolescent↗

Causes of childhood blindness: results from schools for the blind in south eastern Nigeria.

AIM: This cross sectional study was undertaken to identify the major causes of childhood severe visual impairment/blindness (SVI/BL) among students in schools for the blind in south eastern Nigeria with a view to offering treatment to those with remediable blindness. METHODS: 142 students attending three schools for the blind in the study area were interviewed and examined using the World Health Organization programme for prevention of blindness (WHO/PBL) childhood blindness proforma. RESULTS: By anatomical classification, the major causes of SVI/BL identified in the children (aged 15 years or less) were lesions of the lens (30.4%), corneal lesions (21.7%), whole globe lesions (mainly phthisis bulbi) (17.4%), and glaucoma/buphthalmos (10.9%). For the young adults (more than 15 years) these lesions accounted for 31.9%, 21.3%, 23.4%, and 8.5% of SVI/BL, respectively. For all the students, the commonest single diagnoses were cataract (23.5%) and corneal scarring (21.4%), of which 86.7% were caused by measles. By aetiological classification, childhood factors (38.6%) constituted the major cause of blindness: 37.0% in the children and 39.4% in the young adults. In 74.5% of all the students, blindness was considered avoidable. CONCLUSIONS: A high proportion of childhood blindness in schools for the blind in south eastern Nigeria is avoidable. Development of paediatric ophthalmology in Nigeria to manage childhood cataract and glaucoma is advocated.

Adolescent↗

Causes of blindness at the "Wiyata Guna" School for the Blind, Indonesia.

AIM: To determine the anatomical site and patterns of cause of blindness in one of the biggest schools for the blind in Indonesia with a view to determining potentially preventable and treatable causes. METHODS: 165 students in one school for the blind in Bandung, Indonesia, were examined clinically and data reported using the WHO/PBL childhood blindness assessment form. RESULTS: Most of the students (96.4%) were blind (BL); 3% were severely visually impaired (SVI). The major causes of SVI/BL in this study were: (1) corneal staphyloma, corneal scar, and phthisis bulbi (mainly attributed to infection) in 29.7%; (2) retinal dystrophies (mainly Leber congenital amaurosis, early onset retinitis pigmentosa) in 20.6%; (3) congenital and familial cataract (13.3%); (4) microphthalmus, anophthalmus (10.9%). The whole globe was the major anatomical site of visual loss (32.7%), followed by the retina (26.0%), cornea (17.6%), lens (13.3%), optic nerve (6.1%), and uvea (4.3%). CONCLUSIONS: This is a small study in a selected population and the results should be interpreted with caution. This blind school study, adopting the WHO/PBL eye form for data analysing, is the first reported for Indonesia. Hereditary disease and infective causes of blindness are the predominant causes of blindness, accounting for 42.4% and 29.7%, respectively. This pattern of causes is a mixed pattern which lies in an intermediate position between the patterns seen in developing countries and those seen in developed countries. The importance both of preventive public health strategies and of specialist paediatric ophthalmic and optical services in the management of childhood blindness in Indonesia are therefore strongly suggested to cover the problems that exist.

Blindness↗

Causes of blindness in children in the blind schools of Ethiopia.

A total of 721 children in the six schools for the blind in Ethiopia were studied. In 1988-1989 histories were taken to ascertain the predisposing factors and ophthalmological examinations and records were used to determine the causes of blindness. Ninety-five per cent of those examined had bilateral blindness, 12% did not know how they had become blind and, of those who provided information on how they became blind, 21% knew that they were born blind, 30% implicated measles as being responsible, and 13% implicated 'mitch' which is an Amharic term used to describe a very wide range of nonspecific and vague illnesses of which measles probably constitutes a significant proportion. Seventy per cent of the blindness was due to either corneal opacity or phthisis bulbi. Of those with non-congenital bilateral corneal opacity or phthisis bulbi, 40% were preceded by measles and 17% by mitch. A study of 66 adults in the handicraft and skill-training centres attached to the blind schools indicated that the principal predisposing factors of blindness were mitch (30%), smallpox (15%), cataract (12%), and traditional eye medicine (11%). Seventy percent had corneal scars of phthisis bulbi and 14% cataract.

Adolescent↗

Childhood blindness in India: causes in 1318 blind school students in nine states.

It is estimated that at least 200,000 children in India have severe visual impairment or blindness and approximately 15,000 are in schools for the blind. Although this represents a small percentage of the estimated 5 million blind in India, it is significant in terms of 'blind-years'. Strategies to combat childhood blindness require accurate data on the causes to allocate resources to appropriate preventive and curative services. Since socio-economic factors vary in different areas of this industrializing country data should be representative of the country as a whole. This is the first multi-state study to be undertaken in India using the Record for Children with Blindness and Low Vision from the World Health Organization/PBL Programme. A total of 1411 children in 22 schools from nine states in different geographical zones were examined by an ophthalmologist and optometrist. Of these, 1318 children were severely visually impaired or blind (SVI/BL). The major causes of SVI/BL in this study were: (1) corneal staphyloma, scar and phthisis bulbi (mainly attributable to vitamin A deficiency) in 26.4%; (2) microphthalmos, anophthalmos and coloboma in 20.7%; (3) retinal dystrophies and albinism in 19.3%; and (4) cataract, uncorrected aphakia and amblyopia in 12.3%. This mixed pattern of causes lies in an intermediate position between the patterns seen in developing countries and those seen in industrialised countries. The causes identified indicate the importance both of preventive public health strategies and of specialist paediatric ophthalmic and optical services in the management of childhood blindness in India.

Adolescent↗

Coping mechanisms of some blind trainees engaging in agricultural rehabilitation in a Nigerian training centre for the blind.

This study was conducted to assess the coping mechanisms of some blind trainees engaged in agricultural activities at the Nigeria Training Centre for the Blind, Ogbomoso, Oyo State, Nigeria. The participants in this study were blind trainees and agricultural inspectors. Focus group discussions were used to elicit their feelings concerning their coping mechanisms with agricultural activities at the centre. In addition, a practical session, and participatory observation, was carried out to examine the trainees and their reactions to the agricultural training programmes. Findings revealed that the blind trainees could effectively undertake farming activities despite their disability. It was, however, noted that the facilities for agricultural training programme in the centre are not inadequate. Moreover, the study further discovered that the number of blind persons seeking agricultural training was far less than the expected intake for the centre. There were also more male than female trainees in the centre. Based on the findings, recommendations were made to improve the farming training programme for blind trainees at the centre. More facilities should be provided and efforts made to encourage more blind persons to use the centre. This will discourage begging and dependence, activities often engaged in by blind persons who have not been rehabilitated.

Adaptation, Psychological↗

Comparison of blind and non-blind assessments of occlusal sealant retention.

A comparison was made of scoring the retention status of BIS-GMA occlusal sealants 5 years after they had been placed, according to a non-blind and blind method of identification of teeth that had been sealed. Subjects were 175 children ages 15--18. One examiner made all the assessments. Retention of sealant was classified as all present, partly missing or all missing. There was 90.5% complete agreement between non-blind and blind examinations in scoring the retention status of 893 occlusal sites. Essentially no difference in agreement was found between sites on maxillary and mandibular teeth nor according to sites in specific teeth. There was only a slight tendency to classify more sites as having sealant present at the non-blind examinations than at the blind examinations, 56.7% and 55.1%, respectively. These findings would seem to indicate that whether examinations are done blindly or non-blindly is of minor importance in making an accurate assessment of sealant retention.

Adolescent↗

Turning a blind eye: the success of blinding reported in a random sample of randomised, placebo controlled trials.

OBJECTIVE: To examine the reporting and success of double blinding in a sample of randomised, placebo controlled trials from leading general medicine and psychiatry journals. METHODS: Identification of placebo controlled, randomised controlled trials from prespecified general medical and psychiatric journals indexed on Medline between 1 January 1998 and 1 October 2001, from which a random sample of 200 randomised clinical trials was chosen, of which 191 trials were evaluated. RESULTS: Only seven of the 97 (7%) general medicine trials provided evidence on the success of blinding, with five reporting that the success of blinding was imperfect. In trials from psychiatric journals, the success of blinding was reported in eight of the 94 trials, with four reporting that the blinding was imperfect. Overall, only four of the 191 (2%) trials assessed blinding in the participants and either the outcome assessors or the investigators. CONCLUSIONS: The current lack of reporting on the success of blinding provides little evidence that success of blinding is maintained in placebo controlled trials. Trialists and editors should make a concerted effort to incorporate, report, and publish such information and its potential effect on study results.

Double-Blind Method↗

Prevalence of blindness and visual impairment in Pakistan: the Pakistan National Blindness and Visual Impairment Survey.

PURPOSE: To determine the prevalence of blindness and visual impairment in adults aged 30 years and older in Pakistan and to assess socio-demographic risk factors. METHODS: Multistage, stratified (rural/urban), cluster random sampling, with probability proportional-to-size procedures, was used to select a nationally representative, cross-sectional sample of adults 30 years of age or older. Each subject was interviewed; had visual acuity measured (logMAR; logarithm of the minimum angle of resolution); and underwent autorefraction, biometry, and fundus-optic disc examination. Those with less than 6/12 acuity in either eye underwent a detailed ophthalmic examination, including corrected distance visual acuity measurement and dilated ophthalmoscopy. RESULTS: A nationally representative sample of 16,507 adults (95.5% of those enumerated) was examined. The age- and gender-standardized prevalence of blindness was 2.7% (95% confidence interval [CI], 2.4%-2.9%). It has been estimated that there are 1,140,000 (962,000-1,330,000) blind adults in Pakistan (2003 statistics). Blindness prevalence varied throughout the country, being highest in the provinces of Punjab and Baluchistan and lowest in the North West Frontier Province. Rural areas had a higher prevalence of blindness than did urban areas (3.8% vs. 2.5%, P < 0.001). Increasing age and being female were significantly associated with presenting visual acuity of <6/60 (odds ratio [OR], 2.5; 95% CI, 2.3-2.7 and 1.3; 95% CI, 1.1-1.5, respectively). Educational status was also associated with presenting visual acuity of <6/60. Subjects who had attended primary school were 60% (P < 0.001) less likely to have acuity of <6/60 than were subjects who had never been to school. CONCLUSIONS: This comprehensive survey provides reliable estimates of the prevalence of visual impairment and blindness in Pakistan. A significant excess of visual impairment was found among the elderly and the uneducated. After adjustment for age differences, women were found to have a significant excess of severe visual impairment and blindness. Regional variations in the prevalence of blindness were also identified.

Adult↗

Causes of low vision and blindness in children in a blind school in Lagos, Nigeria.

A descriptive study to determine the causes of low vision and blindness in children attending the Pacelli School for the Blind in Lagos State, Nigeria. A standardised methodology was used with structured and semi-structured questioinaires. Twenty-six children aged below 16 years who were identified as having low vision and blindness were examined to determine the causes of the low vision and blindness. The anatomical sites of diseases leading to low vision and blindness in these children were retina (30.8%), lens (23.1%), glaucoma (19.2%), cornea (11.5%) and optic nerve (7.7%). Aetiologically, 38.5% of low vision was due to hereditary factors, 23.1% intra-uterine, 15.4% others and unknown in 23%. Retinal dystrophy was the most common cause of low vision and blindness, while congenital cataract and glaucoma were the major causes of avoidable blindness. Very few cases of corneal scar (Measles/Vitamin A deficiency) were seen. The causes of low vision appeared to be different from those of blindness as hereditary and intra-uterine factors were mainly responsible for low vision. It is recommended that these children be identified early, through low vision care programmes and those with avoidable causes treated accordingly.

Adolescent↗

[An investigation on causes of blindness of children in seven blind schools in East China].

OBJECTIVE: To determine the anatomical sites and underlying causes of blindness and severe visual impairment (BL/SVI), potentially preventable and treatable causes in East China. METHODS: Between April 1998 and May 1999, a total of 385 children attending seven blind school in East China area were examined, and WHO Prevention of Blindness Program (WHO/PBL) Eye Examination Record for children with blindness and low vision was used. RESULTS: Of the 385 children, 356 (92.5%) were blind or visually impaired severely (visual acuity less than 0.1 in the better eye). The commonest anatomical sites of BL/SVI were lens (27.5%), retina (22.5%), whole globe (15.2%) and optic nerve (14.9%). The commonest eye diseases were cataract (26.4%), retinal dystrophy (10.7%), optic nerve hypoplasia (8.4%). The aetiologic causes were hereditary factors (35.1%), meningitis (5.3%), trauma (2.8%), vitamin A deficiency (0.6%) and so on, drugs or alcohol taken during pregnancy (6.2%), retinopathy of premature infant (2.8%). Corneal scarring due to vitamin A deficiency or infection was not a major cause of visual loss. It was considered that 47.5% of cases were avoidable blindness, i.e. 23.0% potentially preventable and 24.4% potentially treatable. CONCLUSIONS: Along with the improvement of health and socio-economic status, nutritional and infective causes of blindness are uncommon, and now hereditary factors become the major causes in children. We shall propagandize rudimentary knowledge of ophthalmology actively, and strengthen the building of pediatric ophthalmology, so as to prevent and treat childhood blindness better.

Adolescent↗

Causes of blindness and needs of the blind in Mansoura, Egypt.

A study of 113 blind people in Mansoura, Egypt highlighted the causes and risk factors for blindness, and health and social care needs of the blind. In two-thirds of cases, blindness occurred before 10 years of age. Risk factors for blindness were reported by more than half the study population. Congenital causes accounted for almost half the cases. The commonest causes of bilateral blindness were corneal opacities, cataract and glaucoma. Almost three-quarters of causes were avoidable. Health and social care for this group was inadequate and more than half would benefit from further management. Legislation for keratoplasty, a registry of blind people, and a nationwide community survey on the epidemiology of blindness are needed urgently.

Activities of Daily Living↗

[Causes of blindness in 25% of the blind population in Croatia and the possibilities of prevention].

AIM: To identify the causes of blindness and to launch preventive actions to reduce the prevalence of blindness in Croatia. METHODS: In February 2005, data on 25% of the blind population in Croatia including associations of the blind in the City of Zagreb, Koprivnica-Krizevci County and Medimurje County were analyzed. RESULTS: The analysis showed the blind to account for 0.13% of the 4.5 million population of Croatia. The leading causes of blindness were myopia, diabetic retinopathy and glaucoma. In 212 individuals, blindness developed before age 16, in 84 of these due to retinopathy of prematurity. CONCLUSION: Many ophthalmologic diseases are preventable or curable if early detected and timely treated. The prevention of blindness is of paramount social importance and definitely among most cost-effective interventions in health care.

Adolescent↗