IT has been estimated by the national committee for the prevention of blindness that one per cent of Pakistan’s population lives in darkness, with children being a significant majority group. It can be safely claimed that at least a third of these cases are preventable. The World Sight Day, that is being observed globally today, is a reminder that what can be prevented should be prevented.

The World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB) have developed a global initiative to eliminate avoidable blindness and have included childhood blindness as one of its five focus areas. But who will bring the change in practical terms? That is a big question.

The pandemic surely made things worse, but our children in any case have remained trapped indoors. Long study hours in schools and seminaries, or excessive screen time led to nearsightedness mandating the need of eye glasses. Parents need to ensure daily outdoor activities and limit their own screen time before instructing their young ones. Additionally, adopting simple routine changes and eye exercise can tremendously improve the situation.

Tragically, the most common cause of sudden visual loss in children is trauma, the incidence of which rises drastically during holidays. We get at least two to three cases of cracker injury every day in the emergency ward during weekends and holidays. At least a fourth of them lose their eyesight permanently. The govern-ment should take strict action against such dangerous articles that are easily accessible.

Another leading cause of traumatic eye injury is sharpened pencils and rulers followed by household items, like knifes, scissors, bleach and limestone. Teachers and parents need to be extra vigilant in this regard. Non-accidental traumas associated with child abuse are on the rise. It is heart-wrenching to see such innocent, voiceless soles being the target of adult frustrations. Violent blows to the head cause damage to the delicate structures inside the eye, and the damage is often irreversible. Child protection units should take action against such crimes.

Practising in low-lying areas, we witness such incidences on a regular basis. The bitter truth is that parents are aware of such atrocities, but they think what they are doing is required in a child’s upbringing. Seminaries and schools are supposed to be sacred and safe places for children, not terror grounds that push them in the world of darkness and ruin their entire lives. What is even more tragic is that many of these children have learning disabilities and hereditary causes of low vision that even parents are not aware of.

A lot of these children are picked on eye camp testing run by Layton Rahmatullah Benevolent Trust (LRBT), a charity providing eye care. Vision testing in early school years is mandatory to pick early disease. One in 10 children presenting to our outpatient department (OPD) have some form of allergy or pink eye. Potent steroids are being dispensed as a magic drug without prescription from pharmacies. Even general practitioners are unaware of its vision-threatening side effects. Steroids cause an irreversible blinding disorder called glaucoma, and can aggravate an existing infection.

Unfortunately, in children, steroid-induced glaucoma accounts for almost half of glaucoma cases. We have new agents that have almost obviated the need of steroids in many ocular conditions. Additionally, we strongly condemn the use of rose water in the eye as it is thought to have steroid-type properties that can harm the eyes.

Premature babies require oxygen during the early days after birth. Interestingly, this interferes with the normal development of the eye and, if not screened on time, leads to irreversible blindness; a disease called retinopathy of prematurity. Pakistan has ranked fourth in the latest global listing in terms of the number of preterm births, and with the rising number of neonatal units in Karachi, more children are likely to survive. This of course is a positive development, but the sad part is that only a few neonatal facilities get their babies screened. LRBT receives at least two babies every month with advanced irreversible eye damage due to lack of screening.

Children are our collective responsibility, as parents, teachers or doctors. Even minor negligence can go a long way, affecting their career choices, and shattering their dreams.

On this World Sight Day today, it is our appeal to all the caretakers that if you notice any abnormal eye reflex or visual behaviour any time after birth, do not ignore. Please don’t. If there are financial constraints, you still have no excuse. We, at LRBT, are here to help.

Saima Amin
Paediatric ophthalmologist, LRBT
Karachi

Published in Dawn, October 13th, 2022