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K.M. Van Dijk, C. Gilbert; Characteristics of Children Attending Low Vision Programmes in India, Nepal and Indonesia . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3482.
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© ARVO (1962-2015); The Authors (2016-present)
Evidence of the effectiveness of low vision (LV) care for children is lacking. This paper describes a retrospective study of children aged <16 years examined in 6 LV programmes in 3 Asian countries in 2002/3. The purpose of the study was to improve existing services, and to design a prospective study of the effectiveness of different models of service delivery (i.e. hospital based LV clinics; independent LV centres) where the amount and nature of additional support varies (e.g. from rehabilitation workers), and which may influence outcomes.
The following data were extracted from clinic records: socio–demographic; diagnosis; presenting/best corrected visual acuities (VA) for near and distance; optical LV devices prescribed. Data were analysed for all children, by type of programme, and according to the amount of additional support children regularly received.
Complete data were available for 1,823 children aged < 16 years. 42.2% attended hospital LV clinics and 57.8 % LV centres. More boys attended than girls (58.2% vs. 41.8%). The majority (64.4%) had no additional support, and only 42.9 % came back for follow–up. Main causes of LV: aphakia/other disorders of the lens 30.7%; refractive errors/amblyopia 26.4 %; retinal lesions 16.7%. Two thirds did not have glasses at first attendance. Among those children who could be tested, 45.1% had a presenting distance VA of < 6/60; after refraction it was 31.4%; 70.8% were prescribed glasses. 58.7 % had a near VA of ≥1.25 M, which improved to 73.8 % after refraction and/or magnification. 22.3 % were prescribed magnification, 82.5% of this need being met by locally produced devices.
Causes of LV differed between programmes: lens related causes – 40.8% in LV centres vs. 16.9% in hospital clinics; refractive errors – 20% in LV centres vs. 35.1% in hospital clinics. Follow–up was 55.9% in the LV centres vs. 25.1% in hospitals.
Children receiving ongoing additional support at home and/or school had lower levels of presenting VA (i.e. <6/60) than children without this support (OR: 0.45; 95% CI 0.25 – 0.83; p =0.006). There were no significant differences in gender, socio–economic status, travelling distance, follow–up, obtaining glasses or literacy.
Access to LV care by girls is lower than for boys, and many children had not been adequately refracted prior to attending the LV services. Rates of follow up were poor. Comparisons of the effectiveness of service provision for children with LV need to take account of case mix, as well as the nature and degree of additional support children receive, which may all influence outcomes.
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