Patterns of Pediatric Visual Impairment in the Public Sector of Barbados

Abstract

Purpose : This study describes the patterns and causes of visual impairment in Barbadian children.

Methods : A retrospective chart review of all patients 18 years and younger who presented to the sole public pediatric ophthalmology clinics in Barbados at Queen Elizabeth Hospital (QEH) and Winston Scott Polyclinic (WSPC) between Jan 1^st and Dec 31^st, 2019 was conducted. Age at the first visit to an eye care provider (A₀) and final visit in 2019, sex, visual acuity and clinical diagnoses were obtained and stored using a REDCap data collection tool.

Results : 955 patient charts were collected from QEH (Jul to Dec) and WSPC (Nov to Dec) with a male: female ratio of 1:1. 11.5% of patients met the WHO criteria for visual impairment (4.5% binocular and 7.0% monocular), with an A₀ of 4.0 years. Refractive error (59.4%) and strabismus (36.9%) were the most common diagnoses among this group (Fig. 1), of which 79.4% had amblyopia. Overall, refractive error was the most common ocular disorder seen in the study population (39.6%), followed by allergic eye disease (35.2%), and strabismus (14%). Children aged 5 to 11 years old comprised the largest group of patients seen in 2019 with an A₀ of 5.9 years.

Conclusions : The burden of eye disease in the Barbadian adult population was described in the Barbados Eye Study over 20 years ago. However, no such studies have been conducted on the pediatric population. Causes of visual impairment in the Barbadian population are treatable and preventable. This preliminary data revealed that refractive error and strabismus were the leading causes of visual impairment in children. These results are comparable with trends observed in epidemiological studies conducted in the United States. On average, Barbadian children are first seen by an eye care provider when they are almost 6 years old. This is later than the US Preventative Services Task Force’s recommended age for pre-school vision screening of 3-5 years. The causes of visual impairment observed in this study can be detected and treated with earlier vision screening. This study only reflects those children whose caregivers actively sought ophthalmic attention through the public sector. Implementation of a nation-wide vision screening program can identify children who do not receive eye care and improvements can be made in the approach to pediatric eye disease in Barbados.

This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.

 

Fig 1. Causes of Visual Impairment in the Barbados Pediatric Population