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					World Sight Day 2007

   VISION 2020: The Right to Sight
   working together to eliminate avoidable blindness in children
In our world, a person goes blind every five
seconds and a child goes blind every minute. An
estimated 1.4 million children are blind worldwide
and millions more are visually impaired.

Approximately three-quarters of blindness in children occurs in low-
income countries where it has a far greater economic impact than in
wealthy societies.

In developing countries, 60% of children will die within one year of
becoming blind and the remainder will, on average, spend 40 years
without sight. 90% of blind children receive no schooling and the
majority will not grow up to achieve their full potential. Thus, blindness
in children accounts for nearly one third of the global economic
cost of blindness, although it contributes less than 4% of its overall

Visual impairment in children not only has an impact on the child’s
life; it also profoundly affects their families. Children can also miss out
on educational, social and developmental opportunities when a family
member experiences vision loss.

Many of the common causes of blindness are readily treated or
prevented: an incredible 75% of blindness is avoidable. In children,
vigilance and early intervention against blinding conditions is crucial.

The following stories are examples of interventions made with the
help of organizations taking part in VISION 2020: The Right to Sight.
VISION 2020 is a global initiative of the World Health Organization
(WHO), with the International Agency for the Prevention of
Blindness, and an international coalition of NGOs, institutions and
corporations, all working together to eliminate avoidable blindness
worldwide by the year 2020

*WHO 2002
                                                                   From child carer
                                                                   confident scholar

                                                                   Simila wants to be
                                                                   a doctor. It’s a big
                                                                   dream, especially for
                                                                   a 10-year-old who
                                                                   lives in a thatch hut
                                                                   10 hours’ drive from
                                                                   Nairobi. Her mother
                                                                   Rose has been blind
                                                                   since before her
                                                                   daughter’s birth; Simila
                                                                   loves school but
                                                                   explains: “Many days I
                                                                   cannot go. If mother
                                                                   is sick or has to go
                                                                   somewhere, I stay
                                                                   home to help her.”
It’s a common story. For every one of the more than 33 million blind people in the developing
world, there are others, generally children and most often girls, who miss out on education or
other opportunities to care for them.

Simila arrived at the Baragoi District Hospital, the site of a four-day cataract and trachoma
surgery clinic run by The Fred Hollows Foundation (FHF), leading her mother by the hand.
They joined about 100 others who had heard that doctors were coming who could make blind
people see again. Many suffered from cataract, a clouding of the lens that can be treated with a
relatively simple operation to insert a tiny plastic intraocular lens (IOL).

Rose was examined by James Maina, a Kenyan cataract surgeon trained by FHF. Shining a torch
into Rose’s eyes, Dr Maina found the right was inoperable due to heavy scarring but the left eye
had a small clear area. He decided to try inserting an IOL.

After the operation, Dr Maina peeled the bandages off and wiped Rose’s eye clean. Moving
away and raising his hand, he asked Rose to say how many fingers he was holding up. As Rose
answered correctly, she and Simila broke into smiles of joy. They traveled home, Rose walking
unassisted for the first time in years. She can now perform many tasks single-handedly and best
of all, her newfound independence means that a world of opportunity has opened up for her
                                                                       OF SAUDI
                                                                       Saving a twin’s sight

                                                                       Naif was born premature
                                                                       at 28 weeks, weighing 1200g
                                                                       and was in an incubator for
                                                                       a month. Naif, the first sibling
                                                                       of a twin Caesarean section
                                                                       delivery, was diagnosed with
                                                                       retinopathy of prematurity
                                                                       (ROP) in both eyes. His twin
                                                                       was diagnosed with late stage
                                                                       ROP and lost vision in both
                                                                       eyes despite undergoing
                                                                       vireo-retinal surgery.

Naif underwent regular follow-ups with a retina specialist and thorough ocular examination
revealed moderate astigmatism. He was prescribed glasses and was referred to the Ebsar
Foundation, Jeddah for low vision care.

In the third grade, Naif sat at the front and centre of his classroom, but still found it difficult to
read from the blackboard until he was trained to use a distance monocular telescope. He could
read his schoolbooks by holding them close up, but the use of a simple overhead reading lamp
made things much easier. The Ebsar vision rehabilitation team provides advice and support as
required, and continues to liaise with his family and school.

   THAILAND diagnosis
   Screening provides vital early

   Thammasak Chuthong spent much of his childhood with vision impairments. At
   age three, he underwent a cataract operation with IOL insertion but nine years later an
   examination at a local Sight for Kids screening revealed healthy and normal vision in his
   right eye, but in his left, an IOL dislocation as well as strabismus and amblyopia.

   Because the problem was caught early, Thammasak was admitted for pars plana
   vitrectomy, IOL removal and reinsertion of IOL with scleral fixation. At a later follow-up
   examination he proved in good spirits and, because of his restored sight, fully able to
   enjoy the pleasures of childhood.

   Thammasak is just one of the million children who have benefited from the Sight for Kids
   program, a collaboration of Lions Clubs International Foundation and Johnson & Johnson
   Vision Care. Sight for Kids is an extension of the Project for the Elimination of Childhood
   Blindness, an initiative of LCIF and the World Health Organization.
                                  BULGARIA sight of newborns
                                  New technology saves the

                                  Not long ago, a premature baby like Valeria
                                  would have had little chance for survival in
                                  Bulgaria. Born after just 28 weeks, she weighed
                                  only 510g but, because of improved neonatal
                                  care, Valeria joined the growing number of
                                  premature newborns to survive.
Low birth weight opens the door to a number of potentially serious complications, amongst
them ROP, for which early diagnosis and treatment are crucial. Yet in many Eastern European
countries, the necessary equipment is either unavailable or outdated.

With a grant from Ronald McDonald House Charities, ORBIS provided training and donated an
essential piece of diagnostic equipment – the indirect ophthalmoscope – to the Specialized Eye
Hospital in Varna. This enables ophthalmologists to identify various eye conditions in children, in
particular the earliest stages of ROP. Now doctors in Varna can treat their tiniest patients with
state-of-the-art equipment including a laser and a cryo unit, also supplied by ORBIS.

These interventions have brought hope to Valeria’s family and the families of hundreds of tiny
babies just like her.

                                  Surgery that transformed a family’s life

                                  Khadija lives with her parents in a one-room house in
                                  northern Tanzania. She was just one when her mother noticed
                                  “white spots” in Khadija’s eyes. She had no idea what they
                                  were or how they might be treated.

Khadija’s mother had to watch her daughter constantly, even carrying her on her back while
cooking so she could not wander towards the stove. Khadija could not tolerate the sun, forever
closing her eyes. People would ask, “Why is your child always sleeping?” Khadija was not eating
well and was bullied by playmates who took things from her knowing that she couldn’t see.

At first the family turned to prayer, but then in January 2006 Khadija’s uncle persuaded her
skeptical father (who was worried surgery might cause more problems) to take her to the
Kilimanjaro Christian Medical Centre in Moshi (KCMC). Surgery was postponed twice due to
anemia but finally, in May, Khadija’s right eye was operated on and her left a week later.

Four months afterwards, Khadija’s mother reported that her daughter (now two) was always
happy, lively and smiling. She herself is more relaxed, able to do chores while her child plays with
friends – so the whole household is more congenial, and the father definitely a happier man. He
never believed in surgery until he saw that his child could see again!
Conquering a family’s sight loss

Stickler’s Syndrome — a familial disorder referring to a combination of eye problems such as
high myopia, vitreous degeneration and lattices degeneration in the retina – had already claimed
the sight of his father and brother by the time Tohfuddin was brought to LV Prasad Eye
Institute (LVPEI) in February 2000, aged just 19 months. The family had noticed that both eyes
seemed larger than normal and white in the centre.

                                                                    A comprehensive
                                                                    examination revealed
                                                                    Tohfuddin to be at
                                                                    risk of numerous eye
                                                                    problems requiring lifelong
                                                                    management. He had
                                                                    congenital cataract and high
                                                                    myopia and needed to be
                                                                    checked for developmental
                                                                    glaucoma that could lead to
                                                                    irreversible vision loss. He
                                                                    was prescribed spectacles
                                                                    but remained under close

                                                                    In August 2006, examination
                                                                    revealed advanced retinal
                                                                    detachment in both eyes, the
                                                                    right more recent than the
                                                                    left. Skeletal features such as
                                                                    a depressed bridge of nose
                                                                    and vitreous abnormalities
                                                                    confirmed the diagnosis of
                                                                    Stickler’s Syndrome.

Retinal detachment surgeries offer best results if undertaken within a week of the condition’s
manifestation. Detachment in children has a success rate of only 50% and is followed by the
problem of glaucoma. Though an operation on Tohfuddin’s better right eye proved successful,
glaucoma developed very quickly. Bold damage control measures averted a crisis and surgery to
Tohfuddin’s left eye followed.

                                     Today Tohfuddin does well in class and can
                                     manage boardwork. On his last visit to the clinic
                                     he tugged at the doctor’s hand with a beautiful
                                     smile on his face: “Doctorbai, I have passed my
                                     exams and I am off for my holidays!”

Vitreoretinal surgery would not be affordable for an Indian family of modest means; it is only
due to the compassion and commitment of LVPEI’s global donor base that children such as
Tohfuddin can find renewed hope and enthusiasm for life.
AUSTRALIA of blindness
Laser surgery prevents two lives

                                                                       Twin boys Harry
                                                                       and Jack were born
                                                                       extremely premature
                                                                       in February 2007,
                                                                       at 600g and 500g
                                                                       respectively. Amongst
                                                                       the many health
                                                                       problems such
                                                                       premature babies face
                                                                       is an underdeveloped
                                                                       blood supply to the
                                                                       retina; such infants
                                                                       once had a 60-70
                                                                       per cent chance of
                                                                       becoming blind due
                                                                       to ROP. The twins’
                                                                       parents went through
                                                                       a harrowing time,
                                                                       fearing that their
                                                                       children could be
                                                                       both blind and deaf.
Pediatric ophthalmologist Dr James Smith, Chairman of Ophthalmology at Sydney’s Royal
North Shore Hospital and the boys’ eye specialist, monitored the twins closely in hospital and
discovered that both had early signs of ROP and needed surgery. “Both boys had laser surgery
on both their eyes, and they’re looking really good now,” their mother Amy explains. “Without it,
it was quite likely that they would have gone blind.”

The twins’ vision will be monitored closely for five years and will require life-long eye checks.
But, as Dr Smith reports: “With careful monitoring and laser surgery at a critical point, we can
turn this disease around. These boys have a 90 per cent chance of having their sight preserved.
This intervention is fabulously successful, and in all likelihood, children such as Harry and Jack will
be spared a lifetime of blindness.”
BRAZILtimely action
Beating ROP with

Congenital cataract and ROP are important causes of childhood blindness in Latin America
but few children have access to early diagnosis and treatment. In Rio de Janeiro, a group of
ophthalmologists working in a private clinic (Brazilian Institute of Ophthalmology), together with
partners including economists, lawyers and businessmen, founded the Infantile Cataract Project.
Its aim is to provide surgery, glasses, IOLs and follow-up for three years for low-income families.

Guilherme was born with congenital cataract in both eyes. He didn’t walk, was considered
mentally retarded and was isolated from other children. When Guilherme was two, he was
referred to the Infantile Cataract Project in Rio de Janeiro.

When Guilherme was operated on, his life changed virtually overnight. After surgery, he learned
to walk and became very communicative. A happy, healthy three-year-old, Guilherme is now
attending a regular school in Rio de Janeiro.

Antonio was born blind because of congenital cataract in both eyes. At 18 months old,
he traveled with his family to Rio de Janeiro from the state of Ceara, hoping to find some
treatment. At first evaluation, he appeared very frightened and could not walk, even with help.
Cataract surgery was performed in both eyes.

Right after the first surgery he smiled at his mother and started to play with toys. Now he walks
by himself, plays soccer with his father, and his mother does not know what to do to keep him

                                                                     Izabelle, now one year
                                                                     old, was born at 23 weeks’
                                                                     gestation. With a very low
                                                                     birth weight of only 780g,
                                                                     Izabelle needed special care
                                                                     and was kept in the neonatal
                                                                     unit for three months. She
                                                                     developed severe ROP and
                                                                     was in danger of permanent
                                                                     visual impairment.

                                                                     Izabelle was successfully
                                                                     treated for ROP at two
                                                                     months old, while still in
                                                                     neonatal care. Now she is
                                                                     at home with her family and
                                                                     doing fine, learning to walk
                                                                     and to play with her toys,
                                                                     just like any other little girl.
                                                                     Thanks to vigilance, and early
                                                                     intervention, Izabelle has the
                                                                     chance of a normal life.

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