Prevalence and causes of blindness in children in Vietnam.

OBJECTIVE: To estimate the prevalence of blindness in children in Vietnam and to assess the major causes. DESIGN: A population-based study sampled children from 16 provinces across Vietnam. The second study examined children attending all blind schools in Vietnam. PARTICIPANTS: In 16 provinces, 28 800 children aged 0-15 were sampled. In 28 blind schools, 569 children aged 0-15 were examined. INTERVENTION: In children not seeing well according to the parents, presenting visual acuity (PVA) was assessed. If PVA was <3/60 in one or both eyes, the child was examined by an ophthalmologist. All children in blind schools were examined by a pediatric ophthalmologist. MAIN OUTCOME MEASURES: Blindness was defined as PVA <3/60 in the better eye. Causes of visual loss were classified using the World Health Organization classification. RESULTS: In the population-based study, 22 children had a PVA <3/60 in the better eye, a prevalence of 7.6/10 000 children (95% confidence interval [CI], 4.9-11.8/10 000). Fourteen children had a pinhole visual acuity <3/60 in the better eye, a prevalence of 4.9/10 000 (95% CI, 2.8-8.4/10 000). An estimated 16 400 (95% CI, 10 500-25 300), children were blind from all causes, with 36.4% from uncorrected refractive errors. In the blind schools, 411 children had a PVA <3/60 in the better eye and 55.5% were male. Conditions of the retina (24.6%) and cornea (24.0%) predominated. Retinopathy of prematurity (ROP) caused blindness in 32.6% of children younger than 10 years, but in only 6% of older children. The converse was true for corneal scarring and phthisis (14.0% and 27.3%, respectively). All other causes were similar between age groups (53.5% and 66.7%, respectively). More than half of all causes were avoidable. CONCLUSIONS: Vietnam is developing very rapidly, and this is impacting health indices. The mortality rate of those younger than 5 years declined from 65/100 live births in 1980 to 14/100 in 2008. The findings of this study show these changes, because the childhood blindness prevalence was relatively low, and the causes show improved control of measles and vitamin A deficiency, as well as increased services for premature babies. Eye care services for children should now focus on refractive errors, cataract, and control of ROP.