International Ophthalmology 24: 53–59, 2002. © 2002 Kluwer Academic Publishers. Printed in the Netherlands. 53 Causes of childhood blindness in Malaysia: results from a national study of blind school students S.C. Reddy & B.C. Tan Department of Ophthalmology, School of Medical Sciences, University Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia Accepted 15 October 2001 Key words: blind school children, cataract, childhood blindness, cornea, retina Abstract A national study was conducted in children attending six schools for the blind in Malaysia to identify the anatom- ical site and underlying causes of blindness (BL) and severe visual impairment (SVI), with a view to determine the potentially preventable and treatable causes so that appropriate control measures can be implemented in the future. The standardized clinical examination of eyes was performed and the findings were recorded on the WHO Prevention of Blindness Programme eye examination record form for children with blindness and low vision. A total of 358 children aged between 7 and 17 years were examined, of whom 332 (92.7%) were blind or severely visually impaired. The results relate to these 332 children. Lens was the major anatomical site (22.3%) of visual loss followed by retina (20.8%), whole globe (17.2%), cornea (15.1%), optic nerve (8.7%) and uvea (5.1%). Glaucoma was responsible for BL/SVI in 7.2% and others in 3.6% of cases. Hereditary diseases were responsible for visual loss in 29.5%, intrauterine factors in 4.5%, perinatal factors in 9% and childhood factors in 7.8% of cases. However, the aetiology was unknown in 49.1% of cases which included congenital anomalies of the globe. Childhood cataract and corneal scarring are major treatable causes of BL/SVI that can benefit from future intervention strategies. Perinatal screening for intrauterine factors and hereditary eye diseases, and appropriate interventional therapy will help in reducing the prevalence of childhood blindness. Introduction Childhood blindness has profound psychological, edu- cational and economic effects, not only for the in- dividual and family but also for the community and the country. There is a great loss of productivity for the country since the period of blinding years in chil- dren is much more than in adults. Moreover, there are additional costs in providing special education and rehabilitation facilities to enable blind children to be independent citizens of the country. A blind child is a person under 16 years of age with corrected visual acuity in the better eye of less than 3/60, or a visual field of less than 10 ◦ . A child with corrected visual acuity of more than 3/60 but less than 6/60 in the better eye is considered to have severe visual impairment [1]. Several studies have been reported on the causes of blindness in children attending schools for the blind from different parts of the world [2–25]. The major causes of blindness in children vary from region to re- gion and are largely determined by levels of socioeco- nomic development and availability of health care services [26]. Corneal scarring secondary to vitamin A deficiency, often associated with protein-energy mal- nutrition, measles and malabsorption of nutrients due to diarrhoea is the main cause of blindness in Africa and Asia [7, 8, 10, 12]. Genetically determined dis- eases of retina and optic nerve, and retinopathy of prematurity are causes of childhood blindness in North America and Europe [18, 27–29]. In certain countries in the Eastern Mediterranean region, in communities that practise close intermarriage, and in communities with particular ethnic or religious traditions genetic- ally determined diseases are the most important causes of childhood blindness [11, 14, 20, 23, 24].