Ocular findings in children attending occupational therapy clinic at Kenyatta National Hospital

Abstract

There is a high prevalence of ocular abnormalities in children with physical and mental disabilities which are often overlooked due to the difficulties encountered while examining them. OBJECTIVES To describe the pattern of ocular abnormalities, their correlation with the physical disorders and describe associated risk factors in children attending the Occupational therapy clinic at KNH. STUDY DESIGN Cross sectional hospital based study at the Occupational therapy clinic in KNH.A hundred and eighty seven children were examined." from both the general paediatric unit and the sensory integration unit. RESULTS A total of 187 children were examined, males were 109(58%) and females were 78(42%). The mean age was 2.56 years. The youngest child was 0.25 years and the oldest patient being 13 years with a range of 12.75 years .. The majority of the children were between one and two years, representing 45.5% of the whole group. Majority of the patients had cerebral palsy, 160(85.6%), while ADHD and autism had almost equal proportions, 20(10.7%) and 18(9.6%) respectively. Only one child had learning disability, which represented 0.5%. Some patients had multiple diagnoses. Among the children, 62% had ocular anomalies. Children with CP had a much higher prevalence (58.3%) compared to the sensory integration deficit group (3.7%). The common ocular abnormalities included cortical visual impairment 48.7%, refractive errors 39% and squints 34.2%. Other less frequent findings included strabismic amblopia13.4%, nystagmus 12.8%, and optic atrophy 5.3%. Corneal scars, cataracts, maculopathy and eyelid anomalies comprised of small proportion (5%). Association between physical disability and ocular anomalies was noted in patients with cerebral palsy compared with sensory integration group. Strabismus, cortical visual impairment and myopia were more likely to occur in patients with cerebral palsy. Significant hyperopia was noted only in the cerebral palsy group.

There was no significant association noted between amblyopia, nystagmus and optic atrophy and either of the physical disability. Some of the known risk factors for the physical disabilities were observed to have an association with the ocular anomalies. Strabismus and cortical visual impairment were more likely to occur in patient with neonatal jaundice, while refractive errors in patients with congenital causes and optic atrophy in patients with meningitis. No significant association was noted between nystagmus, and amblyopia and any of the risk factors. Co-morbid conditions associated with the physical conditions included speech (29.9%), epilepsy (18.7%), mental retardation (MR) 8%, dental problems 8%, hearing loss 6.4% and breathing difficulties 4.3%. CONCLUSION .• Visual disabilities in children with physical disabilities were common. Cortical visual impairment, refractive errors, squint and amblyopia, were seen in a large proportion of these children. Children with CP had a much higher prevalence compared to the sensory integration deficit group. RECOMMENDATION All Children with cerebral palsy and sensory integration deficits should be referred to ophthalmologist and low vision specialist for assessment as part of a broad multidisciplinary approach to their management. The occupational, speech and hearing therapists should work closely with the low vision specialists in co-ordinating the physical and ocular rehabilitation. Low vision unit should be started at KNH and specialist should be trained to provide the much needed services to these children. Follow up of the patients for evaluation of long term outcome of the visual interventions to be offered with the aim of improving the quality of treatment options.