Nepalese Pediatric Visual Impairment Study (NPVIS)

A study among Nepalese children with visual impairment on etiology, activity and sleeping patterns, participation and quality of life
Authors:   , Adhikari Srijana 
Published: February 2025

Background
The Nepal Pediatric Vision impairment study (NPVIS) primarily focuses on physical activity and sleep, participation and quality of life of children with VI and blindness, by comparing them with their normally sighted peers.

Methodology
A total of 300 children 7-17 years from five integrated schools for the blind and the outpatient department of the Tilganga Institute of Ophthalmology were included. Physical Activity (PA) and sleep pattern of children were measured using actimeters, translation and cultural adaptation of the PROMs (Participation and Activity Inventory Children and Youth (PAI-CY) the PedEyeQ (Pediatric eye questionnaire) and the LVP-FVQ II (LV Prasad functional vision questionnaire II) were done into a Nepali version
Results
There was a changing trend in the etiology of childhood VI and blindness with retinal diseases being the common cause of blindness and VI followed by diseases involving lens and the whole globe. Approximately 44% of all children with VI and blindness had potentially preventable conditions. Children with VI had lower overall PA levels compared to their normally sighted peers and spent more time in light PA and less time engaging in moderate and vigorous PA than their normally sighted peers. Both groups spent largest proportion (~40%) of time sedentary.
Before school, children with VI were more involved in light intensity PA, and less sedentary compared to normally sighted children. No significant differences in the mean PA and proportion of time spent in moderate PA were found before school hours. However, during school , children with normal sight were more physically active than children with VI; they engaged in more moderate and vigorous PA while children with VI spent more time being sedentary and engaging in light PA.
During weekend, children were sedentary approximately 43% of their waking time and there was no statistically significant difference between children with VI and normally sighted children in any of the PA levels.
A large group of Nepalese gender and age-matched children, blind children have a lower sleep quantity and better sleep quality compared to their normally sighted peers. The sleep duration of both groups of children was far shorter than the recommended sleep duration for their respective age groups.
Activity and participation as well as functional vision are affected in children with VI compared to normally sighted peers. Younger children with blindness experienced a worse outcome compared to children with VI although results for older children showed a mixed pattern. After further analyzing the association between severity of VI with limitations in activities and participation, we found that children 7-12 years with moderate/severe VI experienced less limitations than children with blindness.
The same result was found for the physical functioning subscale in children 13-17 years. However, for the psychosocial functioning subscale, only small differences in scores between children with blindness, moderate/severe VI and normally sighted children were observed, and children with blindness scored slightly better on activities and participation than children with moderate/severe VI. Finally, there was an association between severity of VI and functional vision, showing worsening scores with increased severity of VI, as measured with the LVP-FVQ II. Younger children with blindness had worse quality of life as measured with the PedEyeQ (5-11) than children with moderate/severe VI for all subscales.

Conclusion:

The study explored various aspects of important daily activities including physical activity, sleep patterns, physical and psychosocial participation and (vision-related) quality of life in children with VI and blindness.
Based on our findings, we encourage policymakers to explore ways to help children with VI to be more physically active and promote participation in society.
We recommend further studies on barriers to implementation of low vision services and rehabilitation.