# Visual Impairment and Ocular Findings in Children With Developmental Delay Attending a Child Development Unit Clinic at a Tertiary Hospital

## TL;DR

This study found that two-thirds of children with developmental delay had visual impairment, mainly due to refractive errors and strabismus, highlighting the need for early eye screening.

## Contribution

The study provides new prevalence data on ocular issues in children with developmental delay in a South Indian tertiary care setting.

## Key findings

- 66% of children with developmental delay had visual impairment.
- Refractive errors were present in 84% of children, with hypermetropia being the most common.
- Strabismus was detected in 12% of children, primarily exotropia.

## Abstract

Introduction

Childhood blindness is largely attributable to preventable causes. In children with developmental delay, identifying ocular morbidity is particularly challenging due to limited cooperation and associated comorbidities. This study aimed to determine the prevalence and spectrum of refractive errors, strabismus, and other ocular findings among children with developmental delay attending a tertiary care center in South India, and to highlight the importance of early ophthalmic screening in this population.

Methods

This retrospective review included 100 preschool children with developmental delay (aged four months to five years) presenting to the ophthalmology outpatient department of a tertiary care center in South India over a period of two years. Visual impairment was defined as visual acuity below the age-appropriate expected level despite best correction, or, in uncooperative children, based on abnormal fixation behavior and inability to maintain central, steady fixation. Evaluation included visual acuity testing, refraction, ocular alignment assessment, and comprehensive ophthalmic examination.

Results

Visual impairment was observed in 66 (66%) children (95% CI: 56-75). Refractive errors were identified in 84% (95% CI: 75-90) of the cohort, with hypermetropia being the most frequent subtype (65, 78%), followed by myopia (15, 18%) and astigmatism (38, 45%). Strabismus was detected in 12% of children, most frequently exotropia. Causes of developmental delay included prematurity (69%), syndromic associations such as Down syndrome (10%), and miscellaneous factors (21%).

Conclusion

Nearly two-thirds of children with developmental delay had visual impairment, predominantly due to refractive errors and strabismus. Early ophthalmic screening and timely management are essential to reduce preventable visual disability and improve neurodevelopmental outcomes in this vulnerable group.