An estimated 1.4 million of the children in the world are blind. A blind child is more likely to live in socioeconomic deprivation, to be more frequently hospitalised during childhood and to die in childhood than a child not living with blindness. The constellation of causes of childhood blindness in lower income settings is shifting from infective and nutritional corneal opacities and congenital anomalies to more resemble the patterns of severe visual disability severe visual impairment and blindness, related to cerebral visual impairment and optic nerve anomalies. Reducing visual impairment and blindness in children in resource-poor countries was one of the key components of the major global prevention of blindness initiative, VISION 2020 the Right to Sight. A lot has been achieved in terms of childhood cataract and ROP but much is needed in the neglected field of severe visual impairment related to developmental disorders

Neurodevelopmental disorders are characterised by early-onset deficits of variable severity in personal, social, academic or occupational functioning. Ocular motility disorders as well as a large variety of visual problems have been associated with certain types of development disorders in children, which leads support to the idea that the development disorders are aetiological factors in such visual issues.

Population-based epidemiological research, particularly on cerebral visual impairment and visual issues in developmental disorders, especially in lower income countries in Asia, is needed in order to improve understanding of risk factors and to inform and support the development of novel therapies for disorders currently considered 'untreatable'.

Improvements in maternal and neonatal health and investment in and maintenance of regional and national ophthalmic care infrastructure are the key to reducing the burden of avoidable blindness Study design: Epidemiological study of Cohort of cerebral developmental children and longitudinal cohort study.

Setting: Multi centric, semi urban and rural multi-speciality hospital and surrounding draining areas including special schools.

Time: Three months

Sampling: Stratified community based

Method: An eye examination of 154 children with developmental disability was undertaken to detect ocular anomaly, record visual capacity, treat visual problems which are neglected, overcome visual handicap in time and facilitate rehabilitation and development.

Most of the information on blindness in children has been recorded on a specialized form designed by the WHO. [14] In this form, the causes are divided according to etiological (Hereditary, intrauterine, perinatal, childhood, and unknown) and anatomical (cornea, lens, retina, cortical, whole globe, uvea, glaucoma, and others) classification. We concentrate on the role of cerevral developmental issues.

Results: 60% of patients had correctable eye problems, 30% had partially and non-correctable eye problems.

The correctable eye problems needed early intervention and simple treatment to prevent amblyopia. Those who had partially correctable and non-correctable eye problems were better managed by vision rehabilitation specialist so as to make the best use of their limited vision.

This study also showed up another interesting fact that child with developmental disabilities had multiple eye problems with an extremely high incidence and prevalence much higher than that due to cataract and ROP.

Discussion: Global estimates on childhood blindness show that there are around 1.42 million and 17.52 million children suffering from blindness and moderate to severe visual impairment, respectively. Almost three quarters of these live in low–middle income countries where the prevalence is reported to be as high as 1.5 per 1000 children in contrast to high-income countries where the prevalence is 0.3 per 1000. The disability adjusted life years (DALY) loss in a blind child is far more than that of adults with blindness and childhood blindness results in 11.2 million blind person years resulting in longer DALY loss as compared to adults. The current prevalence of blindness in children is known to be around 0.8/1000. The prevalence is likely to be affected by the methodology used to estimate the blindness such as community-based surveys and locations like rural or urban settings. We engaged in an active community approach like seek and treat, achieving a far more outreach and in a more systematic manner which seems to get a much larger and yet closer to reality estimation of incidence and prevalence in an etiological manner in one aspect so as to guide further policy and funding.

Conclusion: A comprehensive eye care approach of continuum of seek and treat with educative approach of health promotion, disease prevention and rehabilitation that addresses the full spectrum of eye diseases in neurodevelopmental conditions needs to be coordinated across nations and between G 20 nations and beyond the health sector, and according to these children’s needs throughout the life course and a careful genetic counselling of parents before child birth, especially in the cases of consanguineous marriage, and proper ANC to pick up avoidable causes like cord around neck of fetus should be emphasized to prevent these children from becoming blind in future years with huge DALYs.