active screening and management of cataract, refractive...

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Active screening and management of cataract, refractive errors and ROP Dr.P.Vijayalakshmi Dr.P.Vijayalakshmi Chief, Paediatric Ophthalmology & Adult Strabismus Chief, Paediatric Ophthalmology & Adult Strabismus Aravind Eye Hospital & Postgraduate Institute of Ophthalmology Tamilnadu, India Aravind Eye Hospital & Postgraduate Institute of Ophthalmology Tamilnadu, India

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Page 1: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Active screening and management of cataract, refractive errors and ROP

Dr.P.VijayalakshmiDr.P.VijayalakshmiChief, Paediatric Ophthalmology & Adult StrabismusChief, Paediatric Ophthalmology & Adult Strabismus

Aravind Eye Hospital& Postgraduate Institute of Ophthalmology

Tamilnadu, India

Aravind Eye Hospital& Postgraduate Institute of Ophthalmology

Tamilnadu, India

Page 2: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Aravind Eye HospitalsMadrasKasarayode

Cannanore

Wayanad

CalicutNilgiri

Malapuram

Erode

Dharmapuri

Salem

NamakkalPerambalur

Cuddalore

Pondi

Villuppuram

Thiruvannamalai

Vellore

Tiruvallur

Nagapattinam

Kancheepuram

Available facilities;

Comprehensive treatment, all specialty services, Vision, community centers, Managed eye hospitals, Teaching and training, Research, IOL

CoimbatorePalghat

Trichur

ErnakulamIdukki

KottayamAlleppey

Pathanamthitta

Tuticorin

Quilon

Tirunelveli

Trivandrum

Kanyakumari

PerambalurNagapattinamTrichyKarur

TanjoreTiruvarurPudukotai

Dindigul

TheniMadurai Sivaganga

VirudhunagarRamnad

A2Z Project service area• Population 25 million

MaduraiTotal Out patient 575,392Annual surgeries 111,366

manufacturing division,

Page 3: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Aim and objectives of the project

AimAimTo enhance the service delivery to the needy To enhance the service delivery to the needy childrenchildren

Objectives: three areasObjectives: three areas•• High quality surgical treatment to paed High quality surgical treatment to paed

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

•• High quality surgical treatment to paed High quality surgical treatment to paed cataractscataracts

•• Increase the beneficiaries with refractive Increase the beneficiaries with refractive errorserrors

•• Implement screening and treatment for ROP Implement screening and treatment for ROP in nearby NICUsin nearby NICUs

Page 4: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Project approach-cataract surgery•• Towards case findingTowards case finding

−− Special Special paediatricpaediatric eye camps in under served areaseye camps in under served areas

−− Incorporating Incorporating paediatricpaediatric eye care into our regular campseye care into our regular camps

−− Distribution of IEC materials(professionals) toward s early referralDistribution of IEC materials(professionals) toward s early referral

•• To increase the acceptance rateTo increase the acceptance rate−− Offering a totally free service to the needyOffering a totally free service to the needy

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

−− Offering a totally free service to the needyOffering a totally free service to the needy

−− Good Good counsellingcounselling to the parents/ guardians to the parents/ guardians

−− General General anaesthesiaanaesthesia--improved techniques for sick childrenimproved techniques for sick children

−− Provision of financial assistance for followProvision of financial assistance for follow--up vi sitsup visits

•• Towards Quality treatmentTowards Quality treatment−− Provision of Foldable lenses to all children, Incre asing the follow up Provision of Foldable lenses to all children, Incre asing the follow up

rate, Spectacles for the residual refractive errorrate, Spectacles for the residual refractive error

Page 5: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Organizing a Paediatric eye camp

Planning Planning -- Geographical Information Geographical Information

System (GIS)System (GIS)

•• Identification of the potential areaIdentification of the potential area

•• Selection of a local partnerSelection of a local partner

•• Fix the date and camp siteFix the date and camp site

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

•• Fix the date and camp siteFix the date and camp site

•• Publicity with posters, pamphlets, Publicity with posters, pamphlets,

mike systemsmike systems

•• Visit of a medical teamVisit of a medical team

•• Spectacle distribution Spectacle distribution on the spoton the spot

•• Refer to base hospital for expert managementRefer to base hospital for expert management

Page 6: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Paediatric Eye Camps - performance

Activity Planned for 18 months

(Oct 08- July 10)

Planned for 12 months

(Oct 08- Sept 09)

Actual Performance

Paediatric eye camps 14 8 9

Children examined 4,800 2,800 2,040

Spectacles 800 500 561

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

Spectacles 800 500 561

Challenges

•• Community PartnersCommunity Partners

•• Screening children of 0 Screening children of 0 –– 5 years5 years

How challenges were met

•• A2Z support for publicity and spectacles, training of A2Z support for publicity and spectacles, training of anganwadianganwadi workersworkers

Page 7: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Cataract Surgery PerformanceTotal number planned(Oct 08- Sept 09)

Actual surgeries performed (Oct 08 – Sep 09)

BeneficiariesUnder A2Z support

Cataract Surgery 1000 857 312 + 8

Foldable lens 300 531 220

G.A & Surgery kits 500 438

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

G.A & Surgery kits 500 438

Challenges

Lack of awareness, late referrals, very sick babies, reaching them all at the same time conscious towards sustainability

Overcome?

By paediatric eye camps, increasing the capacity of counselling, A2Z support for IOLs and other help

Page 8: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Finding Refractive errors-correction with spectacles

•• Identification of Identification of SchoolSchool

•• Training Training of teachersof teachers

•• OrganisingOrganising the the

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

•• OrganisingOrganising the the doctor’s examinationdoctor’s examination

•• Provision Provision of of spectacles on the spectacles on the spot. spot.

Page 9: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Activities Planned

(Oct 08- July 10)

Planned

(Oct 08- Sept 09)

Actual Performance

Teachers trained 450 300 662

School screening Camps 70 40 67

Students screened 70,000 40,000 116,991

Spectacle distribution 4,400 2,400 4,338

School Screening Performance

Challenges

•• School Working Pattern School Working Pattern -- 220 days220 days

•• Working hours per day: 9.30 am to 4.30 pmWorking hours per day: 9.30 am to 4.30 pm

•• Plastic lens dispensingPlastic lens dispensingChallenges overcome

•• Systematic planning at base hospitals (weekly revie w meeting)Systematic planning at base hospitals (weekly revie w meeting)

•• Community participation (School management, teacher s, local NGOs and parents)Community participation (School management, teacher s, local NGOs and parents)

•• Letter sent to parents through teachersLetter sent to parents through teachers

•• Acquiring the equipment(ESSILOR) and special train ing to staff to grind and dispense plastic Acquiring the equipment(ESSILOR) and special train ing to staff to grind and dispense plastic lenses on the spotlenses on the spot

Page 10: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Screening and treatment of ROP •• Selection Selection of NICUs and getting approval from the c oncerned of NICUs and getting approval from the concerned

authoritiesauthorities

•• SensitisingSensitising our own staff and the staff at NICU on t he our own staff and the staff at NICU on the procedures procedures

•• Distribution of IEC materialsDistribution of IEC materials

•• counselling on the available free servicescounselling on the available free services

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

Activity Planned

(Oct 08- July 10)

Planned

(Oct 08- Sept 09)

Performance

Babies examined 500 270 542

Babies referred to AEH 45 25 20

ROP Laser procedures 90 50 47

•• Follow up of affected infants with comprehensive Follow up of affected infants with comprehensive wo rkupworkup

Page 11: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Paediatricians getting trained to recognize ROP with simulated eye balls

•• Problems and solutionProblems and solution

•• Entering the government Entering the government sector for ROP screeningsector for ROP screening------Participating in their teaching Participating in their teaching

•• OrganisingOrganising a hands on for the a hands on for the

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I

•• OrganisingOrganising a hands on for the a hands on for the paediatricianspaediatricians

•• Getting the permission from Getting the permission from the Dean the Dean

•• HOD of their own ophthalmic HOD of their own ophthalmic unit admitting their inability to unit admitting their inability to screen for ROPscreen for ROP

Page 12: Active screening and management of cataract, refractive ...a2zproject.org/pdf/ChildBlindnessPartnersMeetingMaterials_ForWeb/16.pdfVision, community centers, Managed eye hospitals,

Much has been done and

Much remains to be done

A R A V I N D - M A D U R A IA R A V I N D - M A D U R A I