Current status of paediatric Current status of paediatric i A i t ii A i t ieye care in Asian countrieseye care in Asian countries

Dr. P.VijayalakshmiDr. P.VijayalakshmiChiefChief

Paediatic Ophthalmology and Strabismus Paediatic Ophthalmology and Strabismus Dept.Dept.

Aravind Eye Hospital& Postgraduate Institute of Ophthalmology

Aravind Eye Hospital& Postgraduate Institute of Ophthalmology& Postgraduate Institute of Ophthalmology

Madurai, India& Postgraduate Institute of Ophthalmology

Madurai, India

IntroductionIntroductionIntroductionIntroduction House for 1 million blind childrenHouse for 1 million blind children Causes are variable in different Causes are variable in different

regionsregionsgg Available manpower and services are Available manpower and services are

not uniform.not uniform. Service dependable on external fundsService dependable on external funds Late presentations are notLate presentations are not Late presentations are not Late presentations are not

uncommonuncommon

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IntroductionIntroduction Quality of service diversified even inside Quality of service diversified even inside

the countrythe country–– Basic to advancedBasic to advancedthe countrythe country Basic to advancedBasic to advanced No mechanism existing for routine No mechanism existing for routine

screening of babies in NICU andscreening of babies in NICU andscreening of babies in NICU and screening of babies in NICU and thereafterthereafter

Inadequacy inInadequacy in anaesthesiaanaesthesia facilityfacility-- almostalmost Inadequacy in Inadequacy in anaesthesiaanaesthesia facilityfacility-- almost almost uniformuniform

Lot of NGO s make an effort to improveLot of NGO s make an effort to improve Lot of NGO s make an effort to improve Lot of NGO s make an effort to improve the case finding, quality care, training HR, the case finding, quality care, training HR, funding for setting up thefunding for setting up the specialityspeciality etcetc

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funding for setting up the funding for setting up the specialityspeciality etcetc

IndiaIndia--The Need..The Need..IndiaIndia The Need..The Need..

407 million children 407 million children 3 20 000 blind (20% of worldwide)3 20 000 blind (20% of worldwide) 3,20,000 blind (20% of worldwide)3,20,000 blind (20% of worldwide) 960, 000 children are with Low 960, 000 children are with Low

visionvisionvisionvision Blindness Blindness –– 6.5/10,0006.5/10,000

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Currently available Currently available infrastructureinfrastructureinfrastructureinfrastructure……

Most equipped to provide basicMost equipped to provide basic Most equipped to provide basic Most equipped to provide basic services onlyservices only

Refraction services by generalRefraction services by general Refraction services by general Refraction services by general ophthalmologistophthalmologistR f ti i tR f ti i t il bl t CHCil bl t CHC RefractionistRefractionist available at CHCavailable at CHC

Only .63 Only .63 pedped ophoph unit per millionunit per million No screening or referral protocol No screening or referral protocol

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Tertiary Tertiary centrescentresHow How are we are we equippedequipped

Keeler acuityCake DecorationCake Decoration

Fixation preference Cardiff cardCardiff card

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Improved Examination TechniquesImproved Examination TechniquesKeeler card SG Chart

Hand slit lamp Handheld keratometer

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VEP Recording ERG

Active Vision Stimulation with

Colored Running Lights

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Electro Video NystagmogramElectro Video Nystagmogram

Preop Postop

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Paediatric CataractPaediatric Cataract Lot of understanding on the Lot of understanding on the

etiology especially of CRS as a etiology especially of CRS as a cause cause

AnaesthesiaAnaesthesia::-- Availability of good Availability of good neonatal neonatal anaesthetistanaesthetist, newer , newer induction and maintenance Drugsinduction and maintenance Drugsinduction and maintenance Drugs, induction and maintenance Drugs, laryngeal airways mask laryngeal airways mask

Possible to take grade III riskPossible to take grade III risk Possible to take grade III risk Possible to take grade III risk patients also for surgery patients also for surgery

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Surgical RevolutionsSurgical Revolutions

After cataract PC opacification

Automated vitrectorAutomated vitrector

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Aphakic Rehabilitation - Nil to spectacles, t t l t IOLcontact lenses to IOLs now

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ROP screening and Treatment ROP screening and Treatment (A2Z USAID PROJECT)(A2Z USAID PROJECT)(A2Z USAID PROJECT)(A2Z USAID PROJECT)

Ret cam Laser

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ROP ScreeningROP Screening Protocol is there, HR is getting betterProtocol is there, HR is getting better Implementation of the Implementation of the programmeprogramme is not is not

uniformuniform Awareness among neonatologistsAwareness among neonatologists\\

paediatricianspaediatricians and their role in referraland their role in referral Quality Quality NICUcareNICUcare is not available to allis not available to all Awareness among parents almost nilAwareness among parents almost nilAwareness among parents almost nilAwareness among parents almost nil More IVF babies with vision impairment More IVF babies with vision impairment

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At present; controlled chemotherapy with At present; controlled chemotherapy with newer and effective drugsnewer and effective drugsnewer and effective drugs newer and effective drugs

BEFORE CHEMOTHERAPY DAY 1

AFTER CHEMOTHERAPY AFTER 6 MONTHS REVIEW

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Visual rehabilitation in childrenVisual rehabilitation in children

More More understanding on understanding on Vision rehabilitation

ggvisual maturation has made visual maturation has made possible to rehabilitate these possible to rehabilitate these children even with multiple children even with multiple ppdevelopmental delaydevelopmental delay..

Only very few institutes Only very few institutes offer thisoffer thisoffer thisoffer this

No existing network of No existing network of referral on thisreferral on this

No registry on this disabilityNo registry on this disability

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Integrated education

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Existing Refractive servicesExisting Refractive services--AravindAravindgg•• TrainTrain thethe teachersteachers•• 66//99 chartchart andand 66mm roperope•• EachEach teacherteacher –– 100100 studentsstudents

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Concept of pediatric campsConcept of pediatric campsp p pp p p To cover up the lacunaeTo cover up the lacunae Find a sponsor & fix a Find a sponsor & fix a

datedate Local publicityLocal publicity Screening by optometristScreening by optometrist Screening by optometristScreening by optometrist Final treatment by Final treatment by

pediatric ophthalmologistpediatric ophthalmologistpediatric ophthalmologistpediatric ophthalmologist

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Perceptions at the public level on paediatric eye Perceptions at the public level on paediatric eye diseasesdiseases

Kariapatty study

diseasesdiseases Focus group discussion with 16,551 persons residing in Focus group discussion with 16,551 persons residing in

24 hamlets24 hamlets24 hamlets24 hamlets Common perceptions were : Strabismus was not Common perceptions were : Strabismus was not

treatable, and that it does not lead to loss of vision, is treatable, and that it does not lead to loss of vision, is also a sign of luckalso a sign of luck

Lack of uniform treatment advise among doctors Lack of uniform treatment advise among doctors Children below 4 years should not wear spectaclesChildren below 4 years should not wear spectacles Children below 4 years should not wear spectacles Children below 4 years should not wear spectacles No necessity for periodic vision testingNo necessity for periodic vision testing Did not consider vision impairment as among the topDid not consider vision impairment as among the top Did not consider vision impairment as among the top Did not consider vision impairment as among the top

ten eye problems among childrenten eye problems among children Uptake of service is better with field worker screening, Uptake of service is better with field worker screening,

d t h id t h i

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and outreach servicesand outreach services

Positive DevelopmentsPositive Developments Awareness increasing regarding the Awareness increasing regarding the

comprehensive paediatric eye carecomprehensive paediatric eye carep p yp p y

Paediatric oriented ophthalmologists are mostly Paediatric oriented ophthalmologists are mostly self made drawn from the general pool withself made drawn from the general pool withself made drawn from the general pool with self made drawn from the general pool with some formal training in the fieldsome formal training in the field

Increased interest among youngIncreased interest among young Increased interest among young Increased interest among young ophthalmologistsophthalmologists

O S i i 0O S i i 0 ORBIS has come with strategies to set up 50 ORBIS has come with strategies to set up 50 paediatric ophthalmology units at tertiary care paediatric ophthalmology units at tertiary care

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centrescentres in near future in near future

BangladeshBangladesh

Involvement of ORBIS International Involvement of ORBIS International have helped them to increase theirhave helped them to increase theirhave helped them to increase their have helped them to increase their human resources and the human resources and the infrastructure facility in the pastinfrastructure facility in the pastinfrastructure facility in the past infrastructure facility in the past decadedecade

Currently almost the total populationCurrently almost the total population Currently almost the total population Currently almost the total population is getting coveredis getting covered

Funds seems to be not a problemFunds seems to be not a problem Funds seems to be not a problemFunds seems to be not a problem Still needs constant improvement Still needs constant improvement

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In NepalIn Nepal

To add slides from Dr. KarthikTo add slides from Dr. Karthik

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Pediatric Ophthalmology services in Nepal 

Population of Nepal: 25 million (2010) ‐ Approximately 

% of children – 43 to 45 % of population 

 

5 years before (Recent Past) 

1. Number of fellowship trained pediatric Ophthalmologists ‐4 

2. Number of pediatric Ophthalmologists in Kathmandu – 3 (75%) 

3. Number of anesthetists at peripheral eye hospitals  ( outside Kathmandu)– 1 

4. Eye Institutes with separate pediatric eye department – 3 

Now 

1. Number of  fellowship trained  Pediatric Ophthalmologists – 9 

2. Number of pediatric Ophthalmologists in Kathmandu ‐5 (55.5%) 

3. Number of anesthetists at peripheral eye hospitals – 1 

4. Eye Institutes with separated pediatric eye department ‐ 4 

5. Photographer’s awareness programme. 

6. Retinoblastoma 

7. Pre ‐School Screening ( Oral polio immunization) 

There are an increasing number of pediatric ophthalmologists and pediatric eye care centers which is 

very good news but no corresponding increase in the anesthesia services which Is really disappointing as 

the pediatric eye services greatly depend on the anesthesia services for proving comprehensive 

pediatric eye care. 

5 years from now, 

1. Chemotherapy for Retinoblastoma at peripheral center / centers 

2. Photographers training 

3. Pre ‐School Screening ( combining with Oral polio immunization) – Make it a national wide 

program 

4. To increase the quality and availability of regular anesthesia services especially in the peripheral 

centers. 

5. Commencement of pediatric Ophthalmology fellowships in Nepal from 2011‐12, to train 

ophthalmologists with in Nepal. 

Anesthesia services 

The availability of regular anesthesia services is critical in further improving the pediatric eye care 

services especially in peripheral centers (Outside Kathmandu valley) 

Other Asian countriesOther Asian countriesOther Asian countriesOther Asian countries

Bhutan: 1 trained paediatric ophthalmologist forBhutan: 1 trained paediatric ophthalmologist for Bhutan: 1 trained paediatric ophthalmologist for Bhutan: 1 trained paediatric ophthalmologist for the whole countrythe whole country

Myanmar: Self trainedMyanmar: Self trained paedpaed carecare Myanmar: Self trained Myanmar: Self trained paedpaed carecareophthalmologistsophthalmologists

MaldhivesMaldhives: No: No subspecialitysubspeciality practice existspractice exists MaldhivesMaldhives: No : No subspecialitysubspeciality practice exists, practice exists, population is lowpopulation is low

Sri Lanka: Fairly good tertiary care availableSri Lanka: Fairly good tertiary care available Sri Lanka: Fairly good tertiary care available , Sri Lanka: Fairly good tertiary care available , then not uniformthen not uniform

Pakistan andPakistan and neigbouringneigbouring countries?countries?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

Pakistan and Pakistan and neigbouringneigbouring countries?countries?

Future expectationsFuture expectationsFuture expectationsFuture expectations Routine screening and referral protocol at all agesRoutine screening and referral protocol at all ages Routine screening and referral protocol at all agesRoutine screening and referral protocol at all ages Improved manpower and infrastructureImproved manpower and infrastructure

U if di t ib ti f d d t tiU if di t ib ti f d d t ti tt Uniform distribution of secondary and tertiary Uniform distribution of secondary and tertiary centrescentres Total eradication of Vitamin A deficiency and CRSTotal eradication of Vitamin A deficiency and CRS Good networking with other Good networking with other paedpaed specialitiesspecialities Involvement of the Involvement of the govtgovt sectorsector Help from NGOs for case finding and service Help from NGOs for case finding and service

deliverydelivery

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