Taking Pediatric Ophthalmology to the Doorsteps

1. Taking Pediatric Ophthalmology to the Doorsteps Dr. Muralidhar Consultant AECS Madurai

2. The Need.. 407 million children 3,20,000 blind (20% of worldwide) 960, 000 children are with Low vision Blindness – 6.5/10,000

3. 11.2 million blind person years 16.3-37% preventable or avoidable 9.2 million children have less than 6/18 in a better eye (uncorrected refractive error)

4. Barriers to Eye Care Delivery Routine screening programmes not in place Poor socio –economic status/awareness Traditional practices Adverse advise Distance to tertiary care

5. Currently available infrastructure… 0.63 ped oph unit per million Most equipped to provide basic services only Refraction services by general ophthalmologist Refractionist available at CHC only

6. Sarva shiksha abhiyan – need to upgrade Need to standardize school screening ROP screening – need to bolster

7. The Solution… Expand coverage Organized service delivery Pediatric and school screening camps Referral facilities to tertiary institutes Innovative strategies

8. School screening by teachers Arch Ophthalmol. 2008;126(10):1434-1440 Br. J. Ophthalmol. 2000;84;1291-1297 Middle East Afr J Ophthalmol. 2009 Apr;16(2):69-74. School children – good target group Teachers – ideal screeners Cost effective

9. The Aravind Model… Train the teachers 6/9 chart and 6m rope Each teacher – 100 students

10. Identify willing schools Teachers screen Defective children listed Letter drafted to parents Hospital team examines defective children

11. Teacher screening Normal Optometrist screen Abnormal Annual review Normal Refraction & Review by pediatric ophthalmologist Treat Refractive Errors Minor ailments Refer rest

13. Calculation of team strength 1500 children in a school Teachers identify 300 Expected refraction – 225-250 Expected glasses – 100

14. Composition of team - 300 children 3 optometrists (each 80 refraction) 2 junior MLOP’s – vision screen -150/head + cycloplegia 2 pediatric ophthalmologists Counsellors -1 (only referral cases) Optical personnel – 1

15. Our Statistics-2010 31 schools 86837 children Our team evaluated 7637 New glasses – 2375 Same -882

16. AEH Plan to screen 200,000 School children this year including ICDS centres with an NGO EKAM Using teachers and health workers as screeners

17. Is School Screening Enough? J AAPOS. 2004 Feb;8(1):18-9. Younger age groups missed Poor enrollment and drop outs Motivation of teachers Follow ups

18. Concept of pediatric camps J AAPOS. 2004 Feb;8(1):18-9. To cover up the lacunae Find a sponsor & fix a date Local publicity Screening by optometrist Final treatment by pediatric ophthalmologist

19. Pediatric Camp 2583 in 15 camps 373 glasses 55 advised to continue same

21. IEC in Pediatric Camps

22. How does the institute benefit? Local publicity Mobilization of extramural funding Learning and training programmes

23. Experience of other centers Good sensitivity and specificity Cost effectiveness Concerns about follow up and compliance Motivation of teachers Coordination with school staff

24. ROP screening Indian J Ophthalmol. 2007 Sep-Oct;55(5):329-30. Advances in neonatal medicine Screening has not kept pace India specific screening criteria

25. ROP screening and Treatment (A2Z USAID PROJECT)

26. Major Milestone • Tieup with the NICU at Govt Rajaji Hospital • In 2009 till june, Screened - 207 in total, Including 170 from Govt NICU • 31 had laser treatment, 2 had surgical intervention

27. Paediatricians getting trained to recognize ROP with simulated eye balls (Pedicon – TN)

28. Where do we go from here…. Universal screening at the earliest Easy access to data – low vision, PHC National database Coordination with OG, pediatricians

29. “Intelligence and capability are not enough. There must also be the joy of doing something beautiful.” - Dr. G. Venkataswamy