A R A V I N D - M A D U R A I Taking Pediatric Ophthalmology to the Doorsteps Dr. Muralidhar Consultant AECS Madurai
A R A V I N D - M A D U R A I The Need.. 407 million children 3,20,000 blind (20% of worldwide) 960, 000 children are with Low vision Blindness – 6.5/10,000
A R A V I N D - M A D U R A I 11.2 million blind person years % preventable or avoidable 9.2 million children have less than 6/18 in a better eye (uncorrected refractive error)
A R A V I N D - M A D U R A I Barriers to Eye Care Delivery Routine screening programmes not in place Poor socio –economic status/awareness Traditional practices Adverse advise Distance to tertiary care
A R A V I N D - M A D U R A I 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
A R A V I N D - M A D U R A I Sarva shiksha abhiyan – need to upgrade Need to standardize school screening ROP screening – need to bolster
A R A V I N D - M A D U R A I The Solution… Expand coverage Organized service delivery Pediatric and school screening camps Referral facilities to tertiary institutes Innovative strategies
A R A V I N D - M A D U R A I School screening by teachers School children – good target group Teachers – ideal screeners Cost effective Arch Ophthalmol. 2008;126(10): Br. J. Ophthalmol. 2000;84; Middle East Afr J Ophthalmol Apr;16(2):69-74.
A R A V I N D - M A D U R A I The Aravind Model… Train the teachers 6/9 chart and 6m rope Each teacher – 100 students
A R A V I N D - M A D U R A I Identify willing schools Teachers screen Defective children listed Letter drafted to parents Hospital team examines defective children
A R A V I N D - M A D U R A I Teacher screening Normal Annual review Optometrist screen Normal Abnormal Refraction & Review by pediatric ophthalmologist Treat Refractive Errors Minor ailments Refer rest
A R A V I N D - M A D U R A I
Calculation of team strength 1500 children in a school Teachers identify 300 Expected refraction – Expected glasses – 100
A R A V I N D - M A D U R A I Composition of team 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
A R A V I N D - M A D U R A I Our Statistics-2010 31 schools children Our team evaluated 7637 New glasses – 2375 Same -882
A R A V I N D - M A D U R A I AEH Plan to screen 200,000 School children this year including ICDS centres with an NGO EKAM Using teachers and health workers as screeners
A R A V I N D - M A D U R A I Is School Screening Enough? Younger age groups missed Poor enrollment and drop outs Motivation of teachers Follow ups J AAPOS Feb;8(1):18-9.
A R A V I N D - M A D U R A I Concept of pediatric camps To cover up the lacunae Find a sponsor & fix a date Local publicity Screening by optometrist Final treatment by pediatric ophthalmologist J AAPOS Feb;8(1):18-9.
A R A V I N D - M A D U R A I Pediatric Camp 2583 in 15 camps 373 glasses 55 advised to continue same
A R A V I N D - M A D U R A I
IEC in Pediatric Camps
A R A V I N D - M A D U R A I How does the institute benefit? Local publicity Mobilization of extramural funding Learning and training programmes
A R A V I N D - M A D U R A I Experience of other centers Good sensitivity and specificity Cost effectiveness Concerns about follow up and compliance Motivation of teachers Coordination with school staff
A R A V I N D - M A D U R A I ROP screening Advances in neonatal medicine Screening has not kept pace India specific screening criteria Indian J Ophthalmol Sep-Oct;55(5):
A R A V I N D - M A D U R A I ROP screening and Treatment (A2Z USAID PROJECT)
A R A V I N D - M A D U R A I Major Milestone Tieup with the NICU at Govt Rajaji Hospital In 2009 till june, Screened in total, Including 170 from Govt NICU 31 had laser treatment, 2 had surgical intervention
A R A V I N D - M A D U R A I Paediatricians getting trained to recognize ROP with simulated eye balls (Pedicon – TN)
A R A V I N D - M A D U R A I Where do we go from here…. Universal screening at the earliest Easy access to data – low vision, PHC National database Coordination with OG, pediatricians
A R A V I N D - M A D U R A I “ Intelligence and capability are not enough. There must also be the joy of doing something beautiful. ” - Dr. G. Venkataswamy