1. Hospital Based Pediatric eye services Furahini Godfrey BSc. (ed), MD, MMed. POFellow. Department of Ophthalmology. 08/04/11 Kilimanjaro Christian Medical Centre

2. Childhood blindness Control of childhood blindness i s one of the priorities…. - "blind-years“ (number of years that a blind person lives after going blind) due to childhood blindness are 2 nd only to cataract. -50% the childhood blindness is avoidable.

3. Global magnitude of the childhood blindness problem The prevalence of childhood blindness varies from country to country. 4% to 5% of all blindness in the world is due to childhood blindness. Global magnitude of the childhood cataract problem -200,000 children blind -1 to 15 children per 10,000 live births (estimate only).

4. Tanzania: Magnitude of the childhood cataract problem In Tanzania = >1,000 children per year born with congenital cataract Unknown # of children with developmental cataract /year: (rough estimate = 500/year) Unknown # of children have traumatic cataract /year: (rough estimate = 400/year) Surgeries/year in 2005 in Tanzania= 450

5. Pediatric Eye Conditions Retinoblastoma Retinopathy of prematurity Strabismus Pediatric glaucoma Pediatric cataract Amblyopia Pediatric eye problems are often very different from adult eye diseases :

6. Pediatric Eye Conditions Blocked tear ducts and defects Ptosis Eye injuries Refractive errors Retinitis pigmentosa

7. Setting For Pediatric eye services Hospital based with access to other subspecialties -ENT, anaesthesia, -Neonatal care unit & Paediatricians, -Radiology, Oncology, VR surgery, etc. Easy access for patients travelling long distance (linked to a developed road system and airport)

8. Evaluation of Pediatric Eye Conditions Clinic: Hx /Exam. Local (ocular) / Systemic Va: -Preferential looking, -Fixation behavior. Anterior & Posterior segments. Refraction etc. red reflex test Fixation

9. Pediatric diagnostic equipments Basic: Slit lump, indirect ophthalmoscope, A Scan, Keratometer, Refraction set, Prism set Essential: Above + Auto refractor, Perkins tonometor, Goldman/Automated perimeter, B Scan, Advanced: Above + Low vision assessment kit, Pre-verbal vision tests, fundus camera.

10. Lea symbolsCardiff Acuity Cards

11. Management of Pediatric eye conditions Well trained, experienced, equipped team: –Pediatric ophthalmologist –Anaesthetist –pathologist/oncologist –ophthalmic nurses and paramedics –Optometrist / Low vision therapist. –dispensing optician –patient counsellors –Childhood blindness & low vision coordinator Parents who understand their role

12. Intra-ocular lenses Small eye, still growing, changing refraction great challenge in choosing a lens power. Biometry

13. Pediatric eye surgical equipments Basic: operating microscope, vitrectomy machine, Boyle’s apparatus Essential: Above + Pediatric anaesthesia equipments, Pediatric monitors, YAG laser ACCURUS VITRECTOMY MACHINE Boyle’s

14. Special equipments in Childhood Eye surgery Good microscope + Special machines to remove the posterior capsule.

15. Special Supplies: -Soft IOL’s, folders, injectors -Blue dye,Heavy viscoelastic - Microincision capsule forceps -goniolens, MMC, diode laser -Strabismus set

16. PO mgt in Childhood Eye surgery Inflammation: – depot inj. Regular refraction: -Myopic shift. - Clear vision for distance and near -Certainly need reading glasses at school -Pediatric size spectacle frames & lenses Amblyopia treatment : -Occlusion therapy. Low vision services -non optical: lamp…etc. -optical: magnifiers/telesc

17. Challenges in mgt of Pediatric eye conditions Problem #1 Late presentation Problem #2 Poor follow up Problem #3 Few surgeries.