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

Taking Pediatric Ophthalmology to the

DoorstepsDr. Muralidhar

ConsultantAECS

Madurai

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

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)

A R A V I N D - M A D U R A I 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 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 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 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 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):1434-1440Br. J. Ophthalmol. 2000;84;1291-1297

Middle East Afr J Ophthalmol. 2009 Apr;16(2):69-74.

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

Teacher screening

Normal

Annual review

Optometrist screen

NormalAbnormal

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

A R A V I N D - M A D U R A I 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 – 225-250 Expected glasses – 100

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

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

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

Our Statistics-2010

31 schools 86837 children Our team evaluated 7637 New glasses – 2375 Same -882

A R A V I N D - M A D U R A I 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 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. 2004 Feb;8(1):18-9.

A R A V I N D - M A D U R A I 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. 2004 Feb;8(1):18-9.

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

A R A V I N D - M A D U R A I 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 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 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 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. 2007 Sep-Oct;55(5):329-30.

A R A V I N D - M A D U R A I 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 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 - 207 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 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 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 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