The VIIO Child Eye Care Project

Childhood blindness refers to a group of diseases and conditions occurring in childhood or early adolescence, which, if left untreated, result in blindness or severe visual impairment that are likely to be untreatable later in life. Significant causes are congenital abnormalities, such as ROP, cataract, glaucoma, and hereditary retinal dystrophies. Many of the causes of childhood blindness are avoidable, being either preventable or treatable. Childhood blindness is one of the priorities in Vision 2020: the right to sight. In the context of Vision 2020, the priorities for action to reduce childhood blindness in India are refractive error, cataract related amblyopia, and corneal diseases.

Vasoproliferative Retinal Tumour with Intermediate Uveitis:Retinal vasoproliferative tumor is the name for a condition in which a mass of blood vessels grows in front of the retina, the neural lining of the back of the eye. The retina is an extension of the brain, adapted to receive light and turn it into a nerve signal that tracks to the brain via the optic nerve. The normal retina is well supplied with blood vessels.  A child aged 9 yrs with above diagnoses was treated with oral steriods and surgical management of LEFT EYE VITRECTOMY + ENDOLASER + OZURDEX IMPLANT UNDER GENERAL ANAESTHESIA. (Ozurdex implants contain dexamethasone, a corticosteroid used to treat inflammation. Ozurdex implant injected into the eye to treat swelling that may occur when there is a blockage of certain blood vessels in the eye. The implant is slowly dissolved by the vitreous gel that fills the eye, releasing medication.  It will be active in the eye for 3 months.  Uveitis can damage the eye and cause long-term complications that reduce the vision. It is very important to receive treatment for the condition).

Ptosis correction surgery:Ptosis occurs due to dysfunction of the muscles that raise the eyelid or their nerve supply.  This condition will need treatment to have his or her vision develop normally. The most serious problem associated with ptosis is amblyopia (lazy eye), which is poor vision in an eye that did not develop normal sight during early childhood.  A male baby aged 3 yrs with diagnosis of developmental delays + Quadriparesis (Weakness of all four limbs, both arms and both legs) + microcephaly (a congenital condition associated with incomplete brain development) was operated for Ptosis - RIGHT EYE PTOSIS SURGERY WITH AUROSLING UNDER GENERAL ANAESTHESIA.

Cataract due to Cracker Injury: Cataract is an opacification of the lens. A 5 year old female girl child was presented to us with diminution of vision post cracker injury to her right eye. The child’s visual acuity was presence of perception of light and projection of rays in right eye.  Anterior segment examination showed corneal edema + traumatic cataract + blood clot inferiorly. Retinal status was ON. The intraocular pressure in right eye was 34 mmHg. The child was put on anti-glaucoma mediation to reduce the IOP + antibiotics drops to control the infection. After IOP control the child was intervened with surgical management of RIGHT EYE PHACOEMULSIFICATION + FOLDABLE HYDROPHOBIC IOL IMPLANTATION UNDER GENERAL

Congenital Glaucoma : Childhood glaucoma is an unusual eye disease and significant cause of childhood blindness. Congenital glaucoma results from abnormal development of the ocular drainage system.  Signs of glaucoma including clouding and/or enlargement of the cornea. The elevated intraocular pressure (IOP) can cause the eyeball itself to enlarge and injury to the cornea. Pediatric glaucoma is treated differently than adult glaucoma. A male child aged 10 yrs with above diagnosis was managed with multiple surgical interventions of Trabeculectomy in April 2016; Lensectomy + Vitrectomy in October 2017. Keeping his visual acuity in view the child was referred for visual rehabilitation post surgery.

Childhood blindness has multiple causes and these causes vary in different age groups. We understand that a single wide-net screening strategy is not suitable for all diseases in differing age groups. We plan to have community health worker, teacher led, technician led and doctor led screening and diagnosis systems, based on specific conditions with full cycle treatment delivery to ensure that no child will go blind. Children with uncorrected vision conditions or eye health problems face many barriers in life academically, socially and athletically. High-quality eye care can break down these barriers and help enable children to reach their highest potential. That's why a comprehensive child eye examination is so important for children. Early detection and treatment provide the very best opportunity to correct vision problems successfully. Under this effort we have treated children for the following eye problems.

1. Congenital Cataract:A cataract is an opacification of the lens. Congenital cataracts usually are diagnosed at birth. If a cataract goes undetected in an infant, permanent visual loss may ensue. Congenital cataracts may be unilateral or bilateral and can vary widely in size, morphology and degree of opacification from a small white dot on the anterior capsule to total opacification of the lens. A Baby with congenial cataract in one eye + down syndrome (Down syndrome, is a genetic disorder caused by the presence of all or part of a third copy of chromosome.  It is typically associated with physical growth delays, characteristic facial features, and mild to moderate intellectual disability, it is a lifelong condition) was treated with surgical intervention of PHACOEMULSIFICATION + IOL IMPLANTATION + PRIMARY POSTERIOR CAPSULOTOMY UNDER GENERAL ANAESTHESIA.

2. Granulomatous Uveitis:Uveitis is a condition causing inflammation of the middle eye or uvea, granulomatous uveitis is associated with toxoplasmosis and systemic mycotic infections. Toxoplasmosis is an infectious disease caused by the one-celled protozoan parasite Toxoplasma gondii. Although most individuals do not experience any symptoms, the disease can be very serious, and even fatal, in individuals with weakened immune systems).  The child was 1^st treated with steroid medication for management of Granulomatous Uveitis & was surgically managed with intervention of LENSECTOMY (Removal of the lens of the eye) UNDER GENERAL ANAESTHESIA

3. Pigmentary Retinopathy + Micro Cornea + Cataract: A child with systemic illness of gross developmental delays + CHD +  congenital Rubella syndrome (congenital heart disease (CHD), is a problem in the structure of the heart that is present at birth + Congenital rubella syndrome (CRS) is an illness resulting from rubella virus infection during pregnancy. When rubella infection occurs during early pregnancy, serious consequences—such as miscarriages, stillbirths, and a constellation of severe birth defects in infants can result. A rubella infection can cause multiple birth defects, including congenital heart disease) was diagnosed at our hospital with partially absorbed cataract + micro cornea in both eyes + pigmentary retinopathy (Pigmentary retinopathy is an inherited eye disorder involving degeneration of the retina).  The child was treated both eyes with surgical intervention of CATARACT EXTRACTION + PRIMARY POSTERIOR CAPSULOTOMY + ANTERIOR VITRECTOMY UNDER GENERAL ANAESTHESIA.

4. Zonular Cataract: This type of cataract is bilateral. It can be congenital or it can be acquired during the first years of life due to tetany or rickets. The cataract is always large enough to occlude the pupil.. The child with Intellectual Disability + delayed milestones (Intellectual disability (ID), previously known as mental retardation, is a term that is used when an individual has below-average intelligence or mental ability. Lack of skill necessary for day-to-day living are also commonly associated with this type of disorder. These children often have a hard time communicating their specific wants and needs, and usually struggle with taking care of themselves. ID is not a disease and it is a lifelong condition) was diagnosed with bilateral zonular cataract & was treated with PHACOEMULSIFICATION + IOL IMPLANTATION + PRIMARY POSTERIOR CAPSULOTOMY UNDER GENERAL ANAESTHESIA.

In accordance to our driving spirit to fulfill the dream of our founder, we are continuously striving to spread awareness and educate regarding childhood vision problems and its side effects in children.  A child needs many abilities to succeed in school. Good vision is a key. 80% of the learning a child does occurs through his or her eyes. Reading, writing, and using computers are among the visual tasks students perform daily. Healthy eyes and vision are a critical part of children development to excel in their curricular activities. To make this effort successful Parents and teachers are educated the need to be alert for symptoms that may indicate a child has a vision problem. Under this effort we have successful treated the below children for the following eye problems.

 1. Paediatric anterior uveitis - Uveitis is a condition causing inflammation of the middle eye or uvea) + Juvenile Idiopathic Arthritis (Juvenile idiopathic arthritis (JIA) can be defined as a group of idiopathic arthritides, which occurs before the age of 16 years and persists for at least 6 weeks. It is the most common cause of uveitis in children and also major cause of visual impairment in children).  Bilateral lensectomy was done to treat the child.

 2. Limbal dermoid- They are usually superficial lesions. They appear most frequently at the inferior temporal quadrant of the corneal limbus. Limbal dermoids are benign congenital tumors that contain choristomatous tissue (tissue not found normally at that site). MRI scan of brain and orbit will be done to see the extention and involvement of eye muscles. Limbal dermoid excision with histopathology examination was done to treat the child.

 3. Herpes zoster & keratitis - Herpes zoster ophthalmicus is reactivation of a varicella-zoster virus infection (shingles) involving the eye. Symptoms and signs, which may be intense, include dermatomal forehead rash and painful inflammation of all the tissues of the anterior and, rarely, posterior structures of the eye, Shingles in the eye could lead to vision loss). Penetrating Keratoplasty was the remedial surgical measure taken to restore the vision for the child.

4. Keratoconus - It is a degenerative disorder of the eye in which structural changes within the cornea cause it to thin and change to a more conical shape than the more normal gradual curve. Keratoconus can cause substantial distortion of vision, with multiple images, streaking and sensitivity to light.  It is typically diagnosed in children in the age group of 10-18 yrs. C3R (COLLAGEN CROSS-LINKING) SURGERY was the remedial measure taken to stabilize the cornea and vision for the child.

In the light of driving spirit to fulfill the dream of our founder, that “No one shall go blind for want of money or lack of care” has further strengthened our child vision care activities. During this reporting period we have covered 8 schools, screened 1812 children, 209 children found with refractive error have been supported with providing spectacles free of cost. We have been able to cover 12schools (August 2016 to February 2017) out of 20 identified schools under our child vision care programme.

Apart from school screening camps our doctors visit Ophthalmology unit at Indira Gandhi Institute of Child Health Centre for 3 days in a week. All those children who require surgically intervention / specialist evaluation are referred to base hospital. Such children are treated free of cost under this programme. Children who were treated were for the following diagnosis.

1. Congenital cataract- which refers to lens opacity present at birth. They cover a broad spectrum of severity; some lens opacities can produce profound visual impairment if left untreated.
2. Developmental cataract – which develops soon after birth. Cataract in childhood not only reduces vision but also interferes in normal vision development.
3. Vasoproliferative retinal tumour – it is a condition in which a mass of blood vessels grows in front of the retina, the neural lining of the back of the eye.
4. Aniridia + Glaucoma - It describes an extreme form of iris hypoplasia in which the iris appears absent Visual acuity is generally low. Glaucoma is a secondary problem causing additional visual loss over time. It requires specialized management. Because of poor visual acuity, low vision aids are very helpful. Lifelong regular follow-up care is necessary.

In accordance to our vision statement “No one shall go blind for want of money or lack of care” we had identified 20 schools from different clusters under our child vision care programme. Starting from LKG up to 10 STD children’s’ are screened for eye ailments. In continuance of our services under this programme we have further screened 1520 children from 4 schools, 92 children found with refractive error have been supported with providing spectacles free of cost. Children who required dilated fundus examination were referred to base hospital. Some children required surgical management & were managed with surgical intervention for curable blindness. Some photographs of children who were managed surgically are attached.