Pediatric Ophthalmology

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According to the WHO bulletin 2001, the number of blind children in the world is approximately 1.4 million. Three-quarters of these children live in the poorest regions of Africa and Asia. In Nepal, most of the childhood eye diseases are prevalent in the rural parts of Nepal due to poverty, lack of awareness of possible remediation and lack of appropriate medical facilities. More than 90% of these diseases are preventable or treatable. The vast majority of these children who are brought to hospital are in very late stages of disease when possibility of salvaging vision is minimal.

The project will help combat these problems in the following ways:

• Provide appropriate medical equipment to facilities in Eastern Nepal
• Provide free medical and surgical services to many children previously deprived of such facilities
• Increase community awareness about eye disease

Project Description

Childhood blindness in Nepal: There are about 5.5 million children in Nepal below 15 years of age.¹  The Nepal Blindness Survey conducted in 1981 showed xerophthalmia ocular infection and cataract to be the leading causes of blindness in children.²  Other ocular conditions that cause visual morbidity in children are trauma, uncorrected refractive error and strabismus. These are the major causes of avoidable childhood blindness in Nepal. More than 90% of these diseases are either preventable or treatable. Prevention and treatment of childhood blindness is disease specific.

Xeropthalmia is the condition occurring due to vitamin A deficiency in children. For Vitamin A deficiency, at a cost of only 5 US cents a dose, vitamin A supplements reduce child mortality by up to 34% in areas where Vitamin A deficiency is a public health problem.

The causes of congenital and developmental cataract in children are idiopathic, hereditary, traumatic congenital rubella etc.³  Cataract in children differs in many ways from adults. The intra operative technique and the post operative management of childhood cataract is still a challenge for ophthalmologists. Timely diagnosis and surgery are very important in these cases to acquire good visual potential.

Other diseases like congenital glaucoma, ocular malignancy like retinoblastoma, and other congenital and developmental eye diseases are common in children of rural Eastern Nepal. One of the most common causes of ocular morbidity in school children in Nepal is the uncorrected refractive error which causes amblyopia (lazy eye).⁴

The most important factor contributing to the burden of childhood blindness in the community is the lack of knowledge about these diseases. Most of the children brought to the hospital are already in very late stages.

 

Project Justification

WHO has assigned childhood blindness as one of the top five priority problems in its ambitious program vision 2020, the Right to Sight5. In Nepal, pediatric ophthalmology facilities are rare, even in urban areas. In the eastern region, a few pediatric ophthalmology services are present in some eye centers but they are insufficient for the problem in such a large population. This project will help diagnosing eye diseases and giving timely intervention to the population who are deprived of these facilities due to poverty and lack of knowledge.

Project Output

This project will provide free medical checkups, medications and surgical treatment to the children of rural areas of eastern Nepal suffering from treatable eye problems. Evaluation of the magnitude of the problem (prevalence of eye diseases in children) will be evaluated and the baseline data regarding the medical and surgical interventions and their outcome will be generated for further research and planning.

Project Activity

The total duration of the project will be one year. In this period as many VDCs (Village Development Committees) as possible will be covered. In the beginning, the VDCs of Sunsari and Morang districts will be covered. If these are completed in less than one year, then an additional VDC will be included in the project. The project will run in two areas:

In the Community:

• Weekly children eye health camps in the local VDCs
• Eye health check up manpower will include a pediatric ophthalmologist, ophthalmology resident, ophthalmic technician, driver
• Free medications for children
• Pediatric vision screening training for the local village health professionals
• Health education for the local community through posters and lectures

In the Hospital:

• As eye surgery in children requires general anesthesia and sophisticated instruments, it is not possible to carry out in rural communities. Children for whom surgery is indicated will be brought to the hospital for free surgery and hospital stay.
• Parents will be counseled for the intensive post operative management of these children as this is very crucial in pediatric surgeries like cataract.

Personnel Required

The following staff are being supplied by the B. P. Koirala Institute of Health. They will spend a year in the villages doing exams, treating simple cases that don't require a hospital stay, bringing children back to the hospital who would benefit from surgery, and trying to educate people about health and treatment options.

• A pediatric ophthalmologist
• An ophthalmology resident
• An ophthalmology technician

Material Requested

Name of the equipments	Number of item	Estimated cost
Loose plastic prism set	1	$250
A-Scan biometry machine (Appasamy India)	1	$2,000
Hand held keratometer	1	$2,000
Total		$4,250

Institution

B. P. Koirala Institute of Health Sciences, Dharan, Nepal.

Dr. Srijana Adhikari, MD, Department of Ophthalmology is heading the project. Dr. Srijana received her pediatric Ophthalmology and Strabismus fellowship with Dr. M. Edward Wilson at the Storm Eye Institute, Medical University of South Carolina.

References

1. Nepal population census 2001. http://www.mope.gov.np/population/chapter1.php visited on 24th July 2006.
2. Pediatric Cataracts, in BCSC Section IV Pediatric Ophthalmology and Strabismus
3. Nepal, B., P. S. Koirala, S. Adhikary, and A. K. Sharma, Br J Ophthalmology 2003; 87: 531-534. doi:10.1136/bjo.87.5.531
4. Brilliant L. B., R. P. Pokhrel, N. C. Grasset, et al. Epidemiology of blindness in Nepal. Bull World Health Organ. 1985; 63(2):375-86.
5. Gilbert C., A. Foster, Childhood blindness in the context of VISION 2020--the right to sight. Bull World Health Organ. 2001; 79(3):227-32.

 

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For more information about this project, see Pediatric Ophthalmology or contact ANMF.