1. 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

2. 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

3. 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)

4. 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

5. 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

6. 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

7. 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

8. 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):1434-1440 Br. J. Ophthalmol. 2000;84;1291-1297 Middle East Afr J Ophthalmol. 2009 Apr;16(2):69-74.

9. 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

10. 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

11. 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

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13. Calculation of team strength  1500 children in a school  Teachers identify 300  Expected refraction – 225-250  Expected glasses – 100

14. 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

15. 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

16. 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

17. 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.

18. 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.

19. 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

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21. IEC in Pediatric Camps

22. 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

23. 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

24. 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.

25. A R A V I N D - M A D U R A I ROP screening and Treatment (A2Z USAID PROJECT)

26. 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

27. 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)

28. 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

29. 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