Hospital Based Pediatric eye services

Furahini GodfreyBSc. (ed), MD, MMed. POFellow.Department of Ophthalmology.08/04/11

Kilimanjaro Christian Medical Centre

Childhood blindness• Control of childhood

blindness is one of the priorities….

- "blind-years“ (number of years that a blind person lives after going blind) due to childhood blindness are 2nd only to cataract.

-50% the childhood blindness is avoidable.

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).

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

Pediatric Eye Conditions

RetinoblastomaRetinopathy of prematurityStrabismusPediatric glaucoma Pediatric cataractAmblyopia

Pediatric eye problems are often very different from adult eye diseases:

Pediatric Eye Conditions

Blocked tear ducts and defects

Ptosis Eye injuriesRefractive errorsRetinitis pigmentosa

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)

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

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.

•Lea symbols Cardiff Acuity Cards

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

Intra-ocular lenses

Small eye, still growing, changing refraction great challenge in choosing a lens power.

Biometry

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

Special equipments in Childhood Eye surgery

Good microscope + Special machines to remove the posterior capsule.

Special Supplies:

-Soft IOL’s, folders, injectors

-Blue dye ,Heavy viscoelastic

- Microincision capsule forceps

-goniolens, MMC, diode laser

-Strabismus set

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

Challenges in mgt of Pediatric eye conditions

Problem #1Late presentation

Problem #2Poor follow up

Problem #3Few surgeries.