Building India’s Capacity for Paediatric Eye Care

Paediatric eye-care in India

India is the second-most populous country in the world and home to over 20% of the world’s blind population. Unfortunately, India is also home to the largest number of blind children in any one country.

“In 2000, India had only four comprehensive tertiary pediatric eye care centres. At that time, with a population of 1 billion, India needed 100 Children’s Eye Centers (CEC) as per the WHO guidelines of one centre per 10 million population. Therefore, building India’s capacity for pediatric eye care has been a mammoth challenge,” said Dr. Rishi Raj Borah, Country Director, Orbis India.

He added, “Examining children needs special skills and treatment requires specific training, knowledge and equipment. Thre is a need to build the infrastructure for service delivery including equipping the facilities and supporting community work, along with the development of all cadres of human resources required; having the right people in the right place is the cornerstone of any successful public health program.”

Keeping all of this in mind, in 2002, the India Childhood Blindness Initiative (ICBI) was launched by Orbis to help ensure that India’s children have access to quality eye care for generations to come.

The India Childhood Blindness Initiative began by identifying tertiary level eye hospitals where CECs could be established. Further, a country-wide survey was undertaken to generate evidence for human resource and infrastructure requirements for the elimination of avoidable childhood blindness. This was the first time that such an extensive survey was undertaken in India along with Dr R P Center for Ophthalmic Sciences.

Today, after nearly two decades, we can proudly say that we have played an important role in establishing pediatric ophthalmology as a distinct subspecialty in the Indian ophthalmology landscape thereby making sure that children across India have access to quality care for generations to come.

Today there are 33 CECs that have been developed with Orbis support across 17 states in India, and the good work is continuing at these child-friendly facilities. This is the largest network of CECs in any one country in the world. Besides, some of these centres as well as continue to provide training and support to the eye care system in India and many neighbouring countries. Further, this model has been successfully replicated in Nepal and Bangladesh.

Besides, three of the tertiary level pediatric facilities in the country that existed in 2000 were developed as pediatric ophthalmology learning and training centres (POLTCs) by Orbis, providing infrastructure as well as technical support. This included standardization of the curricula for different cadres of eye health professionals for the CECs and community work. These POLTCs continue to offer fellowships in pediatric ophthalmology, short/long-term training programs and periodically conducted workshops/refresher training as well as continuing medical education (CME) producing more and more able young child eye care professionals who are making sure that children across the length and breadth of India have access to quality pediatric care.

Through the invaluable support of our partner hospitals, we are reaching children in need of care and continue to extend the scope of this network.

With almost two decades of contribution in this field, Orbis has become a trusted name among the ophthalmic fraternity and community at large in their efforts to improve child eye health.

Addressing challenges of childhood blindness

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. The major causes of blindness in children vary widely from region to region, being largely determined by socioeconomic development, and the availability of primary health care and eye care services. In high-income countries, lesions of the optic nerve and higher visual pathways predominate as the cause of blindness, while corneal scarring from measles, vitamin A deficiency, the use of harmful traditional eye remedies, ophthalmia neonatorum, and rubella cataract are the major causes in low-income countries. Retinopathy of prematurity is an important cause in middle-income countries. Other significant causes in all countries are congenital abnormalities, such as cataract, glaucoma, and hereditary retinal dystrophies.

Refractive errors are the largest cause of moderate and severe visual impairment and this is on the rise. Reduced outdoor play and exposure to the sun are increasingly replaced by indoor activities and game for children. This increases the chances of children developing myopia.

Since children constitute only 3% of the world’s blind population, childhood blindness has not been given its due importance as compared to other causes of blindness and visual impairment. However, if childhood blindness is measured in blind-person-years it is second only to cataract blindness.

Additionally, the divide between the rich and poor continues to increase, leaving a significant portion of the population without access to basic healthcare services — most of whom live either in rural India or urban slums. To further compound the situation, a majority of ophthalmologists in India live and practice in urban areas.

Role of Orbis in India

Orbis India launched the India Childhood Blindness Initiative (ICBI), our flagship program in 2002, to help ensure that India’s children across geographies have access to quality eye care for generations to come. Till date, 33 Children’s Eye Centers (CEC) have been developed across 17 states of the country, and the good work is continuing at these child-friendly facilities

Orbis is fighting the problem of Refractive Error – the largest cause of moderate to severe visual impairment – through the REACH (Refractive Error Among Children) program across 15 districts of India. More information about this innovative model published recently.

Orbis has also worked in the areas of eye banking, diabetic retinopathy and quality assurance. The organisation has developed a Quality Resource Center which is now supporting eye care facilities across India and internationally

As a Founder Member of Vision 2020: The Right to Sight India, Orbis is actively involved in the activities of Vision 2020 – India.

Bridging the gap in training and skilling in paediatric eye care

One of the most critical deficits in global eye health is the lack of an adequately trained workforce. This is the very reason Orbis was founded – to provide ongoing training and support to eye care teams around the world.

Once people were identified for training, ‘where’ and ‘how’ they would be trained continued to remain a challenge when we started ICBI in 2002. To address this, three of the existing tertiary level paediatric facilities in the country were developed as paediatric ophthalmology learning and training centres (POLTCs) by providing infrastructure as well as technical support. This included standardisation of the curricula for different cadres of eye health professionals for the CECs and community work.

POLTCs offer fellowships in paediatric ophthalmology, short/long-term training programmes and periodically conducted workshops/refresher training as well as continuing medical education (CME). Conducting impactful research on child eye health is an integral part of a POLTC.

To aid in continuing education and support, Orbis creates customised hands-on opportunities through the Flying Eye Hospital and hospital-based trainings (HBTs) to increase clinical and surgical abilities of eye care providers. These trainings are tailored to address the requirements of the trainee as well as the community they will be serving. HBTs are especially well-received as they provide an opportunity for the entire clinical staff to get trained and gain experience in their own setting.

In addition, Cybersight, equal parts library, school and remote medicine service, is open to all eye health professionals around the world for training, consultation and research. Also, it keeps professionals who have undergone training connected with their mentors.

These efforts have not only contributed towards building the capacity of various cadres of eye health professionals and their affiliated institutions to provide care and support to children in need but has systematically created a milieu where paediatric ophthalmology could develop and flourish as a distinct subspecialty within the Indian ophthalmology landscape.

The importance of innovation in ophthalmology

Of course, at every step of the journey. For nearly four decades, Orbis has harnessed the latest in technology and innovation to take efforts to end avoidable blindness to an unprecedented scale around the globe.

The organization invented its Flying Eye Hospital – a state-of-the-art teaching facility complete with an operating room, classroom and recovery room – to reach remote communities before the Internet was born. An advanced audiovisual system allows local eye care teams in the plane’s classroom to watch surgeries happening in the operating room live in 3D.

Orbis’s simulation training program uses the latest technology – like virtual reality, artificial eyes, and life-like mannequins – to safely build local eye care teams’ skills.

Orbis’s telemedicine platform, Cybersight, uses the latest internet and mobile technologies to reach eye care teams worldwide, including in remote and conflict-affected areas, with training.

Training activities, including live lectures and surgeries, onboard the Flying Eye Hospital are broadcast via Cybersight to partner hospitals and classrooms around the globe.

A new artificial intelligence (AI) tool on Cybersight examines digital photographs to identify common eye diseases in a mere eight seconds, allowing more doctors in low-resource countries to provide early detection for their patients.

School Eye Health Program

School is the first formal space for learning. Using this space to reach the vast cohort of school-aged children who constitute a particularly vulnerable group because of the high prevalence of refractive error is a common practice. There are several models of school eye health programmes currently operational across India. REACH – Refractive Error Among Children is a model aiming to address challenges in the school eye health space and build innovative, sustainable and scalable programmes.