Retinopathy of Prematurity (ROP)

ROP-CAP And NES Program

RETINOPATHY OF PREMATURITY CONTROL IN ANDHRA PRADESH AND NEWBORN EYE SCREENING PROGRAM

Important Information

Preterm babies can have serious vision loss from Retinopathy of Prematurity (ROP), which may not be externally visible.
All preterm babies with a birth weight less than 2.0 kg, or born less than one month before the Expected Date of Delivery (EDD), need a complete DILATED RETINAL EXAMINATION DEFINITELY BETWEEN 20-30 days of birth.
Follow-up is needed every 1-2 weeks till the retina matures fully.
Very urgent laser treatment is needed if abnormal retinal vessels are seen on a retinal examination.
All normal and preterm newborns should undergo an eye examination for ‘Red Reflex’ and torchlight examination within a few hours of birth and, thereafter, every month till 6 months of age.

Eye Care for Children - Common Myths

Parents and relatives often nurture beliefs regarding eye diseases and treatment, which cannot be proved by scientific reasoning. Lack of awareness and scientific knowledge about the disease and treatment modalities may lead to improper/delayed treatment and subnormal visual acuity (poor vision), even if treated later. Here we discuss the scientific basis for some of the common myths encountered in pediatric ophthalmology.

Myth #1 Regular use of glasses can lead to permanent removal of glasses.

Not true. The eyeball is like a camera. The focusing mechanism of the eye should match the size of the eyeball. By using glasses, we achieve a balance between the focusing mechanism and the size of the eyeball. Therefore, the power of the spectacles does not reduce by wearing glasses constantly. The person constantly has a good quality of vision by using glasses, which lessens the strain on the eyes.

Myth # 2 Eye exercises and herbal eye drops can lead to a decrease in the

power of the glasses, and in course of time, one can get rid of glasses. There are no scientific studies to prove this; rather, it has been proved beyond doubt that there are no quick fixes such as eye exercises or herbal medicines that can reduce the power of the glasses required for vision correction. Young children must be encouraged to play in the natural environment at least for an hour or so every day as it is known that rural children and those who have outdoor activity have lesser instances of myopia than urban children who tend to be more home bound.

Myth # 3 By taking vitamin A and eating vegetables like carrots (which contain a high amount of vitamin A) one can get rid of glasses.

There is no doubt that vitamin A is essential for the normal functioning of the retina. However, it does not have any effect on the focusing mechanism of the eyeball. Hence, excess intake of it does not lead to a reduction in the power of spectacles. Vitamin A is useful only for those with a deficiency of vitamin A. Excess supplementation of vitamin A can lead to damage to kidneys/brain. Hence, it should be taken only when indicated by a doctor.

Myth # 4 Glasses are required only by elderly people and not young children.

This is actually not true. We often observe elderly members of our family wearing eye glasses, as they suffer from presbyopia – weakening of the muscles needed to focus for near sight. However, different kind of refractive errors, such as short-sightedness, astigmatism and far-sightedness can affect young children. Children too need periodic eye check ups. Recommended ROUTINE eye examination schedule for children:

See Myth # 10 for eye examination in newborn babies
One to two eye check-ups between 2-5 years of age per year
Two to three check-ups between 6-15 years of age per year
Urgent check-up in case of any symptoms or any minor/major

change in eye appearance/visual behaviour

Myth # 5 Squinting of the eyes is not an eye problem but God's gift to our family.

It is a common belief that a squint is a sign of good luck. However, this is not true. This condition occurs due to an imbalance in the eye muscles and if appropriate treatment (glasses or surgery) is not given at the correct time, there may be permanent decrease in vision in one or both eyes. Thus it is not only a cosmetic blemish but also leads to loss of vision and depth perception. Also, a squinting eye can have a serious underlying disease including eye cancer, hence, every squint eye needs a detailed complete examination.

Myth # 6 Squint correction should be done around the age of 18 years.

This is incorrect. Squint surgery can be performed at any age. However, if the squint is present from early childhood it is best that surgery is done as early as possible. If surgery is not done early, lazy eye or amblyopia may develop in one of the eyes and 3-D vision (stereopsis) may decrease. If surgery is done later in life, the eyes will appear straight but the vision may not improve.

Myth # 7 Large and blue eyes are beautiful and a gift from God.

Some children may have large and blue looking eyeballs. Though these may look more beautiful than normal ones, they can suggest an underlying eye disease such as glaucoma, a large cornea or a systemic disease. These diseases can affect the vision and even other body parts. Hence, this should not be neglected and the child should be examined early for any eye conditions.

Myth # 8 Watching television or working on computers may damage the eyesight of children.

This is not true. Sitting close to the TV will not damage the eyes; in fact sitting close to the TV may be indicative of an underlying refractive error. It may, however, lead to some muscle strain and watering after prolonged watching. Hence, one should watch the television or use the computer from an appropriate distance and take adequate breaks.

Myth # 9 Use of home remedies like lemon, honey, mother’s milk and some vegetable oils can cure the red eyes of my child.

This is not true. Each case of red eye has to be properly examined before coming to a proper diagnosis and the treatment must be instituted according to that disease. In fact, the use of honey and lemon may cause allergies and infection in the eyes. Therefore, it is best to consult an eye doctor and take appropriate treatment.

Myth # 10 Newborn babies do not get eye problems and do not need routine eye examinations.

Every newborn at birth should undergo an eye examination by torchlight and a red reflex test to detect serious eye problems. Every preterm baby should definitely undergo a retinal examination within 20-30 days of life, as serious problems can occur behind an apparently normal eye.

Dr Somasheila Murthy, Head, Cornea Services at L V Prasad Eye Institute, India, Performs Corneal Transplant Surgeries at The Liberia Eye Centre, Monrovia

LV Prasad Eye Institute reinforces ROP Campaign to fight against needless blindness in preterm and low weight babies

Hyderabad, November 7, 2014: Blindness and vision impairment in newborns and young children are on a rapid rise in India with improved newborn care and swift socio-economic development. In the context of preventing blindness in newborn babies, Retinopathy of Prematurity (ROP) has emerged as a severe challenge particularly in developing and middle-income group countries in Latin America, Eastern Europe, South East Asia, China and India. The World Health Organization (WHO) has underscored the importance of this condition by including ROP as a major target disease in its prevention of blindness program, VISION 2020 - The RIGHT to SIGHT programme to combat needless blindness globally by the year 2020.

Highly efficacious, scientifically proven and accessible technology is available to manage ROP in the last two decades. Various multicenter prospective studies have conclusively proven that timely detection and treatment can markedly reduce blindness due to ROP. Yet untreated ROP blindness continues to be a reality and India has the highest number of blind children. More than 60% of visual impairment in babies is preventable or curable with timely detection, prompt and appropriate preventive and curative management.

ROP has become a mission for LVPEI since 1999 and a constant endeavour to translate information available in books and journals to actual implementation at the bedside of the neonate. On completion of 15 years of the ROP screening program, LVPEI re-dedicates its team that includes Dr. Padmaja Rani and Dr. Divya Balakrishnan in Hyderabad, Dr. Tapas Padhi and Dr. Umesh Behera in Bhubaneswar, Dr. Sameera Nayak in Vijayawada and Dr. Virender Sachdeva in Visakhapatnam to further expand the newborn eye screening program to spread its reach to every baby in the hospital/NICU/SNCU to enable them achieve their RIGHT to Sight! There are a number of risk factors for newborn eye problems including premature birth, familial disorders, Rubella, Congenital diseases, poor cry at birth, etc that need to be addressed through a health sector-wide multidisciplinary approach and LVPEI has pioneered some such approaches.

Addressing the media, Dr Subhadra Jalali, Associate Director, Srimati Kanuri Santhamma Centre for vitreo-retinal diseases, and the Jasti V. Ramanamma Children’s Eye Care Centre, L V Prasad Eye Institute, Hyderabad said, “Our 15 years of sustained efforts in partnership with Indian Neonatologists and other ROP centres in India, helped formulate the National ROP Guidelines in 2010 specific for India. We are an integral part of the Ministry of Health, Govt. of India Task force on ROP and WHO used our expertise to improve ROP blindness programmes under the Philippines Government. We also became the first state in India to expand the program to Government Special Newborn Care Units (SNCU) under the NRHM program for Andhra Pradesh (in the erstwhile undivided Andhra Pradesh that includes current Telangana). All our efforts, including our partners in neonatal and childhood care also helped for the first time to get a mandatory preventive Eye screening status for ROP in the Rashtriya Bal Swasthaya Karyakram (RBSK) and today we are on the expert panel of this Government program.”

To mark 15 years of its INDIAN TWIN CITIES Retinopathy of Prematurity Screening (ITCROPS), L V Prasad Eye Institute (LVPEI) organized a series of activities to bring public focus on the eye disease that affects any baby, especially the preterm and low weight babies. Recognised as the premier Institute for rare and complex surgeries in babies, LVPEI played host to the first ever dedicated hands-on surgical workshop in India devoted to retinal diseases of newborns and small children. Prominent retinal surgeons from India discussed and debated with world leaders, Dr. Michael Trese and Dr. Lingam Gopal, on strategies to improve awareness amongst the community on ROP and conducted skill-transfer for its advanced management. About 100 children with retinal problems were examined for expert opinion during this workshop.

The EIGHTEENTH Dr C Syamala Bhaskaran Endowment Lecture on Blinding diseases in premature newborns: Management of ROP in the 21st century by Dr Michael Trese was also held at the Institute. The annual lecture series was initiated in honour of Bhaskaran’s generous support to L V Prasad Eye Institute for creating public awareness about Retinal diseases.

Dr Subhadra Jalali further added, “Over the last 15 years, LVPEI team has examined more than 12,000 babies and treated more than 16,000 eyes with state of art lasers and surgeries. The smallest baby treated in our program was 550 grams and smallest baby to undergo major surgery was 1400 grams - these tiny eyes require great skill and the team effort of competent surgeons, anaesthetists, highly motivated neonatologists and nurses in partnership with courageous parents.” LVPEI has extended training programs to surgeons not only in India but also in countries like Indonesia, Nepal, Pakistan, Azerbaijan and China. LVPEI has successfully imparted training to more than 350 professionals in India and abroad for ROP screening and treatment.

The most recent WHO estimates confirm 80% of all causes of visual impairment are preventable or curable. WHO estimates that in 2010 there were 285 million people visually impaired, of whom 39 million were blind. Provision of effective and accessible eye care services is the key to effectively control visual impairment including blindness. Comprehensive eye care services need to become an integral part of primary health care and health systems development. Eye health also needs to be included in broader non-communicable and communicable disease frameworks.

About L V Prasad Eye Institute

The L V Prasad Eye Institute provides high quality comprehensive eye care to all people; provides sight enhancement and rehabilitation services at the Institute and through its rural eye health network; offers professional ophthalmic training at all levels; and conducts cutting-edge eye care research. The Institute is a World Health Organization (WHO) Centre for the Prevention of Blindness and a Global Resource Centre for VISION 2020, a worldwide initiative for the elimination of avoidable blindness led by WHO and the International Agency for the Prevention of Blindness. For further information, visit the Institute’s website www.lvpei.org.

For further information, please contact:
Dr Sreedevi Yadavalli, Associate Director and Head – Communications
Tel: +91 040 23547254, +91 040 30612444, Email: ysreedevi@lvpei.org

Rapid Increase in Blindness and Vision Impairment in Newborns and Young Children in India

L V Prasad Eye Institute reinforces ROP Campaign to fight against needless blindness in preterm and low weight babies

About L V Prasad Eye Institute

For further information, please contact:
Dr Sreedevi Yadavalli, Associate Director and Head – Communications
Tel: +91 040 23547254, +91 040 30612444, Email: ysreedevi@lvpei.org

Dear Dr Subhadra and Dr Padmaja,

Thank you very much for giving me an opportunity to be part of ped. workshop. It was indeed a great experience.

Regards,
Dr Pramod S Bhende
Director- Medical Affairs, Deputy Director- Dept of VR Surgery
Sankara Nethralaya, Chennai

Dear All,

It was indeed a pleasure attending the Pediatric retinal surgery workshop. I came back having learnt a lot and having made new friends. I am indebted to Dr Michael Trese and Dr Lingam Gopal for imparting to us with pearls of wisdom gleaned from decades of dedicated work .The presentations from all the participants too were very useful. Thank you Dr Subhadra Jalali madam for making it happen.

Regards
Salil Gadkari , H V Desai Eye Hospital, Pune

Dear Subhadra,

Thank you so much for arranging a fantastic, power-packed, informative, educative 4 day meet at LVPEI the highlight being of course Dr Trese and Dr Gopal whose inputs were stupendous. One has to salute you and your team for putting up this vastly extensive show with a superb variety of cases and a thick jungle of FEVR cases so it could be easily labelled as 'Fevr delight.'

The programme was chalked out in great detail and indeed it was your iron hand which executed it so smoothly.

Kudos to you and your team! Here's to having more meetings like these.

With lots of love and regards,
Karobi Lahiri
Bombay Hospital, Mumbai

Thank you for a wonderful experience. It was an intensive but brilliantly interactive workshop that you thought of and executed. It was obvious that a large amount of planning had gone in to arrange such a large number and spectrum of paediatric cases. And to get two legends in the field as the mentors! Your dedication and tireless energy in your devotion to the cause of paediatric retina is inspiring and commendable. It was a great and unique learning experience. I really hope and would strive so I can take the full advantage of it and translate words into ACTION. Will remain in touch and would trouble you for your help, guidance and opinion in future!

Many thanks again and best wishes,
Daraius Shroff, Shroff Eye Institute, Delhi

Dear Dr Jalali,

I thank you for the wonderful time we had at the workshop with Dr Trese, Dr Gopal and all the new friends I made. It was truly a great learning experience and helped to resolve many queries and doubts. I am sure we all learnt so much from this workshop.

Thanks for all your hard work and effort in organizing this.

And above all thanks for choosing me to be a part of this amazing experience and it definitely made me better.

Best regards and best wishes to you always,
Parijat Chandra
Associate Prof. RP Centre, Delhi

Dear Dr Subhadra

Many thanks for your invitation to me for this Paediatric Retina Workshop. It was really a great learning experience for me. I admire you for the meticulous planning of this workshop and all other activities. I express my sincere thanks for the warmth and kindness extended to me by you all. I will always remain grateful to you for getting stalwarts like Dr Trese and Dr Lingam Gopal on one platform for this intensive interactive workshop. I really enjoyed closed interactive sessions and surgery performed by them. It was a lifetime experience for me to learn so much.

Once again thank you very much for your invitation and hospitality.

Regards
Mangat
Dr Mangat R Dogra
President Vitreo Retinal Society of India
Professor of Ophthalmology, Advanced Eye Centre
PGIMER, Chandigarh

Dear Dr. SJ,

Thanks a lot for inviting me to the workshop. Had an absolutely amazing time. It was a real academic treat.

As a VR surgeon planning to enter the area of ROP surgery, it was a real insight into this new world. Hopefully the confidence that I have gained in last few days will push me into this challenge with lot more vigour. By next meet, I hope to be presenting my results in this area

Regards
Ritesh Narula
Centre for Sight, Safdargunj, Delhi

Dear Subhadra,

It was indeed gracious on your part to have invited me for the workshop. I am very thankful to you for the opportunity you gave me to interact with everybody. I learnt a lot in the process. I truly admire you for the hard work and dedication. It is reflected in the quality of your work and the reputation you acquired over time.

Your team members adore you. Wish you the very best and once again thank you for the wonderful conference.

Regards,
Gopal
Dr. Lingam Gopal, Singapore

Dear Dr SJ,

I'm really happy for the surgical workshop on paediatric retina. The interaction amongst all paed retina giants was amazing. We not only shared our experiences but also cell numbers, now we are a group and you made it possible. We discussed each and every case/step of surgery, each day it ran up to 9 PM and all were awake and enjoying it; this is really praiseworthy. I did not know this could be so interesting. Whatever I learned, I will implement and after one year, I'll send you the report card.

It’s beyond doubt that you always go to exceptional/above the call of duty to teach us. You not only give knowledge but also courage and confidence which makes us better always. I'm glad you are my teacher. I have no words to express my gratitude. Thanks for everything.

My special thanks to the whole group.

Regards,
Sameera,LVPEI-Vijayawada

I have been waiting to share my feelings.

From all those that I interacted with, this program has been simply outstanding. The range of the cases, the eminence and enthusiasm of the faculty, the energy levels and the satisfaction of the delegates; simply everything about the program was outstanding. Congratulations and thanks to Subhadra and team for putting together this great event and executing it so well.

GC,
Dr G Chandra Sekhar, Vice Chair, LVPEI

Newborn Blindness due to Retinopathy of Prematurity: an upcoming epidemic in Uttar Pradesh, Bihar and Jharkhand

Patna, December 6, 2014: Blindness and vision impairment in newborns and young children are on a rapid rise in those parts of India that are rapidly modernising. With development come improved maternal delivery care systems, test tube baby centres and highly sophisticated newborn care units with incubators and ventilators. While improvements in mother and child health are necessary, this development comes with an increased number of premature births. Premature babies are prone to Retinopathy of Prematurity (ROP), which afflicts the eyes of preterm babies that have typically received specialized neonatal care. Such epidemic has already been seen in big cities like Mumbai, Kolkata, Hyderabad, Delhi, Chennai etc and is now creeping into towns and cities of Bihar, Uttar Pradesh, Jharkhand, Gujarat, Madhya Pradesh, Maharashtra etc. LVPEI has worked with partners to enhance ROP programs in Kolkata, Dhanbad, Raipur, Bhilai etc and are now looking forward to working with neonatologists and paediatricians in Bihar and Jharkhand so that blindness can be prevented in the NICU and SNCU here.

In the context of preventing blindness in newborn babies, Retinopathy of Prematurity (ROP) has emerged as a severe challenge particularly in developing and middle-income group countries in Latin America, Eastern Europe, South East Asia, China and India. The World Health Organization (WHO) has underscored the importance of this condition by including ROP as a major target disease in its prevention of blindness program, VISION 2020 - The RIGHT to SIGHT programme to combat needless blindness globally by the year 2020.

In Patna for Neocon 2014, (annual convention of National Neonatology Forum) Dr Subhadra Jalali, Associate Director, Srimati Kanuri Santhamma Centre for vitreo-retinal diseases, and the Jasti V. Ramanamma Children’s Eye Care Centre, L V Prasad Eye Institute, Hyderabad was invited by Dr. Subhash Prasad, Director of the Divyadrishti Eye Centre to share her expertise in this critical field with eye specialists of the region. Dr. Jalali said, “Our 15 years of sustained efforts in partnership with Indian Neonatologists and many ROP centres in India, helped formulate the National ROP Guidelines in 2010 specific for India. We are an integral part of the Ministry of Health, Govt. of India Task force on ROP and WHO used our expertise to improve ROP blindness programmes under the Philippines Government. All the efforts of various partners in neonatal and childhood care and eye care professionals also helped for the first time to get a mandatory preventive Eye screening status for ROP and congenital cataract in the Rashtriya Bal Swasthaya Karyakram (RBSK) and today we are also on the expert panel of this Government program. The challenge now is to make this program operational and ensure that every newborn in our country gets an eye screening at birth and every premature baby in addition gets a Retina screening for ROP within 20-30 days of birth.”

Dr. Rajvardhan Azad, a renowned Retina surgeon and Ex-Chief of R. P Centre, Delhi was Chairperson of the ROP meeting. Dr. Azad has been a leader of ROP and has worked very hard over many years to teach and train many groups in different parts of India to set up ROP care centres. Highly efficacious, scientifically proven and accessible technology is available to manage ROP in the last two decades. Various multicenter prospective studies have conclusively proven that timely detection and treatment can markedly reduce blindness due to ROP. Yet untreated ROP blindness continues to be a reality. More than 60% of blind children in our blind schools could have had normal vision with timely detection, prompt and appropriate preventive and curative management immediately after birth and in first few years of life.

ROP has become a mission for LVPEI since 1999 and a constant endeavour to translate information available in books and journals to actual implementation at the bedside of the newborn. There are a number of risk factors for newborn eye problems including premature birth, familial disorders, Rubella, Congenital diseases, poor cry at birth, etc that need to be addressed through a health sector-wide multidisciplinary approach and LVPEI has pioneered some such approaches. On completion of 15 years of the ROP screening program, LVPEI re-dedicates its team that includes Dr. Padmaja Rani and Dr. Divya Balakrishnan in Hyderabad, Dr. Tapas Padhi and Dr. Umesh Behera in Bhubaneswar, Dr. Sameera Nayak in Vijayawada and Dr. Virender Sachdeva in Visakhapatnam to further expand the newborn eye screening program to spread its reach to every baby in the hospital/NICU/SNCU across the country to enable them achieve their RIGHT to Sight!

Over the years, LVPEI has created awareness on childhood blindness and this year as part of Newborn Care Week in November and World Prematurity Day Nov 17, LVPEI held couple of events to raise awareness of prematurity and the concerns of preterm babies and their families. Over the last 15 years, LVPEI team has examined more than 12,000 babies and treated more than 16,000 eyes with state of art lasers and surgeries. The smallest baby treated in the program was 550 grams and smallest baby to undergo major surgery was 1400 grams.

About L V Prasad Eye Institute

For further information, please contact:
Dr Sreedevi Yadavalli, Associate Director and Head – Communications
Tel: +91 040 23547254, +91 040 30612444, Email: ysreedevi@lvpei.org

Dear Madam,

Thank you so much for coming Patna and organising this CME and motivating us all for the great work of ROP screening. Hope your stay in Patna was pleasant and you have reached Hyderabad safely.

Many ophthalmologists were so much motivated by your talk that they have started ROP screening. Your kind words of the work we are doing, and useful tips, is going to help us a lot. Hope to see you soon again, motivating and teaching us.

Thanking you,
With best regards,
Satya Prakash Tiwary
Consultant, Vitreo-Retina, ROP and Pediatric Retina
Divyadrishti Eye Centre, Patna