Download Effective Pediatric Eye Care Services - Africa

Kilimanjaro Christian Medical Centre
Hospital Based Pediatric eye
services
Furahini Godfrey
BSc. (ed), MD, MMed. POFellow.
Department of Ophthalmology.
08/04/11
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
Pediatric eye problems are often very different from adult eye diseases:
Retinoblastoma
Retinopathy of prematurity
Strabismus
Pediatric glaucoma
Pediatric cataract
Amblyopia
Pediatric Eye Conditions
Blocked tear ducts
and defects
Ptosis
Eye injuries
Refractive errors
Retinitis 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:
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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
Biometry
Small eye, still growing, changing
refraction great challenge in
choosing a lens power.
Pediatric eye surgical equipments
Boyle’s
• Basic: operating
microscope, vitrectomy
machine, Boyle’s apparatus
• Essential: Above +
Pediatric anaesthesia
equipments, Pediatric
monitors, YAG laser
ACCURUS VITRECTOMY MACHINE
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 #1
Late
presentation
Problem #2
Poor follow up
Problem #3
Few surgeries.