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Dear Readers,
Vision 2020 highlighted the world attention to address childhood blindness issues. This issue we focus our attention on different perspectives and resources on this important issue.

The world over every 3 seconds a child goes blind. When this is aggregated we have the magnitude of the problem including the proportion who currently access treatment. When a child goes blind or has an eye problem the economics of childhood blindness is several times manifold as compared to an adult with eye problems. Providing eye care services for a child is not the same as providing for an adult. It requires a different skill set for the entire team right from the ophthalmolgist to the refractionist, orthoptist to the counselor and even the anaesthetist. We bring to our readers resources related to setting up and running a peaditaric ophthalmology department.

However the real challenge is in getting the children to access the eye care. The awareness has to be provided with their caregivers rather than with them. This is work required at the community level. Yet at the same time to get the childrens cooperation we need to provide child friendly environment in treating the ophthalmology paediatric clients.

Several health education materials and other ophthalmic paediatric resources are featured here. The organization we are featuring is Lighthouse international, a worldwide organization dedicated to overcoming vision impairment through rehabilitation, education, research and advocacy.

We wish you an experience of learning that is very practical. Your feedback will let us know how we can improve. Please write in your feedback at eyesite@aravind.org. We look forward to your feedback.

We wish our readers an informative reading!

Happy Reading!

Regards,

Vision 2020 e-resource team
The Issue Features...
Paediatric Eye Care Services
Vol. 4 No. 6 June 2007
•   Magnitude
•   Economics of Childhood Blindness
•   Setting up Paediatric Opthalmology Department
•   Running Paediatric Department
•   Getting Children to Access Eye Care
•   Child Friendly Eye Care Services
•   Treating Paediatric Patients
•   Ophthalmic Paediatric Resources
•   Featured Website Lighthouse
•   Talk To Us

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It has been estimated that globally there are 1.4 million children who are blind, and of this around three quarters live in developing countries. Although the actual number of children who are blind is much smaller than the number of adults blind, e.g., from cataract, the number of years lived with blindness by blind children is almost the same as the total number of blind years due to age-related cataract. The high number of blind years resulting from blindness during childhood is one of the reasons why the control of childhood blindness is the priority programme.

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Childhood blindness is estimated to lead to a loss in earning capacity of US$6,00027,000 million. By extrapolation, assuming a global growth rate of 3%, the economic loss over 10 years for childhood cataract would be in the order of US$1,0006,000 million. Estimates in India, assuming a blind child has on average 33 years of blindness, and that 14% of childhood blindness is due to cataracts, calculate a lifetime loss of earning capacity of US$3,500 million to childhood cataract. The cost of a cataract intervention in India is of the order of US$100200, depending on facilities. The cost of treating the 40,000 blind children from cataract in India would be US$48 million.

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When approaching the task of setting up Paediatric department for children, the working group should look at each of the minute details and spent time identifying the specific conditions that required specialist expertise to treat and the specific interventions that required specialist skills to perform.

Many tertiary centres should also function as a secondary service for their local population. Some may take the view that the secondary services being delivered alongside the tertiary services within a specialised centre should also be included within specialised commissioning arrangements, since it may be difficult to separately identify the secondary and tertiary activity, and/or since it may make most sense to undertake the planning of the two co-located services together.

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The Paediatric ophthalmology services should be unique in providing comprehensive services to all children aged 15 years and below. The clinic must be dedicated to the development of special techniques for examining and treating children's eye diseases. The most common childhood eye diseases treated in this clinic are refractive errors, strabismus, amblyopia, congenital cataract, genetic eye diseases and congenital glaucoma. Jointly with the retina services it should conduct screening and treatment of premature babies for ROP, and makes all efforts to enhance the residual vision in children with visual impairment by providing either optical or non optical low vision aids.

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There should be real comparisons to be made between services but also, more importantly, assist in ensuring that specialised activity is taking place in appropriate locations. Specialised eye care for children should be provided by Paediatric ophthalmologist either directly in a specialist centres or in partnership with local hospitals through a shared care or outreach arrangement, or in children's own homes and schools through a specialist outreach team. The location of care is not the determining factor in identifying the specialised nature of a treatment regime. Any place of delivery should be child-tailored because of the long-recognized need to treat children as children, as close to home as possible, and to involve families in their care.

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Management is complicated by the fact that paediatric cases are technically more difficult to handle and requires frequent post-operative follow up. It is very unwise to equate childhood blindness to a smaller replica of an adult. Questions related to the management of childhood surgery include the timing of surgery, type of surgery, personnel doing the surgery and place where the surgery will be done. Good visual outcome depends on doing surgery by looking at various factors and by proper observation. Treatment should be carried out by ophthalmologists having an orientation in paediatric ophthalmology and with the necessary skills and commitment to supervise the child's visual development.

Surgery for children should be carried out in specialist centres appropriately staffed and resourced with facilities such as paediatric anesthetic equipment and good supportive services for refraction and low vision services.

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This section provides a wide rage of articles, brochure, booklet and posters relating to ophthalmic paediatric resources.

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LIGHT HOUSE INTERNATIONAL
Founded in 1905, Lighthouse International is a leading non-profit organization dedicated to preserving vision and to providing critically needed vision health care services to help people of all ages overcome the challenges of vision loss. Through clinical services, education, research, and advocacy, the Lighthouse enables people with low vision and blindness to enjoy safe, independent and productive lives.
     For more than 100 years, Light house has been leaders in meeting the evolving needs of people across the full continuum of vision impairment - from low vision to blindness - in New York, and across the country and around the globe. In the next century, Lighthouse will continue to expand their efforts to save people's sight and teach people how to live better with vision loss.

LIGHT HOUSE INTERNATIONAL - Mission
We are dedicated to expanding knowledge about vision function and the psychosocial aspects of vision impairment. Our efforts provide an empirical foundation for the development of vision rehabilitation services designed to help people overcome the challenges of vision impairment, as well as for the development of professional training programs.
Visit our website : www.lighthouse.org

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Address:

Vision 2020 e-resource team,
Lions Aravind Institute of Community Ophthalmology,
1, Annanagar, Madurai - 625 020,
Tamil Nadu, India,
E-mail:eyesite@aravind.org
Phone: 91-452-4356500