hospital based pediatric eye services furahini godfrey bsc. (ed), md, mmed. pofellow. department of...
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Hospital Based Pediatric eye services
Furahini GodfreyBSc. (ed), MD, MMed. POFellow.Department of Ophthalmology.08/04/11
Kilimanjaro Christian Medical Centre
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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.
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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).
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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
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Pediatric Eye Conditions
RetinoblastomaRetinopathy of prematurityStrabismusPediatric glaucoma Pediatric cataractAmblyopia
Pediatric eye problems are often very different from adult eye diseases:
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Pediatric Eye Conditions
Blocked tear ducts and defects
Ptosis Eye injuriesRefractive errorsRetinitis pigmentosa
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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)
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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
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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.
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•Lea symbols Cardiff Acuity Cards
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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
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Intra-ocular lenses
Small eye, still growing, changing refraction great challenge in choosing a lens power.
Biometry
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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
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Special equipments in Childhood Eye surgery
Good microscope + Special machines to remove the posterior capsule.
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Special Supplies:
-Soft IOL’s, folders, injectors
-Blue dye ,Heavy viscoelastic
- Microincision capsule forceps
-goniolens, MMC, diode laser
-Strabismus set
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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
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Challenges in mgt of Pediatric eye conditions
Problem #1Late presentation
Problem #2Poor follow up
Problem #3Few surgeries.