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   Table of Contents      
LETTER TO THE EDITOR
Year : 2009  |  Volume : 57  |  Issue : 2  |  Page : 162

Status of pediatric eye care in India


1 Jyotirmay Eye Clinic for Children and Squint and Dilip Kothari Memorial Low Vision Center, 205 - Ganatra Estate, Pokhran Rd 1, Khopat, Thane West-400 601, Maharashtra, India
2 Department of Pediatrics and Neonatology, Kaushalya Medical Foundation Trust Hospital, Ganeshwadi, Panchpakhadi, Thane H.O., Thane West-400 601, Maharashtra, India
3 The Anesthesia Associates, Asha Bldg, Plot D 64, Sector 4, Airoli, Navi Mumbai-400 708, Maharashtra, India

Date of Web Publication17-Feb-2009

Correspondence Address:
Mihir Kothari
Jyotirmay Eye Clinic for Children and Squint and Dilip Kothari Memorial Low Vision Center, 205 - Ganatra Estate, Pokhran Rd 1, Khopat, Thane West-400 601, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.45515

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How to cite this article:
Kothari M, Mithiya B, Gautam R. Status of pediatric eye care in India. Indian J Ophthalmol 2009;57:162

How to cite this URL:
Kothari M, Mithiya B, Gautam R. Status of pediatric eye care in India. Indian J Ophthalmol [serial online] 2009 [cited 2020 Dec 2];57:162. Available from: https://www.ijo.in/text.asp?2009/57/2/162/45515

Dear Editor,

We read the article, status of pediatric eye care in India [1] with keen interest. We have the following comments.

The authors felt that inpatient facility was necessary to qualify for the analysis as pediatric eye care providers. By doing so many pediatric eye care facilities in the private sector, who provide sizeable volume of eye care for children and function as ambulatory surgery centers may have been excluded. Some of us also conduct surgical camps in collaboration with local Zilla Parishad where more than 15 eye surgeries are performed each day as ambulatory surgeries under Sarva Shikshan Abhiyaan. It is only when a child < 1 year or having a congenital heart disease or other systemic morbidity is posted for eye surgery, that an inpatient facility is required. Such situations are managed well by having a pediatrician / neonatologist stand-by during surgery in the eye center followed by transfer and admission of the child in the neonatal intensive care unit (ICU) or pediatric ICU for few hours, for monitoring of the baby. Moreover, the authors have found that the private sector was accessed more often by clients for pediatric surgery than the government sector, and their involvement in service delivery for children was important. [1] Excluding the ambulatory surgery centers may seriously underestimate the status of pediatric eye care in India.

Endorsed by authors and stated by World health organisation (WHO), a pediatric team requires an ophthalmologist, optometrist and an anesthesiologist. We agree to the need of an anesthesiologist. However, we have not found the need of a pediatric trained optometrist much necessary as compared to the need of having a pediatrician / neonatologist as part of the team. Most surgical procedures performed in an infant and more so in a neonate require good coordination between the ophthalmic surgeon, anesthesiologist and a pediatrician. Anticipating and averting the complication of general anesthesia is a far more complex task where an ophthalmologist has to depend entirely on the anesthesiologist and the pediatrician. On the other hand, almost all the optometry procedures can be easily and rapidly carried out by the pediatric ophthalmologist himself.

The authors have stated that there have been no formal training for pediatric ophthalmology till recently. However, literature reports the opening of the first formal Pediatric ophthalmology and strabismus training center in India way back in 1990 which continues without interruption till date. [2]

The data in this study indicates that a pediatric cataract surgery was performed 5.1 times (range 3-7 times) more often than a squint surgery. This data is quite different than one would expect from a well developed, rather a mature pediatric eye care facility where a squint surgery is performed many times more than a cataract surgery in children. This fact should be obvious from the incidence of pediatric cataract (1 in 15/10,000) [3] compared to the squint (2.5 - 4 in 100), [4],[5] or large number of patients with squint do not avail surgical correction due to reasons best known to them.

 
  References Top

1.
Murthy G, John N, Gupta SK, Vashist P, Rao GV. Status of pediatric eye care in India. Indian J Ophthalmol 2008;56:481-8.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
2.
Vijayalakshmi P, Nirmalan P, Kothari MT. Pediatric ophthalmology and strabismus in India. J AAPOS 2004;8:18-9.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.
Foster A, Gilbert C, Rahi J. Epidemiology of cataract in childhood: A global perspective. J Cataract Refract Surg 1997;23:601-4.  Back to cited text no. 3
[PUBMED]    
4.
Gover M, Yankey JB. Physical impairments of members of low-income farm families of 11490 persons. Publ Health Rep 1944;59:1163-84.  Back to cited text no. 4
    
5.
Frandsen AD. Occurrence of squint. Acta Ophthalmol 1960;62:1-122.  Back to cited text no. 5
    



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1 Authorsę reply
Murthy, G.V.S., John, N., Gupta, S.K., Vashist, P., Rao, G.V.
Indian Journal of Ophthalmology. 2009; 57(2): 162-163
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