CHENNAI: Dr Subhadra Jalali, director, Newborn Eye Health Alliance (NEHA), LV Prasad Eye Institute (LVPEI) has a great vision. One that involves ensuring that new born children see the world in all its glory. She was in the city for the fourth annual Retina Summit organised by Sankara Nethralaya on Friday. CE spoke to the doctor to understand more about what needs to be done to diagnose and treat eye diseases in new born babies and the gaps in implementation of guidelines relating to eye screening.
What is the most startling observation you’ve made through your time as an eye specialist for newborns?
India has the largest number of blind children in the world, but 60 per cent of children in blind schools would not have been blind if they had got a routine eye check-up done at birth. Why is this the case?
When a child starts losing vision, often there are no symptoms on the outside.
The eyes often look normal and it will seem like he/she is looking normal because even with a little vision, children will run around. If they do end up bumping into things, parents will brush it off as the child being clumsy or careless. They do not consider eye screening to be a priority. Even paediatricians and gynaecologists don’t advise an eye test many a time and overlook it. This shows the huge gap in our curriculum because no one is taught about how to examine newborn babies’ eyes.
What is the common mistake that parents and doctors make while examining the eyes of newborn babies?
They do not open the child’s eyes after birth. This is the biggest mistake. They let the child keep his/her eyes closed and cite the child sleeping to be the reason for not opening their eyes or even say that they were too caught up with other procedures and overlooked it. Weeks later when they come to me and I ask how the child’s eye looked at birth, they are clueless.
What can parents follow to avoid this?
Like a polio vaccination, an eye examination needs to be done. When you just open the eye, there is so much we can see. You don’t need to be a specialist to notice minor deficiencies that can go a long way in preventing blindness.
Apart from the simple rule of opening the child’s eyes, there is also a simple red glow test which just involves taking the child to a dark room and clicking a picture of the child’s eyes. If there is a red-ish glow that shows up, it means that the retina is normal. It is also important for parents to be aware of their family history because 50 per cent of eye problems are genetic. For instance, eye cancer is genetic. Once the basic eye-opening test is done, we can burn cancer with a laser.
What are the biggest challenges today when it comes to implementing the universal eye screening in newborns?
The foremost problem is that there is no curriculum. It is not included in medical school and it is imperative for nurses, eye specialists, gynaecologists, paediatricians and even high school students to understand that just as you have vaccinations, this is another aspect. Secondly, the public is not aware and not demanding an eye check-up because there is a notion that doctors prescribe unnecessary tests. This myth has to be broken. Another challenge is that once detected, there are very few doctors trained to treat newborn babies. Now, we have about 200-300 doctors but this is still a challenge.
What are the common eye diseases?
A congenital cataract is the most common eye disease which is primarily caused due to family history. Apart from that, rubella is another cause. If women are given the MMR vaccine, 50-60 per cent threat of contracting this can be eliminated. When there is a child who cannot see, there is a developmental delay. The first six weeks of life are critical as it involves setting the wiring of the eye and brain. If there is a problem with the eyes, it must be operated on within those six weeks.
This is why universal newborn screening is essential. Another big concern today is the retinopathy of prematurity which is a man-made disease. About 20-25 per cent of babies who are in incubators are at the risk of blindness. Research in the West showed that the pure oxygen given in incubators acted like a drug and hence needed to be blended with air. In India, we give pure oxygen. If the incubators are coming from the West, why are the safety guidelines not being transferred? You can’t have technology which is not safe. And even if you are giving pure oxygen, don’t give 100 per cent pure oxygen and do the eye check-up at least.