Union government has identified Narayana Nethralaya Post Graduate Institute of Ophthalmology (NNPGIO) to be associated with paediatric eye disease detection under the recently launched Rashtriya Bal Swasthya Karyakram (RBSK) part of the National Rural Health Mission (NRHM).

NNPGIO’s expertise will be maximized to prevent blindness under the government’s comprehensive child health screening and early intervention service which begins with the training of accredited social health activists (ASHAS).

Under NRHM, over Rs.90,000 crore is being disbursed to the states to strengthen health systems as 15 lakh children do not survive before five years of age.

RBSK is evolved around four Ds: Defects, Diseases, Deficiency & Disability to provide comprehensive healthcare for the 0 to 18 age-group. A child diagnosed with a disease would receive follow-up and required surgery free of cost at a tertiary hospital.

The universal screening at grass root level specifically for ophthalmology has not been worked out as yet by the Ministry of Health. But Narayana Nethralaya can chip in its capability as currently it is the only ophthalmology major in the country involved and successful in the paediatric eye outreach programme that screens rural-semi-urban infants for a potentially blinding condition called Retinopathy of Pre-maturity (ROP) under its flagship KIDROP (Karnataka Internet Assisted Diagnosis for ROP) programme.

Gearing up to meet the needs of the Union Government, NNPGIO proposed the pilot project ‘FOREVER’ (Focus on ROP, Eyecare, Vision and Eye cancer & Rehabilitation). “We will train 3,200 ASHAS as a pilot in four districts of Raichur, Davangere, Bagalkot and Bangalore Urban’s Anekal taluk using a low cost algorithmic screening protocol to identify possible eye diseases during specific time periods of infancy at home and at primary health centres accessed by newborns for immunization in their 21st day, 14th week and nine months. Others associated in the project are Block Medical Officers, District Health Officers and District RCH (reproductive health) officers. We hope to commence from April 2013,” Dr Anand Vinekar, programme director and paediatric retinal surgeon at Narayana Nethralaya told Pharmabiz.

Of the 3,200 ASHAS, training will be imparted for over 1000 at NNPGIO, 1,000 at their taluks and 1000 via satellite tele-teaching.

NNPGIO, in 2011-12, had kicked off a pilot project under the Karnataka Universal Eye Screening Programme (KUSP) in select government hospitals which revealed in its mid-term analysis that approximately three per cent of apparently ‘normal babies’ were detected with eye problems. Earlier, KIDROP data had shown that about seven per cent of premature babies had eye diseases other than ROP picked up on imaging. These included cataracts,retinal inflammation, retinal haemorrhages, micro cornea and even potentially fatal conditions like eye cancer (retinoblastoma). “Using eye imaging we were able to detect even systemic problems in an infant and alert the mother for early treatment. However, the modality of rolling it out into the community and its cost utility still needs to be studied,” he added.

Since 2009, NNPGIO spearheaded the successful implementation of KIDROP to prevent ROP and infant blindness in 12 districts. Thus far, over 6325 babies both old and new cases have been screened. ROP incidence in rural areas is 35.6 per cent and 14.9 per cent is the incidence of those requiring treatment. Under KIDROP, no baby needing treatment was denied it and this was done at no cost to the family of the baby, said Dr Vinekar.