Developing paediatric eye care teams in India

We confess that the word ‘adult’, in the strictest sense does not deserve to be part of the title. Although not deliberate, we have used it in the sense of ‘visually mature’ patients being enrolled in this study. Even though it escaped the review process, the fault if any is entirely ours. Interestingly, there exist other articles using the word ‘adult’ which have included patients with a minimum age of 15 years![4,5]


Authors' reply
Dear Editor, We are thankful to Dr. Gopal, [1] for keenly perusing our article. [2]e agree that there exists evidence that suggests that recovery of binocularity is a likely outcome aft er successful squint surgery. [3]ur study only serves to substantiate that.
Although not stated separately, a simple arithmetic subtraction of the period of duration of strabismus from the age at presentation would have yielded the age of onset of strabismus.Remarkably the average was 6.6 Ϯ 10 years, and with a median of one year.
We confess that the word 'adult', in the strictest sense does not deserve to be part of the title.Although not deliberate, we have used it in the sense of 'visually mature' patients being enrolled in this study.Even though it escaped the review process, the fault if any is entirely ours.Interestingly, there exist other articles using the word 'adult' which have included patients with a minimum age of 15 years! [4,5]tably, 12 of the 15 patients had strabismus onset at Յ6 years; and eight at one year of age.This only justifi es questioning the assumption whether disruption in the 'critical period' really is all that critical, since many of these patients, with early onset strabismus, gave favourable responses.
We agree that our study has largely exotropes and thus is more representative of them, and we have clearly said so.Still, one study in adults shows that 74.2% (23 of 31) of esotropes achieved postoperative fusion compared to 65% (52 of 80) of exotropes. [5]In fact, Kushner's research showed that 81% (60 of 74) of congenital esotropes demonstrated binocularity on Bagolini striated glasses (BSG). [3]Signifi cantly, he reveals that in patients with best corrected visual acuity Յ 20/200 in the deviated eye, 68% (45 of 66) demonstrate binocularity on BSG.Once again our preexisting notions, such as congenital esotropes or those with dense amblyopia being less likely to recover binocularity, need to be questioned.
Patients of cataracts with exotropia who recover binocularity postoperatively have litt le in common with our study.
Our basic message that visually mature patients, the majority with onset of strabismus in the 'critical period', are likely to recover binocularity following surgical realignment, still holds.

Developing paediatric eye care teams in India
Dear Editor, Tackling childhood blindness is a priority for many reasons -the number of blind years a child has to face is much more than an adult and, secondly, many causes of childhood blindness are preventable or treatable. [1]Of the approximately 1.4 million children who are blind, about three-quarters live in the poorest countries of Asia and Africa. [2]It is estimated that the prevalence of childhood blindness in India is about 1 per 1000 children. [3]he VISION 2020 -Right to Sight initiative considers control of childhood blindness as one of the priority areas.
Examining children needs special skills and the treatment requires specifi c training, knowledge and equipment.There are few trained paediatric-oriented ophthalmic personnel in India. [4]n a survey of paediatric eye care facilities in India, opportunities to train a paediatric eye care team was noted to be grossly lacking.[4] The paediatric ophthalmology learning and training center (POLTC) project is an initiative by ORBIS International, an international non-governmental organization, in collaboration with tertiary eye care institutes in India toward the development of comprehensive paediatric eye care teams.
The POLTC project aims at the development of a paediatric eye care team comprising of six personnel: An ophthalmologist, anaesthetist, optometrist, nurse, counsellor and outreach coordinator by building their capacity through specifi c training in the management of eye diseases in children.Hospitals throughout the country designate teams through ORBIS to the respective tertiary eye care institutes.The ophthalmologist gets training for 12-18 months with a focus on the management of squints, paediatric cataract, amblyopia, corneal problems, retinopathy of prematurity, retinoblastoma management and congenital glaucoma.In addition, it also includes the component of community eye care, especially vision screening and awareness initiatives.Targets and indicators are set for number of children examined, number of children treated, number of children undergoing surgery and number of children receiving spectacles.The project also encompasses capacity building of partner hospitals by providing infrastructure and technical support.Providing various research opportunities and conducting research on topics that have a profound impact on the community is again an integral part of this project.The project also supports regular hospital-based training programs and supports continuing medical education programs that are important to build the capacity of the POLTC staff .Training of all the personnel is performed in established international, acclaimed centers of excellence in India.The teams,