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Editorial: Pediatric Ophthalmology
Indian J Pediatr (December
Editorial: Pediatric Ophthalmology
Pradeep Venkatesh 0
0 Diseases of the Retina, Vitreous and Uvea, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences , New Delhi , India
1 Pradeep Venkatesh
-
The practice of Medicine has evolved from a period in which
one had a broad knowledge of a variety of ailments to the
present scenario of super-specialization in which one knows
more and more about less and less of the ailments. It is a given
however that most of the ailments do not need the care of a
super-specialist, provided the non-specialist has been exposed
in his postgraduate days to ways of diagnosing and managing
a broad variety of common diseases, including the art of
timely referral. It is also given that access to super specialist care is
often available only to a small segment of the population and
so it would be in the best interests of the patient if the first care
provider is able to recognize ailments that are innocuous and
those that need urgent referral. In this context, the current issue
of the Journal has embarked on an important path of
highlighting ophthalmological problems in the pediatric population.
Most of the reviews have been written by experts with decades
of expertise and it is hoped that readers of this issue will obtain
a better understanding of some of the important ocular
problems that the young children they see in their day to day
practice may harbor.
The magnitude and causes of pediatric blindness in our
country is dealt with in detail in the review by Murthy GVS
[
1
]. This review reminds us about how the excellence of child
health and primary care services in a country can be singularly
judged by noting the severity of preventable childhood
blindness. It also points out the high economic and social cost of
childhood blindness compared to adult onset blindness and
emphasizes that about half of all childhood blindness can be
prevented or treated with early diagnosis, timely referral and
intervention.
Neonatologists and pediatricians have the onus of
preventing their premature babies from going blind secondary
to retinopathy of prematurity. Blindness from this disease is
increasing in magnitude in our country due to better survival
rates of premature babies but poor awareness about
retinopathy of prematurity. Risk factors for the occurrence of this form
of blindness, methods of prevention and timelines for seeking
regular screening of the retina by a trained ophthalmologist is
highlighted in the review article by Dogra MR et al. [
2
].
Pediatricians may often times hear the parents saying that
they notice a ‘white’ reflex from their child’s eye. The causes
of this presentation are quite ominous and must never be
ignored. These children may have a cataract, blindness from
which can be entirely prevented by early referral and prompt
surgery. Or they may have retinoblastoma, which is a fast
growing intraocular tumor with a high risk of systemic
metastasis and death. Rao and Honavar [
3
] provide an insight into
the genetics, pathogenesis, presentation, classification,
treatment and prognosis of retinoblastoma, the most common
intraocular malignancy in childhood.
Infections and ulcers involving the cornea are an important
cause of preventable blindness in low and middle income
countries. Malnourished children are at most risk of
developing such non-traumatic corneal infections and so it is
important for pediatricians to be aware of its early features, means of
diagnosis and primary initiation of therapy. If there is a failure
to diagnose and manage these corneal infections early, the end
result may be blindness from a dense corneal scar or
perforation of the globe. Srinivasan M and Radhakrishnan N [
4
]
discuss a range of important conditions including
Ophthalmia neonatorum, xerophthalmia and conjunctivitis.
The pediatrician may be the only available specialist to make
a prompt diagnosis and initiate therapy in these cases and so a
broad knowledge about them would go a long way in
preventing visual morbidity in their young patients.
Compliance with Ethical Standards
Conflict of Interest None.
1. Gudlavalleti VSM . Magnitude and temporal trends in avoidable blindness in children (ABC) in India . Indian J Pediatr . 2017 ; https://doi.org/10.1007/s12098-017-2405-2.
2. Dogra MR , Katoch D , Dogra M. An update on retinopathy of prematurity (ROP) . Indian J Pediatr . 2017 ; https://doi.org/10.1007/ s12098-017-2404-3.
3. Rao R , Honavar SG. Retinoblastoma. Indian J Pediatr . 2017 . https:// doi.org/10.1007/s12098-017-2395-0.
4. Muthiah S , Radhakrishnan N. Management of extraocular infections . Indian J Pediatr . 2017 . https://doi.org/10.1007/s12098-017-2409-y. (...truncated)