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Times of India
28 October 2010
By Jayashree Nandi
Bangalore, India

Nethralaya Achieves New Milestone: Visually Challenged Children Find Hope In Vision Rehabilitation
Light At End Of Tunnel For These Babies
Sithil (name changed) was brought from Colombo to Bangalore with advanced Retinopathy of Prematurity (ROP), a condition affecting premature children with low birth weight. One eye of the 18–month–old boy was inoperable. The other eye underwent retinal surgery. The poor vision had led to a delay in all other growth milestones, including gross and fine motor, social, cognitive, compensatory and all activities of daily life. He could barely smile.

After intensive vision rehabilitation at Narayana Nethral aya here, all these growth milestones improved on the scoring system, and so did his vision.

Vision rehabilitation is emerging as a ray of hope. Even though research and practice is still nascent in India, some infant blindness cases have been seeing huge improvements at Narayana Nethralaya’s new rehabilitation department.

About 42% of blindness cases in India are due to unknown causes and a huge number are infants. Opthalmologists now use rehabilitation for cases of complete blindness that cannot be rectified even with surgical interventions. "Though vision rehabilitation is not new, it’s not widely practised in India. Both on infants who have undergone surgery and those inoperable, huge improvements can be seen if it is practised scientifically. Blindness is associated with a lot of other handicaps.
Children who don’t see often can’t even smile, talk, and walk. This therapy develops those parameters too," said head, department of paediatric vitreo–retina and paediatric visual rehabilitation, Dr Anand Vinekar.

The rehabilitation starts with functional vision assessment and can start even on the day of birth. The youngest baby these doctors have rehabilitated is three days old. Since infants cannot be tested for vision with charts and other devices, they are assessed by responses to different objects like lights, shapes and colours.

For babies with blindness, opthalmologists assess the area of defect and try to stimulate residual vision with various exercises. In most infant cases, the causes are genetic, prematurity related eye diseases, children with multiple challenges and others. The first two years are the most important for vision rehabilitation and improvement.

After seeing improvements, the team has devised a special funding mechanism by which patients from poor backgrounds can be rehabilitated for free. "We have 3x and 5x cards for middle–class and upper middle–class patients and ask them to fund three or five poor patients.

There are many patients from very poor backgrounds who have no other option except vision rehabilitation," explained vice–chairman, Narayana Nethralaya, Dr Rohit Shetty. OUT OF THE DARK DAYS Manjamma’s 9–monthold child, who she hasn’t yet been named, has only one fully formed eye. He was suffering from child cataract.

After surgery, the baby wears glasses and comes for vision rehabilitation every 2–3 months. "Earlier, he could barely see light. Now, he responds to light and coloured objects. He also sits with supports and his neck is erect. These improvements are only after regular exercise at home," said Manjamma.

"The other milestones include gross motor, fine motor and social milestones have also become age appropriate," Dr Vinekar said. The baby was born of a consanguineous marriage and the cause of blindness could be genetic.

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