The Low Vision Centre (LVC) at Aravind Eye Hospital (AEH) in Madurai brims with playful children. “Summer vacations have started and so the rush,” says the Chief Paediatric Ophthalmologist Dr.P.Vijayalakshmi, as we weave our way through the crowd.
From toddlers to young teenagers -- some wearing eye pads or shields, some with an odd nod in their heads or a squint in their eye, some walking awkwardly due to blurred vision, some suffering from autism -- they all wait patiently for their turn for examination, diagnosis, therapy and rehabilitation sessions in the multiple tiny rooms. One doesn’t hear a wailing child here. One sees pairs of laughing or mischievous eyes here and there.
One among many is eight years old Safa, who has been visiting the LVC with her mother since she was six months old. She suffers seizure disorder threatening her cognitive development. “But for her mother’s motivation and patience,” says Dr.Vijayalakshmi, “Safa would not have been standing and walking independently today.”
Safa’s mother quit her job and has been bringing her daughter regularly for sessions with special educators at the LVC. How does an ophthalmologist fit into the puzzle of unspecified delays in a child’s milestones?
Visually impaired individuals are all very different. The visual impairment could be either at birth due to genetic anomalies or due to some injury. Or a child may suffer brain damage during birth or later years but have perfect eyes and yet the environment becomes too visually complex to cope with. This is common in children with Cognitive Visual Impairment (CVI).
Minimising deviant behaviour
“Ophthalmologists can make the environment more visually acceptable for such children. It barely takes us an hour to assess each child. And with regular therapy, teaching them what next can minimise their deviant behaviour,” explains Dr.Vijayalakshmi.
The severity of visual impairment, additional intellectual disabilities, emotional problems, language disorders, personality and background of other disabilities have varying effects on a child’s reading, writing, motor skills and behaviour and can lead to tragic consequences if ignored. But early initiation of simple stimulating activities can enhance the cognitive coordination. “If one part of the brain responsible for doing a particular activity is not functioning, another part can be trained to carry out the task to an extent,” she says.
“Vision rehabilitation does not cure or restore lost sight. But good care and therapy makes these children with no or negligible vision come alive,” asserts Dr.Vijayalakshmi and wishes that more physicians do neuropsychological evaluation of children and refer them to ophthalmologists. She recommends mandatory follow-up of all premature babies discharged from NICU and better school health programmes. The AEH has tied up with six special schools in the city for regular screening camps.
Many times parents and teachers mistake vision problems for behavioural issues or learning disabilities, or they think the child is playing up. But children who have had dark times actually do not realise they can’t see clearly because they themselves don’t know how it is supposed to look, says Dr.Sahithya, a key educator at the LVC.
“Systematically detecting vision issues in children is absolutely essential,” she adds, citing the example of a two-year-old child who was misdiagnosed with unspecified learning delays whereas all she required were a pair of glasses to correct her far-sightedness and amblyopia (lazy eye).
The LVC does not offer treatment or promise cure to people with low vision. “We provide cost adaptive devices and assistive technologies that can help improve quality of life,” says Dr.Vijayalakshmi. Through counselling and training, we equip the children with techniques and tools to maintain an independent and confident lifestyle as they grow up, she adds.
Like in the case of Safa. She was scared to stand or walk alone as she never looked down given the awkward tilt in her neck. But Venkatesh, a low vision staffer at the LVC who has conquered his own battles and moves around in the department like a breeze, did some shadow teaching for Safa helping her to walk by pushing a wooden support. Today the child moves around confidently and is also ready to mainstream in regular school from this year.
Uncorrected vision problems in children can have serious impact on their development. The most crucial years to focus on are from birth to three years, says Dr.Vijayalakshmi. Ideally, every new born should be examined on the 30th day after birth for ROP (Retinopathy of Prematurity) and there should be vision exams every six months till three years of age and every two years between the ages of six and 18.
Early detection, intervention and rehabilitation are the key to help children with cognitive visual dysfunction. If a child has fever we immediately rush to a doctor. But regular headaches, squint while reading, blurring or trouble seeing distant objects don’t receive as much priority of visiting an ophthalmologist. Why? asks Dr.Vijayalakshmi
The latest low vision aids added at the centre are two mobile applications - Digital Nethra for Eyes (Dignify) and Visual Intervention Kit with Analytics for Children with Special Needs (VIKAS) - developed by Bengaluru-based MindTree Foundation in collaboration with Aravind Eye Care System.
Dignify requires a small gantry to hold the mobile phone above any reading material. It scans and takes a screen shot of the page and reads out the content, in English at present. Plans are afoot to support other Indian languages and make the kit available at an affordable price with a tablet-like device.
The VIKAS application includes variety of simple exercises related to shapes and size, emotions and memory involving pattern matching, colour recognition, and puzzle solving.
Both the mobile applications can be downloaded free from the hospital website.
MADURAI, TAMILNADU, 22/03/2018. : Rostow Ravanan, CEO &MD, Mindtree Foundation, launch two mobilebased applications for the visually impaired and children handing over function of Assistive Technologies to Dr. P.Vijayalakshmi, Chief, Paediatric Ophthalmology Services at Aravind Eye Hospital in Madurai on Thursday. Photo : S. James
Quote:
Eye care in childhood should not be overlooked. If children’s eye problems are picked up early, it will dramatically and positively change their lives. Or else they are forced to living with all types of incurable vision impairments -- Dr.P.Vijayalakshmi, Chief Consultant, Paediatric Ophthalmology and Strabismus Services, Aravind Eye Hospital, Madurai,
(This column features human inspiring stories from Madurai and surroundings. E-mail soma.basu@thehindu.co.in to tell her about people you know who are silently working to make a difference in your respective areas)
