“AARAMBH ROP SCREENING PROJECT” AURANGABAD UNIQUE MODEL BY DR.SANTOSH AGRAWALSUSHILA NETRALAY AURANGABAD MOB NO- 09325382000/09689360352 drsantoshagrawal@gmail.com www.sushilahospital.com www.drsantoshagrawal.in

1. “AARAMBH ROP SCREENING
PROJECT”
AURANGABAD UNIQUE MODEL
BY
DR.SANTOSH AGRAWAL
SUSHILA NETRALAY
AURANGABAD
MOB NO - 09325382000/09689360352
DRSANTOSHAGRAWAL@GMAIL.COM

2. INTRODUCTION
 RETINOPATHY OF PREMATURITY IS A DISEASE
AFFECTING THE RETINA OF PREMATURE INFANTS.
 WITH FEATURES OF RETINAL NEOVASCULARIZATION .
 IMMATURE , INCOMPLETELY VASCULARIZED RETINA.
 CONTEMPORARY NEONATOLOGY PRACTICES IN THE
PREMATURE INFANTS HAVE INCREASED SURVIVAL
RATE WHICH ESCALATE THE RISK OF DEVELOPING
ROP.
 LEADING CAUSE OF PREVENTABLE INFANT BLINDNESS
IN THE WORLD .

3. INCIDENCE AND INDIAN
SCENARIO
IN INDIA – 5 MILLION BABIES BORN PRE-MATURE
EVERY YEAR.
INCIDENCE OF ROP – 40-50%
GREATER IN RURAL & REMOTE AREAS.
ANNUAL LIVE BIRTHS IN INDIA – 26 MILLION
ROP SCREENING REQUIRED – 5 MILLION
<100 ROP EXPERTS IN INDIA
5-10 % NEED TREATMENT (INTRAVIT INJECTION OR
LASER)

4. PRESENT SCENARIO
REFERRAL RATES VERY LOW
58 % PEDIATRICIAN’S REFERS
8 % PEDIATRICIAN’S REFERS ONLY
SOMETIMES
34 % PEDIATRICIAN’S NEVER REFERRED
NON-AVAILABILITY OF ROP EXPERT
OPHTHALMOLOGIST

5. CURRENT SCENARIO
• APATHY ON THE PART OF PEDIATRICIANS /
OPHTHALMOLOGIST
• DROP OUTS DUE TO LACK OF AWARENESS IN
PATIENTS.
ILL INFORMED , FINANCIAL PROBLEMS ETC.

6. SCREENING BY BIO
(INDIRECT OPHTHALMOSCOPE)
• TRADITIONAL GOLD STANDARD
• DIFFICULT TO PERFORM – SKIP AREAS ,
TIME CONSUMING, TEDIOUS & SUBJECTIVE
• ROP EXPERT HAS TO VISIT NICU.
• HAS TO DRAW A DIAGRAM , USE
DEPRESSOR ALWAYS
• NO PROPER DOCUMENTATION

7. WIDE FIELD IMAGING FOR ROP
SCREENING
BY USING WIDE ANGLE FUNDUS
CAMERA
BY TRAINED AND ACCREDITED
OPTOMETRIST/OPHTH.ASSISTANT
SINCE 2008- DEVELOPED, VALIDATED BY KIDROP
ORGANIZATION
(DR. ANAND VINEKAR)
IN 2015 (AUSTRALIAN REPORT)
( DEVIATION FROM THE WIDE FIELD IMAGING AND PHOTO
DOCUMENTATION COULD BE FRAUGHT WITH THE
DANGER OF SUBOPTIMAL CARE – THEREBY FIRMLY
ESTABLISHING IMAGING AS THE PREFERRED MODE OF ROP
SCREENING IN INDIA. )
 GOV. OF INDIA ACCEPTED & ADOPTED THIS SCREENING

8. FORUS –NEO CAMERA
• WIDE FIELD , PORTABLE , INFANTS RETINAL
(ROP) CAMERA
• NOVEL , LOW COST, INDIGENOUSLY
MANUFACTURED
• DEVELOPED IN INDIA (BANGALORE) BY FORUS
HEALTH OPHTHALMIC IMAGING DEVICE
COMPANY

9. FORUS NEO VS RETCAM
 ILLUMINATION ‘LED’
 RELATIVELY LIGHT
WEIGHT (310 GM)
 MORE COMPACT,
PORTABLE
 NON DETACHABLE
120° LENS
 COST – 16 LACS
(1/6TH)
 SENSITIVITY 96 %
 SPECIFICITY-73%
 130° , DETACHABLE
 COST 90 LACS

10. ADVANTAGES
LOW COST (1/6 TH TO IMPORTED RETCAM)
PORTABLE , COMPACT , GOOD ADDED FEATURES
ACCESSIBLE TO RURAL AREA
MASS SCREENING POSSIBLE
(3 MINUTE FOR EACH BABY IN EXPERT HAND )
TELE ROP SCREENING , DIAGNOSIS .
TREATMENT AT NICU (LOCAL OR TERTIARY
CENTER)
AT RISK BABIES SCREENED IN A LARGE EXTENT.
REDUCING BURDON OF UNMET SCREENING IN

11. ADVANTAGE
• WITH MASS ROP SCREENING- REDUCING
BURDEN OF BLINDNESS- COULD BE OVER
RS 2400 CR

12. - OUR MODEL -
“AARAMBH ROP SCEENING
PROJECT”
PARTNERSHIP (JOINT VENTURE) -‘TEAM APPROACH’
 2 VITREO-RETINA SPECIALISTS AND 1 PEDIATRIC
OPHTHALMOLOGIST COME TOGETHER
INSPIRED BY DR. ANAND VINEKAR /DR.SUCHETA KULKARNI
GOT REFINED AND SKILLED IN VARIOUS WORKSHOPS AND
CONFERENCES
MET NEONATOLOGISTS , NICU’S & SNCU’S .
ASSISTANT – OPTOMETRIST- GRADUATE WITH A GOOD
EXPERIENCE IN OPHTHALMOLOGY WORK
 - GOT TRAINED AT NARAYANA NETRALAYA SPECIALLY FOR
ROP SCREENING & TAKING IMAGES.

13. CONTINUE…
 GOOD COMMUNICATION/CO-ORDINATION BETWEEN PATIENT -NEONATOLOGIST
AND ROP EXPERT –UTILIZING MULTIMEDIA/SOCIAL MEDIA
 ONE DAY – ONE ROUT/ ONE CITY
 TREATMENT IN TERTIARY CENTER PREFERABLY IN NICU
 COUNSELING - POSTERS, HANDBILLS KEPT IN EACH NICU
 ( PATIENTS / RELATIVES –SHOWING IMAGES-GOOD IMPACT)
 AWARENESS AMONG NEONATOLOGISTS-WORKSHOPS/SEMINARS IN EACH
DISTRICT)
 TAKING LOCAL INTERESTED OPHTHALMOLOGIST IN THE LOOP AS
COLLECTION CENTER
FOR DIAGNOSIS
FOR TREATMENT
 SNCU IN CIVIL HOSPITAL – GET FUNDS FROM GOVERNMENT AND NGO’S
 25-30 BABIES SCREENED IN EACH VISIT
 GOVT.MEDICAL COLLEGE-NO FUNDS,TRYING TO TAKE HELP FROM NGO,WORKING
ON NO PROFIT,NO LOSS BASIS

21. EASY TO CARRY

22. CAN KEEP IN AUTO OR ON BIKE

23. TRAVEL IN AUTO

24. SCANNING THE BABY

25. SCANNING THE BABY

26. TELE - R.O.P.

27. INTERPRETATION

28. ANT.SEGMENT

29. PLUS ROP

30. STAGE 1 ROP

31. STAGE 1 ROP

32. STAGE 2 ROP

33. STAGE 2 ZONE 2

34. PLUS DISEASE

43. COLOBOMA

44. R.D.

45. RETINOBLASTOMA

46. ALBINOTIC FUNDUS

47. PRIVATE NICU’S
SCREENING AT THEIR OWN SET UP
AT TERTIARY CENTER(REFERRED
PATIENT)
AT SOME THIRD PLACE
(PREFERABLY LOCAL

48. UNIQUE ROP SCREENING MODEL
KID ROP PROGRAMME-NARAYANA NETRALAY ALONG WITH
KARNATAKA GOVERNMENT ALREADY RUNNING
SUCCESSFULLY (SINCE 2008)
H.V.DESAI HOSPITAL IN PUNE
GOVT. OF INDIA HAS ADOPTED THIS AS A MODEL FOR
OTHER STATES
WE ARE THE UNIQUE IN RUNNING THIS PROJECT AS A JOINT
VENTURE IN PRIVATE COVERING 5-6 DISTRICTS AND
EXPANDING AS WELL.

49. OUR DATA
• FROM JAN’2018 TO JULY’2018
• AROUND 700 BABIES SCREENED
• NEARLY 35 BABIES RECEIVED TREATMENT(5%)
• INTRAVIT.INJ /LASER
• SAVED FROM GOING TO BLIND
• COVERING 5 DISTRICTS(GOVT.& PVT.) SO FAR-
REACHING OUT TO
MANY MORE.

50. PROBLEMS
SKILLED ASSISTANT
TRAVELLING
IMAGE QUALITY TO IMPROVE FURTHER
APATHY OF PEDIATRICIAN
SOME PATIENTS REFRAIN FROM REPEATED FOLLOW
UP
IMAGES TAKEN BY ASSISTANT-OBJECTIONABLE TO
MANY

51. LIMITATIONS
 LESS RESOLUTION AT PERIPHERY– HOWEVER
“ENHANCE FEATURE” HAS SOLVED IT TO A GREAT
EXTENT.
 PERIPHERAL ILLUMINATION
 LACK OF ANT VITREOUS FOCUS
 DIFFICULT TO PERFORM IN LARGE BABIES

52. CLOSING REMARK
THIS UNIQUE MODEL CAN BE ADOPTED IN
INDIA(ESPECIALLY IN PRIVATE SECTOR) TO CURB THE
INCIDENCE OF ROP AND HUGE BURDEN OF
CHILDHOOD BLINDNESS.
 LOW COST INDIGENOUS CAMERA , TELE – ROP
SCREENING AND TEAM WORK OF EXPERTS CAN
MAKE IT SUCCESSFUL
DOCUMENTATION-HELPS IN COUNSELLING/DATA
COLLECTION
MEDICO LEGAL ISSUES ARE CURTAILED DOWN
IDEAL MODEL TO GET ADOPTED BY MANY OTHERS.

53. THANK
YOU