Pediatric ophthalmology training in India.

Dear Sir,

Two recent editorials discussed the status of pediatric ophthalmology in India and thought it did not get the importance it deserved.[12] In the same issue of the journal, the article titled “Is Pediatric Ophthalmology a popular subspecialty in India – present scenario and future remedies,”[3] stated that close to 70% residency (postgraduate) programs do not have a structured rotation and surgical training in pediatric ophthalmology. Surveys may not always give an accurate picture, but they indicate the existing trend. The said article refers to pediatric ophthalmology in India even though its respondents are from a single eastern state of Orissa. Prestige and personal interest were cited as the main reasons for choosing this subspecialty.[3]

India houses the largest number of blind and visually impaired children in the world, more than any other country.[245] While specialized pediatric ophthalmology fellowships started in 1981, pediatric ophthalmology and strabismus developed as a separate subspecialty only at the turn of the century.[6] The Orbis supported childhood blindness initiative in India and Nepal in 2003–2010 saw the establishment of 34 pediatric eye care centers in large trust hospitals in most states of India.[7] The existing four pediatric eye care centers were designated pediatric ophthalmology learning and training centers.[2]

A nationwide comprehensive survey of young ophthalmologists (trained in the 21st century) reported that while cataract and retina subspecialties were fairly well covered during residency training, the same could not be said about strabismus and pediatric visual acuity testing.[8] On a scale on 0–10, the respondents had rated pediatric visual acuity testing as mean 3.2 (standard deviation [SD] 2.9), orthoptic evaluation mean 4.3 (SD 3.1), diplopia charting 3.2 (SD 3.2), and synoptophore use 2.5 (2.9).[8]

On comparing the responses of 20th century-trained ophthalmologists (those who completed their residency training in 1967–2002) and 21st century-trained ophthalmologists (those who completed their residency training in 2003–2012), the 21st century trained reported better training in use of A-scan biometry, B-scan ultrasonography, optical coherence tomography, pachymetry, automated perimetry, fundus photography, fluorescein angiography, and use of LASERs (all having P < 0.0001).[9] There was no significant improvement in training in orthoptic evaluation (P = 0.074) and pediatric visual acuity testing (P = 0.094). The 21st century trained reported scored use of synoptophore and diplopia charting less than their 20th century trained counterparts (P < 0.001) indicating that these skills are perhaps taught lesser than they were earlier. This does not bode well for India's childhood blindness and visual impairment challenge.

On being questioned about their surgical experience, the 20th century-trained ophthalmologists had performed an average of 13.4 strabismus surgeries during their residency training compared to 1.4 for those trained in the 21st century. The median strabismus surgeries performed independently by both the groups was zero.[9] So while strabismology seemed to be ascendant in pediatric ophthalmology and strabismus as noted by the two editors, it was not reflected in the Indian ophthalmology training scenario.[129]

The lacunae are not on the curriculum, but failure on our part in teaching and creating interest in the subject. If this happens appropriately, they can catch up the right way of treating the common diseases such as refractive errors, cataract and amblyopia in children and learn to refer them appropriately which will definitely increase the quality of services apart from reducing the burden on pediatric ophthalmologists.

Indian ophthalmology has developed impressively in the past decades with respect to increased cataract surgical rate, coverage and development of ophthalmic subspecialties, and reduction in visual impairment and blindness.[1] While avenues for fellowship training in pediatric ophthalmology and strabismus after residency have increased, more needs to be done to make pediatric ocular and vision assessment a part of routine ophthalmology training programs if the challenge of childhood visual impairment and blindness is to be met. Children's vision is far more important to be left to the care of few “super specialists.”

Financial support and sponsorship

This was financially supported by All India Ophthalmological Society, Academic and Research Committee (2014–2017)

Conflicts of interest

There are no conflicts of interest.