MACHO 1

Eye Department KCMC Newsletter

Issue 1 Volume 1 Serial 1                                                                      30^th September 2011

A note of Introduction                                                                                       W. Makupa

After attending the annual scientific conference of OSEA in Dar es Salaam it became evident that eye care cadres in Tanzania will need to have a forum of their own. This would mean an annual meeting and also a newsletter for sharing information. It was in this spirit that “MACHO” developed as an idea on 12^th September 2010. It is only now that this is coming to fruition. For a while it was thought that it may be possible to have it strictly as internet group mailing list, but most of primary eye care cadres and some of mid level eye care cadres do not have regular access to the internet. This means that we will have to produce a few hard copies for those who do not have access to the internet.

The aim of this newsletter is to share information on best practices, eye care updates and eye care services rendered at the Eye Department KCMC.

White Pupil                                                                                                           I. Makupa

The normal appearance of the pupil of the human eye is black. In flash photographs the pupil may appear red, called the "red eye/red reflex", and is entirely normal. The appearance of a white pupil is never a normal condition and requires immediate evaluation by specialists trained in ophthalmology. Pre-referral treatment is not recommended for abnormal red reflex or white pupil. White pupil in an infant or child may occur in a number of eye diseases. Most commonly occurs in congenital cataract and retinoblastoma (Rb- a malignancy of the retina). It can also be caused by other rare eye conditions. Both Congenital Cataract and Retinoblastoma are eye diseases with grave consequences on the child’s vision or even life (Rb). Early presentation and immediate referral to an eye care professional are essential for good outcomes.

Awareness & Education: public and healthcare professionals

Increased awareness and education about the white pupil (leukocoria), may lead to earlier diagnosis, and consequently, a higher likelihood of cure and better vision potential for affected eyes.

Parents, rather than healthcare professionals, are usually the first to notice the white pupil. It is very important to inform and empower parents by public education about white pupil. As the time frame available for observation is much greater for parents, focusing on educating parents rather than increasing professional screening may be the most effective way to increase early detection of leukocoria. Educating the public on white pupil could also empower parents to persuade a reluctant primary healthcare professional to refer to a specialist.

Educational resources for parents:

• Internet resources
• Public awareness campaigns                                                                      Awareness materials include:  posters and flyers, television and radio advertisements.

Education for healthcare professionals

Once parents notice the white pupil, their healthcare practitioners must know to respond with prompt referral. Children with white pupil need immediate referral to an ophthalmologist. This is essential for timely diagnosis and good treatment outcomes. The referral lag has serious consequences both in congenital cataract and retinoblastoma. To increase awareness of leukocoria among healthcare professionals, posters and educational leaflets (e.g. describing the correct method for how and when to administer the red reflex test) can be provided to healthcare professionals throughout Tanzania.

Public & healthcare awareness & education: recommendations

We recommend that:

• Information on white pupil be included in public healthcare packages given to new parents.
• Major pediatric and vision screening provide information on white pupil in their print and online public information materials.
• Information on leukocoria, information about the proper performance of the red reflex test be provided to healthcare professionals who see young children and pregnant women in their clinics.
• White pupil education be included in the healthcare curricula.

Eye Health Care Services available at KCMC are:

1. Optical services, complete with refraction, prescription and making of eye glasses for both adults and children
2. Complete ophthalmolgical consult, with paraclinical diagnostic tools such as: autorefractor, ophthalmic ultrasound, automated perimetry, fundus flourescein angiography and optical coherence tomography.
3. Comprehensive ocular surgical services, biometry is performed in each cataract patient to calculate the power of intraocular lens to be implanted with the aim of achieving best possible outcome.
4. Ocular pharmacy stocked to cater for basic and necessary ocular therapeutics
5. Rehabilitative services for the visually impaired are available with a range of low vision devices.
6. The Eye Department in collaboration with its partners (KCCO and EACO), conducts Day Eye Diseases Screening Outreaches (Direct Referral Site) within Kilimanjaro Region twice every week to screen the population for sight threatening conditions and transports to hospital all those who need intervention. Also Week Eye Surgery Outreaches are conducted to places too far from KCMC but the need for care exists.                                                           

Editor: W. Makupa, Eye Department KCMC, P.O.Box 3010 Moshi – Tanzania

Tel: +255 27 275 4890 Fax: +255 27 275 4381 Email: makupauw@yahoo.com