BLOG: How tiny Armenia ended ROP blindness
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Tom Lee was crushed. Having just flown home across 12 time zones returning from a volunteer trip to Armenia, he heard some very disturbing news.
He took his trip to set up a laser treatment program for retinopathy of prematurity as part of the Armenian EyeCare Project (AECP). Before leaving Armenia for home, Lee, a pediatric retina specialist from Children’s Hospital Los Angeles, and Paul Chan taught local retina specialists how to treat ROP with argon laser in four tiny preemies with impending blindness.
Over Skype from Armenia, Lee learned that, following treatment, three of the four babies showed regression of neovascularization, heralding the future development of potentially normal vision. Because of more advanced disease, however, the fourth preemie was progressing toward bilateral retinal detachment and certain lifelong blindness.
Lee asked the Armenian doctor how the parents received the news of their child’s impending blindness. Speaking in broken English, his colleague said, “Not well,” and he went on to explain that following the news, those parents never returned to the neonatal intensive care unit (NICU) to claim their child, making her a blind orphan in a developing country.
Prior to 2009, the doctors of Armenia, a small former Soviet country of 3 million people, had never heard of ROP because the smallest preemies never survived. The advent of NICUs in Armenia gave preemies a fighting chance for life — and all the accompanying risks of prematurity like ROP, which was made worse by unbridled oxygen use, a major driver of ROP. Before the AECP began its ROP program, more bilaterally blind children were showing up in Armenia’s pediatricians’ offices than the country had ever seen.
The future would look much brighter for preemies in Armenia when Tom Lee, Paul Chan, Michael Chiang, James Smith and Chien Wong joined Roger Ohanesian, the founder of the AECP, and devised an ROP screening treatment program that evaluated every preemie in the country. Initially, the project was funded by donors to AECP and Children’s Hospital Los Angeles and administered by Nune Yeghiazaryan and her staff in Armenia. Eventually, Ohanesian and Lee convinced Armenia’s health ministry to fund the program because the cost of ROP screening and treatment was trivial compared with the cost of caring for a blind person.
In 2012, the AECP, with the support of the U.S. Agency for International Development, created a center of excellence for neonatal retinal surgery, the world’s only fully equipped vitreoretinal surgery center housed within an NICU. This placement was necessary to avoid transporting fragile preemies to another hospital because the maternity hospital had no adequate surgical facilities.
Surgeons like Chien Wong (Lee’s former fellow) from London’s Moorfields Eye Hospital would travel dozens of times to perform early vitreoretinal surgeries. Later, local doctors in Armenia, Tadevos Hovhannisyan and Levon Grigoryan, worked closely with local neonatologists and provided all the needed surgical skill while pediatric ophthalmologists like Ruzanna Harutyunyan and others performed daily screenings across the city’s growing number of NICUs.
Today in Armenia, through the protocols developed by Lee and his colleagues, every preemie receiving oxygen is screened for ROP. All NICU physicians are trained in modern oxygen protocols, and laser is performed immediately when criteria are met. Without equivocation, the AECP can claim that, since 2018, no child in Armenia has gone blind from ROP. And some of the principals who created this program like Lee, Chan, Chiang and Wong have done well by doing good — themselves becoming giants in the world of ROP, in some part because of the experience they gained creating an exemplary system to battle blindness in the tiniest eyes in the tiniest country of Armenia.
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For more information:
John A. Hovanesian, MD, FACS, an ophthalmologist specializing in cataract, refractive and corneal surgery at Harvard Eye Associates in Laguna Hills, California, can be reached at drhovanesian@harvardeye.com.
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