It has been nearly a year since the WHO launched its global guidelines to support eye health for children and adults. https://www.who.int/publications/i/item/9789240048959 ( Package of eye care interventions). These recommendations include the much needed universal Newborn Eye Screening (NES) care directives. Dr. Lola Solebo, a pediatric ophthalmologist and respected academic at Great Ormond Hospital and the Institute on Child Health in London, shared with Megan Webber, founder of Know-the-Glow, her part in helping to put together this package of eye care interventions.
Dr. Solebo said the new guidelines will give low-income countries the framework to make some visual screening accessible to the 0-5-year-old age group, a group globally overlooked when it comes to vision care. “With this package, developing countries have been given a recipe to follow in order to ensure they are delivering these services as part of their standard postnatal vision screenings,“ Dr. Solebo expressed. By laying the foundational groundwork for lower-resource countries and the rest of the world to follow, health care providers can be shown the path forward with this methodology in place. When planning, even countries with limited resources should recognize that it is efficacious to invest in preventing childhood blindness from a country’s own budgeting perspective. However, it is equally important to have the right people in the room who understand what it takes to get these screenings implemented in low to middle income countries.
Dr. Solebo acknowledges that fighting communicable diseases and climate change will always be highly prioritized but there is still room to improve eye screening for children and the publication of these guidelines by the WHO is a step in the right direction. Dr. Solebo has worked with her colleagues to ensure that proper and early diagnoses as well as treatment are a top priority. As a researcher, her work to collect and analyze the impact with data has helped inform these decisions to invest in high quality postnatal vision care. Her passion for the work that she does in this field and her love of children was obvious to Megan.
Dr. Solebo became interested in pediatric ophthalmology at a young age. In fact, she had unknowingly been preparing for this role all her life. She is the eldest child in her large family. Her mother worked in a nursery and her father was a pediatrician, meaning Dr. Solebo grew up around many children. Because of this, she developed an ease and patience with children that does not come easily to many young pediatricians in training.
When Dr. Solebo was completing her ophthalmological training at the Great Ormand Street Hospital, she saw other students struggling to work with small children, but for her, it was easy! “Children are honest and fair and their life energy is affirming,” she said with a glowing smile. As a pediatric ophthalmologist, many conditions that she treats are chronic so she often cares for these children through to early adulthood. “It is a privilege to watch them grow and to help make them capable adults.” Dr. Solebo continued, “It is like being an auntie over and over again.”
Dr. Solebo is equally proud of her research and told Megan that it is an exciting time to be a scientist in the UK due to the increasing coordination of national health services and electronic data collection. It is, however, not without its challenges. It is still difficult to gather community care data from primary health care doctors and then be able to harmonize it with what is available on record.
Dr. Solebo not only works with patients and as a researcher, but she also contributes to the guidance on childhood eye health produced by the National Health Services (NHS) for the United Kingdom. The environment of early detection in the UK has several benchmarks in place for infant screenings. Within 72 hours of live birth, every newborn has a red reflex test, with congenital cataracts being the primary target of this test. Then, at 6-8 weeks, when infants are getting routine vaccinations, they are again given a red reflex test. This serves as a “safety net” test in case something was missed at the hospital. At birth, parents are sent home with a Personal Child Health Record more commonly known as the “Red Book” (Personal Child Health Record (PCHR). This book explains abnormalities and milestones that parents should watch for in babies. Sadly, there is not currently any mention of watching for leukocoria, otherwise known as “the glow.” Dr. Solebo is hopeful that by the next time the Red Book is updated information about leukocoria can be included.
From two months of age through the toddler years, children should continue to see the community child health teams regularly but there is nothing specifically required for checking the eyes. Doctors are busy looking for basic mile markers of development, although of course children need good vision to achieve many of these markers. Finally, by the age of five, children are given their first vision check at school where each eye is checked separately by a school nurse or a school orthoptist.
Since COVID-19, there have been additional challenges within certain communities where there still is work to be done to build up trust (often due to cultural background or language barriers) between patients and the medical community. There are many families that do not know what to watch for as potential signs of blinding conditions and COVID-19 has further delayed some families from bringing in their children for evaluation. This has led to an increase in late stage presentation of various eye conditions. One such condition is childhood cataracts and Dr. Solebo is trying to empower parents to recognize how to know if something is not right. Even after being diagnosed and treated, Dr. Solebo admits that compliance with patching therapies after diagnosis is important but not always easy to implement when dealing with a 9-month-year-old or a toddler!
Due to the pandemic, there has been an increase in accessibility to medical data and records and it is now more possible than ever to re-extract records from rolling sweeps of data allowing for increased research, more clinical data and better epidemiology. This could prove vital in getting children into examining rooms faster. Dr. Solebo finds that families can become so overwhelmed with the fear of their child losing sight that they often go into a state of denial and do not want to face it. With doctors like Dr. Solebo and her team working hard to educate and improve vision screening across the UK and beyond, we know that many more children will be diagnosed early and their vision preserved. Know the Glow applauds Dr. Solebo’s exemplary research and devotion to her patients and we look forward to hearing more about her work and the impact of the WHO guidelines she’s helped establish in the near future.