Training in use of OCT machine at Muhimbili, Tanzania with VISION 2020 LINKS partner St Thomas’ Hospital, London

Building  networks to combat preventable blindness across the Commonwealth

The Consortium is addressing the growing burden of diabetic eye disease across the Commonwealth by developing three networks of hospital-based training LINKS between overseas and UK partners. Part of the VISION 2020 LINKS Programme, these networks will enable Commonwealth eye health professionals to share their experiences and knowledge in diabetic retinopathyretino-blastoma and retinopathy of prematurity.

Through the networks, partner hospitals in Africa, the Pacific and the Caribbean will develop appropriate strategies and services to screen  patients.

By catching these diseases early, more people will have their sight saved and the number of people going blind unnecessarily across the Commonwealth will be reduced.

More information

For more information about these Networks please Contact us.

Image: Training in use of OCT machine at Muhimbili, Tanzania with VISION 2020 LINKS partner St Thomas’ Hospital, London. VISION 2020 LINKS Programme

DRNET

Training in use of OCT machine at Muhimbili, Tanzania with VISION 2020 LINKS partner St Thomas’ Hospital, London

Building a network to combat diabetic retinopathy across the Commonwealth

The Consortium is addressing the growing burden of diabetic eye disease across the Commonwealth by developing a network of hospital-based training LINKS between overseas and UK partners. Part of the VISION 2020 LINKS Programme, the network will enable Commonwealth eye health professionals to share their experiences and knowledge.

Through the network, partner hospitals in Africa, the Pacific and the Caribbean will develop appropriate strategies and services to screen diabetic patients. The participating LINKS partnerships are:

  • Ministry of Health, Botswana and Addenbrooke’s Hospital, Cambridge, UK
  • Kitwe, Zambia and Frimley Park Hospital, Surrey, UK
  • Muhimbili University, Tanzania and St Thomas’ Hospital, London, UK
  • KCMC, Moshi, Tanzania and University Hospitals Birmingham, UK
  • Mbeya Referral Hospital, Tanzania and WHSCT Altnagelvin, N Ireland, UK
  • Makerere University, Uganda and Royal Free Hospital, London, UK
  • Mbarara and Ruharo Hospitals, Uganda and Bristol University Hospitals
  • Lilongwe, Malawi and Edinburgh, UK
  • Blantyre, Malawi and Liverpool University Hospital, UK
  • LUTH, Lagos, Nigeria and Royal Bolton Hospital / N W Deanery, UK
  • UNTH Calabar, Nigeria and Wolverhampton University Hospital
  • Korle Bu, Accra, Ghana and Homerton and Moorfields Eye Hospital, UK
  • Kenyatta National Hospital, Kenya and University Hospitals, Coventry, UK
  • University of the West Indies, Jamaica and Homerton University Hospital, UK
  • Pacific Eye Institute, Fiji and RANZCO, Sydney, Australia
  • Solomon Islands and RANZCO, Sydney, Australia
  • Vanuatu and RANZCO, Sydney, Australia

By catching diabetic retinopathy early, more people will have their sight saved and the number of people going blind unnecessarily across the Commonwealth will be reduced.

 

More information

For more information about the diabetic retinopathy LINKS network please  Contact us.

Image: Training in use of OCT machine at Muhimbili, Tanzania with VISION 2020 LINKS partner St Thomas’ Hospital, London. VISION 2020 LINKS Programme

RBNET

Participants at the RBNET workshop

Retinoblastoma Training Network

Every year, thousands of babies and children in Africa lose their sight and their lives to the childhood eye cancer retinoblastoma (Rb). Retinoblastoma is a form of eye cancer that affects young children. Although it is relatively uncommon it is very serious, frequently leading to the loss of the eye and invasion of the brain and death (70% mortality is typical in Africa). In contrast, more than 90% of children in the western world with Rb survive, due to early diagnosis and specialist treatment.
Advanced Rb is a distressing condition seen all too often in the main tertiary eye care centres across Africa. The ophthalmologists working in these centres are desperate to diagnose and treat children early, while it is still curable. The successful treatment of Rb requires a health systems approach, working in the community to raise awareness of the signs, in tertiary centres with multidisciplinary teams (trained ophthalmologist, pathologist, oncologist, nurse), and internationally, through sharing specialist skills and protocols via North-South and South-South collaboration.

To date there have been few systematic programmes. Much of the work to date in Africa has been in Kenya in a collaboration involving the Hospital for Sick Children in Toronto, the charity Daisy’s Eye Cancer Fund and Kenyatta National Hospital, Nairobi. There is also work based in Mbarara, Uganda and Dar es Salaam, Tanzania, building Rb services there. These projects have shown that a modern, multidisciplinary approach to awareness, diagnosis and treatment increases uptake of services and saves lives.

The VISION 2020 LINKS Programme is well placed to build on the work of the Kenyan and Ugandan teams to share learning and strengthen services in Kenya, Uganda and Tanzania, with a view to subsequently scaling up the project to include other VISION 2020 LINKS that are developing children’s eye services in the Commonwealth. The network, initially with seven African partners in three countries, will provide specialist training by multi-disciplinary teams from the UK, Canada and Kenya. There will be ongoing mentorship visits over the next three years. The key activities will be an initial training workshop followed up by specialist training for the multidisciplinary team in each location.

The LINKS selected initially are:
1. Muhimbili University, Tanzania and St Thomas’ Hospital, London
2. Kilimanjaro Christian Medical Centre, Tanzania and University Hospitals Birmingham
3. Mbeya Referral Hospital, Tanzania and Altnagelvin Area Hospital, N Ireland
4. Makerere University, Uganda and Royal Free Hospital, London
5. Mbarara University, Uganda and Bristol Eye Hospital
6. University of Nairobi / Kenyatta National Hospital, Kenya and University Hospital, Coventry
7. Lighthouse Hospital, Mombasa, Kenya and Southampton University Hospital

One of the main public health interventions to improve outcome would involve education around the urgency of an abnormal red reflex. This ties in with other work funded by the CEHC using PEEK Retina to pick up abnormal red reflexes in babies with congenital cataract. This technology will potentially lead to earlier detection and treatment of Rb as well as congenital cataract.
Provision of prosthetic eyes that are implanted during the initial operation to remove the child’s eye will be included, as this increases compliance with treatment by parents of affected children. The removal of their child’s eye is often too traumatic for parents and they decline treatment when the cancer is curable, returning later when it is too late to save the child’s life.

Impact

Although Rb is a relatively uncommon condition, it has devastating consequences for affected individuals and their families. This investment in developing well structured and trained teams and programmes will lead to a dramatic improvement in the care of these children, potentially saving not only the sight but also the lives of many thousands of young children for the decades to come. We anticipate that the learning in these three countries would then be spread to other countries in the region. The systems approach described will have wider benefits in the fields of childhood blindness and childhood cancer care in Sub-Saharan Africa.

Global Retinoblastoma Presentation 2017 Study

The ‘Global Retinoblastoma Presentation 2017’ study led by Didi Fabian and Richard Bowman from LSHTM aims to report on the presentation mode of children diagnosed with Rb throughout the world, during 2017, with special attention to intra- versus extraocular disease presentation.

Please enlarge the map to view the participating centres.

More information

For more information about the Retinoblastoma Training Network please Contact us.

 

ROPNET

Retinopathy of Prematurity Network

ROP is an increasing cause of blindness in babies in middle-income populations. Some ROP can be prevented by high quality neonatal care. ROP can be treated in the first two months of life if diagnosed and specialist treatment is available. The UK and other high-income Commonwealth countries have good preventive, diagnostic and treatment services for premature babies with ROP. India is currently developing a national ROP programme, with support from the Trust. Lessons learnt from high-income countries, being applied in a middle-income country (India) can also be promoted and implemented in other Commonwealth middle-income countries.
We propose identifying one lead centre in 7 of the larger middle-income Commonwealth countries, and providing training on how to plan and implement a national ROP programme using expertise from within the Commonwealth and the India model programme.

Participating Countries

1. India x 2 centres
2. Bangladesh
3. Pakistan
4. Sri Lanka
5. Kenya
6. Nigeria
7. Ghana

Impact

The impact of this network would be the development of national frameworks and “demonstration centre” for ROP care (prevention, screening, treatment), at a stage before the anticipated increase in the number of children affected. This would result in improved quality of care for newborn babies, a lower incidence of sight threatening ROP and greater coverage of high quality initiatives for detection, treatment and long-term follow up.

More information

For more information about the ROP Net please Contact us.

 

Networks News

June 2017 – RBNET

The highlight for June from the Networks was the establishment of the Retinoblastoma Network. The Retinoblastoma Network (Rb-NET) involves seven institutions in three countries in Africa (Kenya, Tanzania and Uganda) partnered with four institutions in India and the UK – LV Prasad Eye Institute in Hyderabad, Sankara Netralaya in Chennai, and the two UK centres that treat children with retinoblastoma (Rb) – the Royal London and Birmingham.

The Network got underway with a workshop in Hyderabad attended by 64 people. As well as teams from Kenya, Uganda and Tanzania, small teams from Malawi and Indonesia had also managed to find their own funding to attend. A further country – Zimbabwe -wanted to join but was unable to attend and was represented by Ashwin Reddy from the Royal London, who has been working with them for some years.

Participants at the RBNET workshop

Photo –  participants at the Rb-NET workshop in Hyderabad, June 2017 

The teams that attended from Kenya, Uganda and Tanzania included ophthalmologists, paediatricians, oncologists, pathologists, nurses and Ministry of Health. Likewise the teams from India and UK were well-represented with ocular oncologists, a paediatric oncologist and ocular pathologists as well as ophthalmologists specialising in treatment of children with Rb.

Ministry of Health participants included Maternal and Child Health (MCH) as well as ophthalmology. This was important because the level of awareness of Rb is low in African countries and there is a great need to strengthen primary health care and public awareness so that children with white pupil (leukocoria) are referred to an ophthalmologist immediately.

The workshop took place over four days and was facilitated by Allen Foster and hosted at LV Prasad Eye Institute which was started 30 years ago by Gullapalli (Nag) Rao and has grown to a network of primary, secondary and tertiary eye centres serving a population of 50 million people.

March 2017 – DRNET

Jamaica – The theme for this year’s Ophthalmological Society of Jamaica Conference held on the 19th March was ‘Diabetes and the eyes: diabetic retinopathy’, and was led by Dr Lizette Mowatt, President of the Ophthalmological Society of Jamaica. There was also a workshop on DR screening. Guest speakers included Zubin Saihan and Dawn Sim, ophthalmologists from the LINK with Moorfields; Gohar Beint, manager of the NE London DR screening programme run from the Homerton, and Marcia Zondervan, DR-NET Programme Manager. There were 180 participants drawn from all over Jamaica and there was great appreciation of the input from the LINK with the UK, and the funding from the Trust, to enhance DR services in Jamaica.


Degazon

Photo –  Dr Zubin Zaihan receiving an award from the family of the late Dr. Denis Degazon after giving the first annual eponymous lecture. Dr Degazon is considered the ‘father of ophthalmology’ in Jamaica. 

Zambia – Professor Geeta Menon and the team from Frimley Park Hospital have won a prestigious award from the Royal College of Physicians for their work in developing DR screening and treatment, initially through their LINK with Kitwe Central Hospital and then expanding across Zambia. Besides the Copperbelt region, diabetic screening is now taking place in Lusaka, Livingstone and most recently Mongu.

February 2017 – DRNET

The DR-NET is benefiting from input from Chloe Cornes, a screener and grader in Staffordshire’s Diabetic Eye Screening Programme. She has offered her experience to help advise and support screener/graders in the Commonwealth LINK partner institutions who are undertaking the Certificate of Higher Education in Diabetic Retinopathy Screening (from Gloucestershire). Some of the modules are quite challenging and her mentoring and support will be very valuable.

Charlotte Wallis, a screener from Dorset Diabetic Eye Screening Programme, has started development of an online learning resource for screener/graders. She has joined DR-NET and is participating in the ICEH working group for a DR MOOC/OER that is about to start development.

The team from Frimley Park Hospital has carried out a national DR training event in Zambia, with all ten provinces represented. There were presentations from the visiting team on the theoretical aspect of diabetes register database management, administration and development, image acquisition, reasons for diabetic screening, grading the image and counselling the patient. This was done over the course of a three-day training workshop and was underpinned by a number of practical workstations which brought these areas into an operational aspect using the theory learned. Existing programme teams from Kitwe and Lusaka shared how it is used in a clinical setting. Patients were counselled, screened and treated to bring the subject to life and demonstrate how the teams should be operating the equipment, using and developing a robust database and managing the patients under their care. The attendees were then tested on all these areas at the end of the three days (a practical and written exam) to ensure knowledge and learning had been embedded for practical application on returning to their provinces.

January 2017 – DRNET

The DR-NET team has developed a three-month follow-up questionnaire to obtain feedback from the participants of the DR-NET Workshop and assess progress with their action plans. This has been sent out and responses are awaited.

An experienced UK screener/grader has come forward and would like to be a mentor to DR-NET staff undertaking the DR Screening and Grading online course run by Gloucestershire Hospitals.  A second screener has volunteered to help the e-learning team at ICEH to develop an open educational resource (OER) for DR screeners.

A database development group was established at the Durban workshop. Its work is progressing: a meeting was held with the Peek team to discuss development of an in-house database.

October 2016 – DRNET

In November 2014 a workshop was held in London at which each LINK developed a two-year action plan to strengthen their DR services, specific for their national or regional situation. In addition, the resolve was made by LINKS teams to increase their treatment outputs by at least one patient per week. Over the five years of the project this would equate to the prevention of 37,500 years of blindness.

This October, almost halfway through the 5 year initiative, a DR-NET planning and review workshop was held in Durban, South Africa, alongside the Queen Elizabeth Diamond Jubilee Trust’s DR Advocacy Workshop. At this workshop each partner reviewed and built on the progress made in 2015 and 2016. They further developed their local and national activity plans for 2017-2019 using the DR Toolkit guide, and all shared learning so that practical improvements can be made in 2017-2019.

Each delegate was provided with a practical Toolkit guide to help develop their country’s DR services and contributed to an action plan specific for their LINK, including training visits over the next two years.

Some 70 invited participants from 15 individual institution-to-institution VISION 2020 LINKS partnerships (between Africa, Caribbean and Pacific countries and their UK partners) worked together to develop and implement their local and national plans for DR services.

Nairobi-Coventry LINK update 

Muchai Gachago has recently returned from his one-year CEHC vitreo-retinal fellowship at LV Prasad and is reviewing DR services with key colleagues Patrick Nyaga, Joseph Nyamori and Michael Gichangi, Head of Ophthalmic Services, MoH, and the rest of the DR team. They are also sharing the learning from the Durban DR Symposium. There was a strike in December so the number of patients seen and treated has fallen.

Planning is underway for the next training visit by the LINK team to Nairobi in March and also for a medical retina observership in Coventry for an ophthalmologist from the Rift Valley Provincial General Hospital. One of the Nairobi screener/graders is currently undertaking the DR Screening Certification online course run by Gloucestershire Hospitals. It is hoped that a second person from Kenya will undertake the Gloucestershire course starting this year.

Publication 

Tackling diabetic retinopathy globally through the VISION 2020 LINK Diabetic Retinopathy Network

Nick Astbury, Philip Burgess, Allen Foster, Denise Mabey, Marcia Zondervan

Eye News | February/March 2017 | Vol 23 No 5