Features | 09.07.10 | 18:07
Sight and Synchronicity: Blindness averted for Armenian “premies”, due to good timing and good medicine
Mothers of premature babies in Armenia can now see their children treated against ROP.
A special camera donated by California AECP supporter Luther Khachigian is the first of its kind in Armenian eye care.
In previous visits to Armenia AECP visiting doctors had been encouraged by local ophthalmologists to devote training to prevention of ROP. AECP arranged a fellowship in 2007 in neonatal ophthalmology in the United States for the chief of Pediatric Ophthalmology of the Sergei Malayan Eye Center (Republican Eye Hospital) in Yerevan.
Then, at an Academy of Ophthalmologists meeting in New York, Ohanesian approached doctors considered the top world specialists in the field and asked them if they would like to join his team on a mission to Yerevan.
Through persistent follow up and planning, AECP was able to bring together in Yerevan Dr. Thomas Lee, Director of the Retina Institute of the Vision Center at Children’s Hospital in Los Angeles; Dr. Robison V. Paul Chan, Director, Retina Service at Weill Cornell Medical College; Dr. Patrick Walsh, a recognized neonatologist from Anaheim, California; and Dr. James E. Smith, recognized as a world-leader in ROP treatment from Australia.
The doctors (as with all AECP associates) traveled to Armenia at their own expense and volunteered a week of lecture and consultation. They didn’t, however, expect their training to take on the dramatic significance that was found here.
After two days of lectures, attended by about 200 doctors at the Ani Hotel in Yerevan, the third day of training was devoted to screening babies at the neonatal wards of the capital.
According to Ohanesian, the intent of the screening was to familiarize local physicians with contemporary practices in identifying ROP. It was also occasion to train ophthalmologists in how to use a Laser Ophthalmoscope – a device essential to the treatment of ROP.
Such a tool -- a diode laser -- had not existed in Armenia, until it was donated by the Burns Committee, which each January in Yerevan holds a traditional “Burns Supper” during which auctions are held, with proceeds going to benefit worthwhile causes in Armenia (see http://www.armenianow.com/news/20625/burns_supper_in_armenia).
Much to their surprise and alarm, doctors found one baby who had “Plus Disease” – an abnormality of the retinal veins.
Dr. James Smith pulled Ohanesian aside during the examination. “This baby will be blind in a week if not operated on immediately,” he said.
They continued examining the 20 or so premature infants in the Republic Hospital neonatal ward, many of whom had been transferred from the rural areas of the country. Another case was found. Then another. And finally four cases. The doctors were stunned
“These doctors might go an entire career and only see a few cases of this severity of ROP,” Ohanesian said. “To find four cases in only one neonatal unit is extraordinary.”
Ohanesian says there is no indication whether ROP is more prevalent in Armenia than in other societies, but that AECP hopes to find funding to study the phenomenon. He is sure, though, that it was a remarkable turn of events that six babies’ diseases were identified and immediately treated.
The Australian and the American doctors were scheduled to fly out of Yerevan the morning after the screening training. After finding the first couple cases of ROP, however, Smith said to Ohanesian “I’m not leaving here until we’ve looked at every premature baby in the city.” Two more cases were then discovered.
After consulting parents of their children's dire condition, the surgeons operated until past midnight at the Neonatal ICU, with local ophthalmologists including Malayan Center retina specialist Tatevos Hovhanesyan at their side. After observing the laser procedure, Hovhanesyan performed the last two surgeries to the satisfaction of the foreign mentors, who were pleased to leave behind a local specialists who is now charged with teaching his colleagues.
“The great thing is that now Dr. Hovhanesyan has had the experience, and can help other local doctors to identify and perform treatment,” Ohanesian said. “This is exactly the goal of the eye project’s training – watch one (surgery), do one, teach one.”
Beyond that, however, the foreign doctors – after finding the surprising need in Armenia – volunteered to hold weekly telemedicine consultations with the Armenian doctors for one year.
Because a baby’s eye develops so quickly, a week’s growth can cause considerable changes in the makeup of the eye. For that reason it is essential that eye doctors examine each child at least once a week to be on the lookout for signs of ROP.
Using a Retinal Camera (donated by AECP California supporter Luther Khatchigian), doctors in Yerevan will post photos of patients’ eyes online at a dedicated website. The American and Armenian doctors and the Australian doctor will look at the photos and then, using Skype internet telephone service, will discuss the cases.
(In addition to the camera for the neonatal ward, AECP purchased a Retinal Camera that is portable, for use by its local associates who will visit the 10 neonatal units in Armenia, after which the photos can be studied by specialists here and abroad.)
“This is an incredible opportunity for the Armenian doctors. Even young doctors in America don’t typically get this sort of specialized attention from such acclaimed experts,” said Ohanesian, a native of Watertown, Massachusetts, who graduated Harvard Medical School and trained at who trained at Massachusetts Eye and Ear infirmary and National Institutes of Health before establishing his practice in Southern California.
Ohanesian, who made his first trip to Armenia to tend to war and earthquake victims, has some five decades in medicine, but still gets excited and emotional about the synchronicity of events that led to his project’s most recent success.
“The babies treated this week, and many more, will not go blind because these doctors and these donors did something extraordinary,” he said. “Imagine: these Armenian babies will grow up being able to enjoy normal lives, and may never know that not only their local doctors, but doctors from the United States and Australia, and a group of benefactors from Scotland (from which the Burns Committee originates) and elsewhere are the reason why they can see.”
Baby Hakob Raganyan is one of the lucky ones. He came into the world early, on May 11, two months before his mother Markruhi expected to meet her first child.
Born after just a 27-week pregnancy, the boy weighed 2.4 pounds (1.1 kilograms) and mother Markruhi held little hope that he would survive.
Not so long ago in Armenia, his chances would have been less. About 4 out of 100 babies in Armenia are born prematurely. Last year about 600 babies were born pre-term and about 200 were at risk of ROP, according to AECP.
Not so long ago there would have been less attention to the quality of life for infants like Hakob. To survive at all was miracle enough.
Medicine in general has gotten better in Armenia. That’s the good news. The challenging news is that with the ability to sustain endangered life, comes the need to protect it.
Babies born prematurely are typically placed in incubators, where they are exposed to 100 percent oxygen. Whereas this is the ideal condition for sustaining life, the presence of pure oxygen actually can damage a baby’s eye development. For that reason, babies who have been determined as at-risk for ROP need a lesser amount – about 27 percent – of oxygen (controlled in the incubator by a “blender”).
Ohanesian fears that up to half of the at-risk “premies” would eventually be blind. It is not, he underscores, because Armenian doctors missed anything in their routine examinations. Rather, it is because identifying disease such as ROP is a relatively new phenomenon in Armenia, and fighting it has confounded doctors here until now.
“It’s a very difficult thing if you’re in medicine,” Ohanesian says, “to see a kid survive premature birth, but then develop blindness.”
That is the sentiment behind AECP’s motto for its campaign to stop ROP in Armenia. Babies, even at premature birth, are born with the ability to see. But in the crucial weeks of development – especially weeks 31-36 – ROP can take away sight. And so the Armenian Eye Care Project appeals to patrons, “Don’t let her first sight be her last”, as it hopes to provide further development of ROP awareness among Armenian neonatologists, pediatricians and ophthalmologists.
To learn more about AECP and to join its campaign, visit www.eyecareproject.com