(Note: Unusual post, not about network routing or Linux systems. For purely technical audience of this blog, feel free to pass unless you have a young kid at home!)
In Sept 2021 - my wife and I were blessed with a baby boy (Avyukt). He is now around 1.6 years old. Since Oct 2022 he is wearing specs on his eyes. It’s not common (so far) to see babies that young with eye specs, this often brings up curiosity and questions across friends, family members and even strangers we meet outside on the road, on public transport etc. I am going to document in this blog post about his eyes, our interactions with the doctor and more.
One important note I must say here is that there are lots of varying factors in the treatment and I am not a medical professional. Thus this post will cover only our experience and must not be taken as medical advice in any form.
Avyukt was born prematurely by a few weeks. This is important in the context of eyes because babies who are born prematurely are required to go for an eye test somewhere around the time when they hit maturity week. Pediatrician would advise to see the eye doctor when they discharge a pre-mature baby after birth.
The eye test is to check for risk of ROP i.e Retina of Prematurity. The ROP is a specific condition which can happen in premature babies where the growth of blood vessels is abnormal and this may or may not require treatment depending on the specific case. In the case of Avyukt local doctor was extremely worried about the “bleeding in the eye” and advised us to immediately go to PGI Chandigarh. Till this time Avyukt never went out of the city and we were a little afraid to travel that far with 3 weeks old baby but the doctor had a strong opinion that this situation of bleeding can be fatal and must be treated by doctors who have expertise in this at PGI Chandigarh (immediately). In a panic, we went to another local doctor on the same day and he re-confirmed bleeding in the eyes but did offer local treatment starting right away. We did not go for it. It was a stressful time but we ultimately decided to go for a 230km ride to Chandigarh on late evening.
Bleeding eyes and vessel growth
We met the retina expert - Dr Simar Rajan Singh in PGI Chandigarh the following day. According to him while there was considerable bleeding in Avyukt’s eyes, it was not fatal at that stage. He was able to look deep using the headgear with the lens as well as using a machine called “Retcam” which is a high-end machine for looking inside the eyes. It takes a high-resolution video of the eyes and then pictures are taken out of the video showing the specific stage of the bleeding as well as blood vessel growth. The doctor advised us to visit again in a week, re-do the retcam capture of the eyes and compare pictures. We did that and there was some improvement. The important thing here was that situation was not getting bad (which is what the doctor was looking for to act if needed). The same test was done again for a few weeks for the next few weeks. Initially at a gap of one week and later two weeks, one month and so on. This went on for months.
While the actual meeting with the doctor was for a few mins and this test was 10-15 mins, the travel time was massive beside the waiting time at PGI Chandigarh (more on this later). Since Avyukt was only a few weeks old, he was on 2 hours feeding cycles and it would take us typically 6-7hrs to reach Chandigarh with pauses every two hours. Winters were about to start here in North India and that further added to the complications of heating baby milk on such a long route. The best thing about all these long two-day travels was the result. The eye kept getting better and ultimately doctor concluded that the eyes were out of danger, blood vessel growth was satisfactory and did not require any treatment i.e an eye operation. This was a massive relief for us. The risk due to bleeding can be extremely high and the worst case is retinal detachment causing blindness. I must say it was one of the most stressful times I ever had in life for a few weeks. While we had good confidence in the doctor, we were told that if needed operation can be performed but it can be risky for a month-old baby. That further kept us very stressed thinking about the possibility. Luckily eyes healed on their own under the strict regular watch of the doctor.
Eye specs and number difference
After one of the eye checkups in Oct 2022, we were told to get the eye number checked. While it may seem unusual but babies can be and are tested for eye number. This is using a refraction test. In this doctor projects a beam of light, that moves up, down, left & right while looking at the movement of the light refracted from the back of the eye. The test is performed multiple times using the different numbers of the lens at the source. This is done until the doctor finds the refractive error by the eye and hence the number. This is not the most accurate number but seems to be the best possible test for young ones who cannot go for a traditional test of reading alphabets at this age.
With multiple tests after dilating the eyes, the doctor concluded that there was a considerable difference in both eye numbers. The right was close to zero and the left was close to +4. Next, we consulted with Dr Savleen Kaur who is a pediatric ophthalmologist at PGI Chandigarh. According to her number may not be the problem but the difference in number is. The difference in the eye numbers will push Avyukt to use his right eye instead of both eyes. That can develop a disease called “lazy eye”. And hence it’s good to correct this using specs as well as a technique called “patching”. In patching, the better eye (right) is patched to force him to use his left eye for a few hours every day.
This is a specific condition which can develop due to several reasons and one of that is the difference in eye numbers. In this case, the baby would “like to use” the eye with better vision and that would have a spiralling effect on the eye will less clear vision as optic nerves won’t develop beyond a point and will lead to poor vision as well as squint in the eyes. Here’s a video of Dr Savleen herself explaining the condition (in Hindi).
Why PGI Chandigarh?
Over time this is a question we asked ourselves initially and so do many friends and family members. We live 70km from Delhi. Chandigarh is 3x farther compared to Delhi.
There are multiple reasons for sticking to PGI Chandigarh:
- Initially, we had no choice as the local doctor’s response panicked us. It was a question of looking for “somewhere in Delhi” or rushing to what we were advised.
- We developed confidence in the doctors at PGI Chandigarh & thus an overall reluctance to change. We always felt it’s important to meet good doctors even if it takes longer travel and wait times.
- Advanced Eye Center at PGI Chandigarh was significantly upgraded during the tenure of Dr Mangat Dogra who were there for close to 28 years and retired as head of Ophthalmology. He was passionate about the subject and was able to pull through resources for many things including retina treatment.
- The initial treatment needed Retcam for taking a digital picture of the eyes. This is an expensive machine and can cost over 50 lakhs or more. Not many hospitals have it. Surely there would be a few in Delhi possibly AIIMS but anyways there are limited options.
- Govt. run hospitals can be stressful. This is especially true for most middle-class folks who are afraid of the crowd, standing in long queues, waiting for hours to meet doctors. Coincidently the Advanced Eye Center at PGI Chandigarh is next to the heart department and the area can be packed with long queues in the morning. Once you go with the “process” a couple of times, there is somewhat of a comfort zone with the system as a whole and a reluctance to explore alternate options.
Eye checkup at an early stage
Unsure why but somehow paediatricians do not recommend getting eyes checked at an early stage. It might have to do with not overburdening new parents or could have to do with ICMR guidelines. I am not sure.
In our case, we were advised due to the pre-maturity factor but after meeting and talking to so many people around, it seems like it’s not very uncommon for children at a young age to have issues. This is true for non-premature i.e full term babies as well.
And some of these can only be treated in the early phase. For instance, lazy eye cannot be treated typically after 7 years of age. We met young children (while waiting at the hospital) where parents did not get the eye checked initially & found issues at a much later stage and some of those issues had become permanent by now. Often parents figure out the issue in children’s eyes when they have focus issues in school or during play (dropping the ball regularly, missing to hit the ball etc). All those abilities are developed at a much later phase. In a way, we were lucky to be advised to go to the doctor at the initial phase (for a different reason as described above) but that ended up in catching the number difference in the eyes. So for anyone reading with young children, it’s a good idea to get eyes tested by a doctor. Experts who deal with this are pediatric ophthalmologists.
Public sector Vs private sector in healthcare
I am a right-wing person and believe in the private sector. I prefer the private sector, market-driven economy, very low involvement of govt. in most of the sectors including telecom (where I work!) but in healthcare I have mixed thoughts. The problem with the private sector in health care is that incentives are not correctly aligned. This is very different if we compare say public Vs private banks, public Vs private telecom players, and public Vs private infra development. In all cases except Healthcare, the incentives are aligned to deliver and make money. But in healthcare, incentives can be to act (when medically may not need to act) with a treatment, drag the treatment etc. There is lot more “subjective” part in the treatment and one cannot easily judge on the direction and is heavily dependent on the doctors.
Take for instance this specific case of initial bleeding in the eyes the local doctor (at a private hospital) advised starting treatment with multiple laser sessions immediately while a doctor at PGI Chandigarh (a Govt. run hospital) advised us to wait and watch. I think private hospitals are needed especially when we look at massive crowds of people but eventually some different model has to be worked out. The private sector can invest, build up capacity and serve a large number of people who are ready to bear the cost as opposed to govt. a model where treatment is massively subsidised. But this model of “treatment deciding the earning of doctor/hospital” greatly worries me for anything serious. It may be a fine less serious, minor illness but I would prefer the advice of a Govt. run hospital doctor on anything serious or with long-term effects. While the majority of doctors do great work (including the ones doing private practice), I must say that doctors at Govt. run hospitals do an exceptional job. The amount of patients they see every day is huge.
The heavy crowd impacts both doctors as well as patience’s experience but on positive side gets us way more experienced doctors in return for patience (in waiting time) to see them.
With that being time to end this post. Again, in summary, the specs are not a problem but rather a solution to a possible problem which may occur if specs are not used. If you have young children around you, it would be a good idea to get your eyes checked by a doctor.