Eyeworld

EW IN OTHER NEWS December 2011 61 Armenian Eyecare Project works to eliminate ROP through telemedicine W hen Thomas Lee, M.D., agreed to travel to Armenia with the Armenian Eyecare Project (AECP) to spend 3 days giving lectures on retinopathy of prematurity (ROP), he had no idea he and the team would cancel their flights out to per- form emergency surgery on six pre- mature infants, that he would find the most aggressive forms of ROP in one neonatal intensive care unit (NICU) that he had ever witnessed, or that the experience would lead him to embark on a year-long telemedicine training program he'd come to regard as the "capstone" of his career. If you ask him, he was reluctant to go in the first place, repeatedly turning down the invitation to de- velop a teaching program on ROP for Armenian ophthalmologists from Roger Ohanesian, M.D., asso- ciate clinical professor of ophthal- mology, University of California, Irvine, and founder, AECP. "I wear a lot of hats here at the hospital, so my free time is really minimal," said Dr. Lee, director, Retina Institute in The Vision Cen- ter, Children's Hospital, Los Angeles. "I told him I had a great series of lec- tures I could give him so the next time he went there, he could give them this series of talks. But Roger is very persuasive. He wasn't taking no for an answer." You have to be persuasive and persistent to run a highly successful nonprofit eyecare organization that benefits an often-overlooked coun- try. AECP was established in 1992 by Dr. Ohanesian to bring eyecare to the impoverished, battle-weary na- tion. Dr. Ohanesian has traveled to the country twice a year for the last 20, bringing with him equipment, medicine, and a team of eye special- ists ready to educate. The trip in June 2010 was to train doctors in ROP management. Dr. Ohanesian and his team—which included Robison V. Paul Chan, M.D., director, retina service, Weill Cornell Medical College, New York; and Australian ophthalmologist James E. Smith, M.D.—knew the country was struggling with the complicated, blinding disease, but not on such an astonishing scale. In one NICU alone they found six out of the 15 children hours away from irreversible blindness. "It was really shocking to us," said Dr. Lee. "None of us had seen ROP that severe and I've been doing this now for 11 years. It was a real eye-opener." The doctors worked through the night, successfully saving the sight of the Armenian six. But their real work, to get a handle on the ROP epidemic that had enveloped the country in recent years, was far from over. Creating AECP Armenia has a lengthy, tortured his- tory marked by extreme poverty, re- ligious wars, genocide, invasions, and epic earthquakes. Located in the Southern Caucasus, a political pow- der keg between Eastern Europe and Southwest Asia, Armenia is fenced in by historically hostile neighbors: Georgia, Azerbaijan, Iran, and Turkey. The tiny, Maryland-sized country was subjected to Soviet oc- cupation for 70 years, not tasting freedom until 1991 when the Soviet Union finally dissolved. "It's a rough part of the world," said Dr. Lee. "They've gone through nonstop wars with Turkey. The peo- ple who have been the nicest to them are the Iranians, which tells you a lot." The years leading up to its inde- pendence had devastating conse- quences. Between an earthquake in 1988 that killed more than 50,000 people and a 6-year-long war with Azerbaijan, Armenia's economic and healthcare infrastructure was in shambles in the early 90s. "In 1992, Armenia was asking for help from neurosurgeons, gen- eral surgeons, ophthalmologists, etc.," said Dr. Ohanesian. Although Dr. Ohanesian, a sec- ond-generation Armenian-American, was far removed from his Armenian ancestry, he still felt called to help. He headed to the country with $10,000 worth of medicine and sup- plies donated from drug companies and six corneas. "When I went, it was utter dev- astation," he said. "Their equipment was poor, and they only had elec- tricity for an hour a day." Doctors who volunteered in Ar- menia during that time describe a beautiful but tragic place with dingy hospitals teaming with cats, surgical tools that couldn't cut butter, and shoddy equipment with no light bulbs, for example, in microscopes. "After I left," said Dr. Ohanesian, "I decided things could be made bet- ter. Over the next 20 years, the Ar- menian Eyecare Project brought them more than 20 million dollars worth of equipment." Triumph The past two decades have proven enormously successful for AECP and Armenian eyecare thanks to AECP's 5-Point Program approach: medical education and training, direct pa- tient care, public education, re- search, and building capacity. "Our whole effort is to build up the infrastructure though training, to work ourselves out of a job," said Dr. Ohanesian. To do this, the project estab- lished 6- and 12-month-long fellow- ship programs, bringing Armenian ophthalmologists over to the U.S. for skills transfers. Since 1998 AECP has trained doctors in subspecialties such as vitreo-retinal, glaucoma, cornea-uveitis, neuro-ophthalmol- ogy and orbital surgery, low vision, eye banking, cornea transplantation, and pediatrics. AECP has a twice- yearly magazine, fundraising galas, an international meeting in its 12th year, and an impressive Armenia- based Mobile Eye Hospital built into an 18-wheeler with two exam rooms and a fully functioning operating room, capable of performing glau- coma, cataract, and retina surgeries. "It's crisscrossed the country," said Dr. Ohanesian. "It takes 2 years to make a revolution, and we've been around four times. We've done full exams on 300,000 patients and performed 12,000 cataract surgeries. "We have these major clinics there now and they're just terrific," continued Dr. Ohanesian. "[Armen- ian ophthalmologists] have stayed educated with continuing medical education, they've done surgical and medical research, they have gotten patients to come from other coun- tries. I've been so pleased with what the Armenians have been able to do." Tragedy There is no doubt Armenia is an eye- care success story. But while the country was establishing eye clinics and manning them with specialists, while its healthcare infrastructure was strengthening, and while it was developing NICUs to save the 1,600 premature infants born in 2010 alone, Armenia was chest-deep in a child blindness epidemic that was ignored for years. "The state of its NICUs is proba- bly what the U.S. was like 40 years ago," said Dr. Lee. "It's better than nothing, but it's a relativity recent phenomenon. About 2 or 3 years ago, the ophthalmologists in the country started seeing children bilat- by Faith A. Hayden EyeWorld Staff Writer No child left blind continued on page 62 From left to right, Roger Ohanesian, M.D., Thomas Lee, M.D., and James E. Smith, M.D. Training with the retcam in Yerevan, Armenia A baby and nurse in the NICU Source: Lonnie Duka Photography

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