Eye doctor leads the way to children’s clearer vision across the Caribbean

Medical intern Dr. Christina Dowell visits a clinic in Suriname as part of the Pediatric Preventable Blindness initiative, an effort led by University of Miami opthalmologist Dr. Alana Grajewski to stem vision loss among children across the Caribbean Basin. Photo courtesy of Bascom Palmer Eye Institute/University of Miami.
By Janette Neuwahl Tannen

Medical intern Dr. Christina Dowell visits a clinic in Suriname as part of the Pediatric Preventable Blindness initiative, an effort led by University of Miami opthalmologist Dr. Alana Grajewski to stem vision loss among children across the Caribbean Basin. Photo courtesy of Bascom Palmer Eye Institute/University of Miami.

Eye doctor leads the way to children’s clearer vision across the Caribbean

By Janette Neuwahl Tannen
A University of Miami ophthalmologist is spearheading an effort to improve pediatric vision screenings in the Caribbean Basin.

A few years ago, Dr. Alana Grajewski was having dinner with an ophthalmologist visiting the University of Miami’s Bascom Palmer Eye Institute to train with her in pediatric glaucoma surgery, when he admitted a realization he had in the operating room earlier that day.

The physician from the South American coastal nation of Suriname was unsure he would even get a chance to perform the techniques Grajewski had taught him because some children show up to his office in such poor condition that it is too late to repair their vision. If left untreated, glaucoma can cause blindness in children.

Although the message was disheartening, after the doctor’s confession, Grajewski began researching the problem more. She learned that vision impairment and blindness is four times higher in the Caribbean—although in South America, Suriname culturally is considered to be a Caribbean nation—than it is in the United States, and she saw an opportunity to help.

“In the Caribbean, there is very little that has been done in the way of identifying children’s eye disease early, and if you don’t identify these problems, it becomes a more expensive and more damaging problem down the road,” said Grajewski, who has been treating children as an ophthalmologist for 30 years and who directs the Samuel and Ethel Balkan International Pediatric Glaucoma Center at the Bascom Palmer Eye Institute. “But if you are able to catch something and fix it, you’re improving their ability to function in school and in the world.”

Starting with Suriname, Grajewski is now leading an effort called the Pediatric Preventable Blindness (PPB) initiative to help eradicate vision loss in children. Currently, there is no formal vision screening in Suriname until children reach the age of 5. Yet by working with her colleagues at Bascom Palmer, other U.S. experts in the fields of ophthalmology and public health, as well as the University of Suriname, Grajewski came up with a strategy to screen children’s vision earlier—by doing it when they get their vaccines. If it is implemented fully, this model would allow Suriname doctors to mitigate vision problems before they worsen, she said.  

“The Caribbean loves this concept,” Grajewski added. “When we presented our model at a recent ophthalmology conference at the University of West Indies, ophthalmologists throughout the Caribbean were thrilled.”

Grajewski
University of Miami research fellow Matthew Javitt, along with opthalmologists Dr. Elena Bitrian and Dr. Alana Grajewski, and Dr. Denise Doelwijt, along with her medical student, Ravish Panchoe, from the University of Suriname at the Pediatric Preventable Blindness Symposium at Bascom Palmer in December. The conference brought together opthalmology experts from across the U.S. and the Caribbean to discuss how to improve and expand the PPB initiative.

With early detection and treatment, more children who need glasses at an early age will be able to get them, and children with more severe vision impairments like pediatric glaucoma can be referred to an ophthalmologist, said Matthew Javitt, research fellow. With surgery, pediatric glaucoma has an 80 percent to 90 percent chance of restoring a child’s vision. And with the vision screening model Grajewski’s team designed, it will only add four minutes to a family’s vaccination appointment.

The PPB initiative began with a trip to Suriname last May when Dr. Christina Dowell, a resident at the University of Miami Miller School of Medicine, visited several clinics and trained health care workers in how to use vision screening equipment. For children younger than six months, an arc light is used, which is a device that can be attached to a mobile phone to take a photo of the eye and detect any abnormalities. For children older than six months, a device called a spot vision screener is used to detect any impairments. While she was there, Dowell visited clinics near the country’s capital of Paramaribo with Dr. Denise Doelwijt, a University of Suriname ophthalmologist, and trained health care workers on how to conduct vision screenings. In July, another team from Bascom Palmer visited four clinics in Suriname. At the end of this month, Doelwijt, along with Bascom Palmer researchers Dr. Eleonore Savatovsky and medical student Adriana Grossman, are planning to expand their reach to visit 17 clinics across the country.

“We were looking to put a screening in as part of the existing infrastructure, which was why we chose the vaccination process where there is 95 percent participation from parents in Suriname,” said Javitt, who helped develop the initiative.

As Suriname’s only current pediatric eye surgeon, Doelwijt is often inundated with young patients who have not even gotten an eye screening when they arrive in her office. In December, she had a six-month wait to see new patients, she reported.

“This will make the wait time a little shorter because children will have already been screened elsewhere,” she said.

Doelwijt is a surgeon at the Suriname Eye Centre, which is part of the academic hospital for the University of Suriname. She has gathered a team of medical students and is collaborating with Grajewski to implement the initiative at an expanding number of clinics across the nation of more than 500,000 people. Doelwijt’s students also will help University researchers collect data that can evaluate if the initiative is improving the diagnosis process. However, Doelwijt is confident the model will help Suriname’s physicians.

“If this can help us operate earlier on the kids who need it, patients would get a better visual end result,” she said.

Since vision develops in the brain from what a child can physically see, Doelwijt and Grajewski said that the faster vision problems are corrected, the best chance a child has to either improve his or her vision or avoid blindness.  “Children grow into their vision, so if they are seen later, or not evaluated properly, they can still develop poor vision even if they have a beautiful eye,” Doelwijt said.  

After a model is working in Suriname, Grajewski wants to implement a similar PPB program in Trinidad, Jamaica, and Barbados through the University’s new partnership with the University of the West Indies.

In December, Bascom Palmer hosted a conference for physicians from across the hemisphere to learn about the initiative and discuss ways to implement a similar model in other countries that need a better way to conduct vision screenings. Ophthalmology experts from several universities in the region attended to learn about the initiative.

“Once it’s in place, this effort will be self-sustainable and will be part of the policy in these countries,” said Grajewski.