Fighting infant blindness in sub-Saharan Africa

Moi Teaching and Referral Hospital Ophthalmology OR (Eldoret, Kenya) Pictured (L to R): Hospital Staff, Sarthak Shah, Dr. Ernest Ollando (pediatric ophthalmologist), Dr. James Bett (head of department, ophthalmologist)

IN SUB-SAHARAN Africa, thousands of premature newborn babies go blind annually from retinopathy of prematurity (ROP). ROP is an eye disease that occurs when blood vessels in the eye begin growing abnormally, leading to weakened or leaking vessels that can cause retinal detachment.

Babies with ROP are at high risk of partial or full retinal detachment and, even with successful surgeries, live with lifelong visual impairment. Several stressors, including high oxygen delivered in the hospital after premature birth and other oxygen stresses are associated with ROP, although even without these stressors, ROP may still present.

Caught early enough, ROP can be reversed and the lifelong visual compromise lessened, but in sub-Saharan Africa many premature babies live a life of unnecessary blindness because a shortage of equipment and training prevents these babies from being diagnosed and treated. Sadly, the numbers of newborn babies with ROP are increasing at an alarming rate. As more premature infants survive in neonatal intensive care units (NICU), it is estimated that 31,200 African infants may develop ROP annually.

To tackle this tragic increase in untreated ROP, Scott Lambert, MD, professor of ophthalmology, serves as co-chair for Stop Infant Blindness in Africa, a project that seeks to provide much-needed training and equipment for ROP in sub-Saharan Africa’s NICU.

The project will provide to the doctors in sub-Saharan Africa oxygen blenders and sensors to regulate and keep oxygen levels from getting too high, thus decreasing the chance for ROP development. This equipment costs less than $2,000 in total and can be used repeatedly.

Lambert is collaborating with Sherwin Isenberg, MD, a professor of ophthalmology at the UCLA Jules Stein Eye Institute; Dupe Popoola, a pediatric ophthalmologist in Nigeria; and Martha Mkony, a neonatologist from Tanzania. Together with a committee of about 30 people, they will oversee the startup of three initial centers in Kampala, Uganda; Port Harcourt, Nigeria; and Kigali, Rwanda.

“We will train the staff at these sites so that they can become self-sufficient in providing patient care and eventually expand to additional sites in other parts of sub-Saharan Africa,” Lambert said.

Lambert has also teamed up with Sarthak Shah, a second-year Stanford medical student, to gather data on how improved oxygen management practices and technology effects the monitoring of ROP. Their study is funded through the Department of Ophthalmology and the 2022 Global Health Seed Grant provided by Stanford’s Center for Innovation in Global Health.

Shah began conducting surveys to collect data on possible additional sites virtually, but it became apparent that traveling to Africa in person would be beneficial for gaining a deeper understanding of necessary equipment for each site.

“A lot of these sites are not equipped to treat ROP patients, so patients have to travel to other hospitals, which can be risky as ROP must be treated urgently before a patient goes blind,” Shah said.

As the number of babies with ROP skyrockets in Africa, the need for not only equipment but trained staff also grows. The sites Shah visited were understaffed, with most sub-Saharan Africa countries having two or fewer pediatric ophthalmologists for the entire population. To address this, they plan to train nurses to assess ocular images and then use telemedicine resources to send their notes to an ophthalmologist for final evaluation, thus optimizing workflow.

Shah, who plans to specialize in ophthalmology after graduating from medical school, has a passion for helping ROP patients because his own uncle went blind from untreated ROP. At the time, not much was known about ROP, but through family support his uncle was able to excel in his career and other endeavors. However, Shah noted that families may not have the same resources to adequately care for a child with ROP, which may cause a great burden on them.

Shah spent a little over two weeks in Africa, finding it was a valuable experience for information exchange.

“While I traveled to Africa with hopes of helping the hospitals, I felt I equally learned from them,” Shah said. “The hospitals may have space limitations, but they come up with creative solutions to still provide adequate care in an efficient manner.”

Lambert and Shah are eager to see how this research project could help shape the future for ROP patients in sub-Saharan Africa and by extension around the world.

“By equipping the different sites, we estimate we could see a change in a short time, and we are eager to play a role in helping these patients,” Lambert said.


Kathryn Sill is the former web and communications specialist for the Byers Eye Institute in the Department of Ophthalmology, at Stanford University School of Medicine.