Armenian Infants Saved from a Lifetime of Blindness
Friday, June 27th, 2014
Neonatal Intensive Care Unit in Yerevan.
Roger Ohanesian received an emergency phone call -- it was the middle
of the night. The director of the Armenian ROP (Retinopathy of
Prematurity) Clinic in Yerevan, Dr. Tadevos Hovhannisyan, was calling.
He told Roger there were 11 infants and seven children under the age
of five who required immediate eye surgery. If they were not treated
they would lose vision in one or both of their eyes and be fated to a
lifetime of blindness. Because Armenia's ROP Clinic is the only one in
the Caucuses and the surrounding regions with the ability to perform
this very challenging surgery some of the infants were from other
After learning about the situation from Dr. Hovhannisyan, Dr.
Ohanesian set out to plan his trip to Armenia. He needed to leave
immediately, but first it was essential for him to find a highly
skilled pediatric retinal specialist (fewer than 30 worldwide) who
would join him in Armenia to perform these difficult surgeries.
Roger called Dr. Tom Lee, an international ROP expert, who has been to
Yerevan each year since 2010 with the EyeCare Project's Medical
Missions to train the ROP physicians how to diagnose and treat at-risk
infants. Dr. Lee has been instrumental in developing the ROP screening
and laser program which has resulted in a significant reduction in
advanced ROP cases requiring surgery in Armenia. Dr. Lee has also
established a telesurgery connection between the Children's Hospital
of Los Angeles and Hospitals in Armenia. Interactive lectures and
supervision during surgery provided by pediatric academics in the
United States to colleagues in Armenia, with highly specialized
cameras and surgical equipment, has significantly impacted the lives
of Armenian children.
Unable to travel to Armenia on such short notice, Dr. Lee referred Dr.
Ohanesian to Dr. Chien Wong, a London-based pediatric specialist who
is experienced in ROP surgery and related disorders. Dr. Ohanesian
filled Dr. Wong in on the situation and, recognizing the urgency of
the matter, Dr. Wong immediately rearranged his duties at Moorfield
and Royal London Free Hospital and made plans to travel to Armenia.
While Drs. Ohanesian and Wong were making their arrangements and
traveling, the EyeCare Project's ROP surgical team in Yerevan was
making preparations to operate on the babies. The doctors met in
Yerevan late Saturday night and saw all of the babies on Sunday in the
Neonatal Intensive Care Unit.
They had an enormous task ahead of them -- 18 complicated surgeries on
the tiniest of patients and very little time. Dr. Wong, lead surgeon,
Dr. Ohanesian and the Armenian ROP team -- Dr. Adik Hovhannisyan, Dr.
Hasmik Haratunyan and Dr. Ruzanna Haratunyan -- performed multiple,
extremely difficult surgeries. One surgery, on a five-month-old
infant, required nearly four hours to complete.
While Dr. Wong taught the Armenian surgeons the delicate intricacies
of his surgical techniques and endoscopy -- operating from within the
eye -- Dr. Lee was at his home in California, electronically connected
to the operating suite. He was able to view the exact images seen
through the endoscope and surgical microscope and to advise the
surgeons in real time during the surgeries. Despite the 12-hour time
difference and surgeries lasting well past midnight in California, Dr.
Lee participated for two days providing invaluable training for the
Infants examined following surgery
Soon after the first surgeries were complete, Dr. Hovhannisyan took
over as lead surgeon and Dr. Wong assisted. Dr. Ohanesian said these
were the worst cases of abnormal intraocular vascularization he had
seen in 40 years of practice.
The day following the surgeries the exhausted physicians examined
their patients and all of the babies were doing well -- a lifetime of
darkness averted. Since the development of the Project's ROP Program
in Armenia, with physician training, extensive screening of all
premature infants in the NICUs and laser treatment of those found to
have ROP, the EyeCare Project has been able to reduce ROP-related
blindness in infants by more than 90 percent -- from approximately 60
infants per year to little more than six.
Retinopathy of Prematurity (ROP)
The EyeCare Project established an ROP Program in Armenia in 2010, to
treat infants and young children afflicted with this devastating and
potentially blinding disease. ROP affects the developing vessels of
premature infants between the eighth and ninth month of pregnancy.
These abnormal blood vessels grow and spread throughout the retina --
the paper thin tissue that lines the back of the eye -- causing
The risks of Retinopathy of Prematurity have been known in the United
States for decades. First encountered in the early 1950s, an epidemic
of ROP left an estimated 7,000 American children blind in one year
alone. In Armenia -- a country the size of Maryland landlocked between
Iran, Turkey, Azerbaijan and Georgia -- awareness has come only
recently. As the health care infrastructure is advancing in Armenia,
with improvements in the medical care of smallest premature infants,
the rate and severity of ROP have increased. Previously, infants did
not live long enough to show the effects of ROP. With higher levels of
oxygen in their incubators they survive, but develop ROP.
Neonatal Intensive Care Unit nurse with her tiny patient.
Now, every year in Armenia, many children are born prematurely and
survive because of advanced care in the NICUs, but tragically grow up
blind because of ROP. Approximately 60 percent of children in a
neonatal intensive care unit will go on to develop some degree of ROP
and 10 percent will progress to the advanced form even with laser
treatment. Without surgery more than half of the children with the
advanced form will go on to develop irreversible blindness. This
process can occur in as little as one to two weeks.
The first treatment for ROP is a non-invasive laser therapy that can
be performed at the child's bedside in as little as 30 minutes. One
treatment is generally sufficient to produce complete regression of
ROP if it is performed in a timely fashion. The success rate overall
is 90 percent, although in the most aggressive form of ROP, the
success rate falls to 50 - 70 percent. In those cases where laser is
To halt the progression of the disease, surgery is necessary to
physically remove the residual scar tissue that remains and tugs on
With Dr. Lee's telesurgery medical education program, Armenian doctors
are able to receive ROP surgical training that is the equivalent of a
medical residency or fellowship. The Armenian physicians scan the
retinas of infants in local NICUs and send the images to The Vision
Center at Children's Hospital in Los Angeles via the Internet.
Experienced pediatric ophthalmologists at the Vision Center review
them and discuss the appropriate treatment with the Armenian
Dr. Wong will travel to Armenia again in July and September to train
the Armenian physicians and to perform surgeries. Dr. Wong will assume
the role of assistant surgeon while the Armenian retinal surgeons with
the Project's ROP team will be the primary surgeons. The long-range
goal of the EyeCare Project is to have the Armenian physicians reach a
level of competence equal to that of retinal surgeons in the United
States so they will be able to perform independently.
A lifetime of darkness averted.
In September, the EyeCare Project will host an international
conference on the diagnosis and treatment of ROP. Pediatric
ophthalmologists and retinal specialists from CIS and other countries
will attend. A number of these countries have sent their patients to
the Armenian ROP Center for treatment, which has been designated as a
"Center of Excellence" by the United States Agency for International
Development (USAID) and the United States Ambassador to Armenia, John
The Armenian Eye Care Project
The Armenian EyeCare Project, a nonprofit organization founded in
1992, by Dr. Roger Ohanesian, is based in Orange County, CA. Their
mission is to eliminate preventable blindness in Armenia and to
provide access to eye care for all Armenians. This is accomplished
through a comprehensive, integrated approach with medical education
and training as the cornerstone. Components of the program include
eight specialty clinics and a mobile eye hospital that travels
throughout the country.
Initially, the Project provided eye care for those wounded in the
Nagorno-Karabakh War that Armenians fought with Azerbaijan from 1988
to 1994. After the war Ohanesian redirected the project toward
conducting specialized trainings for Armenian ophthalmologists and
providing eye screenings and eye surgery for isolated and vulnerable
members of the population with a Mobile Eye Hospital that travels
throughout Armenia. The ROP program was added to the mix of eye care
programs after learning that better neonatal care was increasing the
survival chances for Armenian preemies, but lack of proper eye
screenings meant many were going blind. In 2010, he recruited Dr. Tom
Lee, chief of Vision Sciences at Children's Hospital Los Angeles, to
travel to Yerevan and to teach ophthalmologists how to diagnose and
treat ROP. www.eyecareproject.com
The Vision Center
The Vision Center at Children's Hospital Los Angeles is an
international referral center known for its family friendly
environment of children afflicted with all forms of eye disease and
provides a full range of inpatient and outpatient services. It is the
largest pediatric ophthalmology program in the nation with multiple
subspecialty programs that are considered to be among today's finest
resources for diagnosis, treatment and research. Children's Hospital
Los Angeles is one of America's premier teaching hospitals, affiliated
with the Keck School of Medicine of the University of Southern
California since 1932. It is a national leader in pediatric research.