Developing pediatric eye care program in Nepal: Insurmountable Mountains can be reduced to mole hills. The Orbis experience in Nepal

Background Nepal straddles the Himalayas and its geography has posed challenge to delivering eye care in children. This manuscript describes the pediatric eye care facilities developed, and children examined and treated under the Orbis International’s childhood blindness initiative. Methods Between 2010-2017 Orbis International had supported the Nepal Netra Jyoti Sangh (NNJS) and Tilganga Institute of Ophthalmology (TIO) to develop pediatric eye care centers in major hospitals, along with their outreach. This manuscript looks at the impact of that intervention. Reports of Nepal Netra Jyoti Sangh, Tilganga Institute of Ophthalmology and Orbis International were studied, along with publications on ophthalmology from Nepal. Eight child friendly pediatric eye care centers were set-up, pediatric eye care teams were trained, an outreach program especially for children’s eye problems was designed and outcome monitoring and research promoted. Results Between 2010–17 1,281,153 children had been examined by 8 pediatric eye centres (average 20,018 per hospital per year, range 10,729 –39,485) and the average outpatient per month per hospital was 1668 (range 894 - 3,290). Between 2010 – 2017, 42,430 children had been operated upon by 8 hospitals (average 663 per hospital per year, ranged from 96 – 1,465) and the average pediatric eye surgery per month per hospital was 55 (ranged from 8 to 122). In the years 2018 & 2019 (21 months) post-project, all the 8 hospitals had operated on 14,252 children (average of 1,782 per hospital, range 185 - 4438) and the average pediatric eye surgery per month per hospital was 85 (range 9 to 211). 19 publications on pediatric eye care were published in indexed journals. Conclusion Orbis childhood blindness amelioration initiative in Nepal resulted in more than a million children examined, and >50,000 children underwent eye surgeries in the 8 pediatric eye care centres and the good service continued after the project was over. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement There was no specific funder for this work. It was done purely out of academic interest ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Permission was sought and obtained from the ethics committee of Nepal Netra Jyoti Sangh, Kathmandu, Nepal. Annual reports of Orbis International, India Country Office, Nepal Netra Jyoti Sangh and Tilganga Eye Institute were studied as were the project reports, quarterly reports and midterm and final evaluation reports. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable We have made available the data used for this manuscript in the form of an excel sheet