Look at those big, beautiful eyes! This is baby Aarsh, from a small village just outside Moradabad city, in Uttar Pradesh, India. At seven months old, he weighs about seven pounds – what many babies weigh at birth.

Aarsh’s mother, Shabana, was only seven months pregnant when she delivered him prematurely. Little Aarsh had been in an incubator in the neonatal intensive care unit (NICU) at their nearby hospital for 15 days when his parents learned that he needed to have his eyes screened for Retinopathy of Prematurity, or ROP.

ROP is one of the leading causes of vision loss in children, and preterm infants are at high risk of developing this blinding condition. ROP occurs when abnormal blood vessels grow and spread throughout the retina, the tissue that lines the back of the eye. These abnormal blood vessels are fragile and can leak, which can scar the retina and pull it out of position. This causes a retinal detachment and visual impairment.

To save a child’s sight, early detection and treatment of ROP are critical. Unfortunately, many infants go undiagnosed due to the lack of awareness of ROP and the lack of screening services available outside of tertiary-level hospitals. That’s why we are working with partners like C.L. Gupta Eye Institute (CLGEI), located in Moradabad city, to provide remote diagnosis and referral services for at-risk infants and their families. With a case of specialized teleophthalmology equipment and pediatric supplies in hand, optometrists from CLGEI regularly visit 40 NICUs and maternity centres across the Moradabad District, where they capture retinal images of premature infants with assistance from nursing staff who help keep the wriggly babies calm and still.

When Aarsh’s parents first learned their baby could have ROP, they were fearful of the treatment process, and they refused to have Aarsh screened in the NICU. Fortunately, the team at CLGEI are known for their compassion and persistence. After continuous follow-up phone calls and messages from the ROP Coordinator, Aarsh’s parents agreed to bring the little boy, then six weeks old, to CLGEI for screening.

Aarsh’s retinal images revealed that he had ROP in both eyes and required urgent treatment to prevent blindness. First, his eyes would be injected with a drug that inhibits abnormal blood vessel growth, then, at a later appointment, he would receive laser treatment.

Shabana couldn’t help but get emotional she when she heard Aarsh’s little cries from the next room as the doctor did the injections. She knew that timely treatment was necessary to save her son’s sight, but still the tears streamed down her face. Her little one wasn’t even two months old, and he’d already been through so much.

Following the injections, Aarsh’s eyes were covered with bandages, and they were sent home that same day with eye drops and a list of post-procedure instructions. No doubt, the experience was a lot for Aarsh’s parents to take in, worrying about their newborn baby who required special care while also tending to their other children; but they took comfort in knowing that the pediatric staff at CLGEI were available to help them every step of the way.

Later that week, Aarsh received laser treatment. The procedure, which is done with local anesthetic, uses a beam of light to create scar tissue on the outer edges of the baby’s retina, which prevents abnormal blood vessels from forming.

Aarsh’s family went for several follow-up visits. His parents were diligent about making and keeping their appointments, even though it meant that his father, Ajmat, had to close his shop so they could travel to the hospital, which meant a loss of income. They were thankful that Aarsh’s treatment was provided free of charge. They were also grateful to the CLGEI staff who checked in with them and sent them reminders.

Today, Aarsh is doing great, and his vision is good. His mother, who is also happy and in good health, says that Aarsh even watches cartoons on the television like his big brother and sister.

“Little Aarsh's journey is a testament to the transformative power of our ROP screening program. Through the dedication of our team and the support of generous donors, we're not just preventing blindness; we're nurturing futures," says Lokesh Chauhan, Deputy General Manager at CLGEI.

“Aarsh's bright eyes now reflect a world of possibilities, and his story motivates us to continue our mission of bringing vision and hope to every child in need."

Aarsh will require lifelong follow-up visits. Doctors have stressed to his parents the importance of regular eye exams, as infants with ROP are at higher risk for developing other eye problems later in life, such as myopia (nearsightedness), strabismus (crossed eyes), amblyopia (lazy eye) and glaucoma. In many cases, these eye problems can be treated or controlled.

Thanks to the generosity of our donors, the diligence of Aarsh’s parents, and the expertise of the staff at CLGEI, little Aarsh has a big future ahead of him.

Please donate today to help more infants like Aarsh.

Dr. Ashi Khurana, Vice-Chairman, C.L. Gupta Eye Institute is a cornea specialist and manages the Retinopathy of Prematurity Eradication Project. The project screens premature infants in Moradabad and five surrounding districts for Retinopathy of Prematurity (ROP), which can cause irreversible blindness if left untreated.

World Prematurity Day: Dr. Ashi Khurana, Vice-Chairman, C.L. Gupta Eye Institute on preventing blindness in premature babies

An eye condition that is all but invisible to parents, pediatricians and the community can silently rob premature and low-weight infants of their sight. The condition must be treated early or the infant can go blind, not as a baby, but years later as a child. The condition is called Retinopathy of Prematurity (ROP), and in 2016, it became all too visible to eye doctors at C. L. Gupta Eye Institute.

Dr. Khurana remembers a doctor coming to her and being “very concerned as they found that a lot of children were coming in and had gone blind due to ROP.” It was a major problem that no other organization was addressing. ROP can be treated but it requires screening, diagnosis and urgent treatment that can include injections and laser eye surgery.

However, there was no widespread public health initiative to address ROP. Dr. Khurana and her team saw the shadow that blindness from ROP caused on children, their families, the health care system and society. Though a small number of babies develop ROP and lose their sight, “there is a huge impact on the life of that child and their family because someone, often the mother, becomes the caregiver.” There is a direct impact on the mental, physical and financial resources in a family, she says. Later treatment is also often complex, intensive and has poor outcomes. “It is very frustrating as a doctor,” says Dr. Khurana, “when there is not much you can do for a condition that could have been prevented.”

Conditions impacting premature infants, such as ROP, are on the rise

Premature births are a global issue. The World Health Organization data from 2020 estimates that 13.4 million babies, or one in 10, were born premature.

India has the highest prevalence of premature births in the world. Data from the Lancet found that three million premature babies were born in India in 2020.

The emergence of local NICUs has greatly increased the survival rate of premature infants. This has led to a shift from survival to quality of life by addressing the complications of prematurity. “ROP is a modern disease as more babies survive due to high quality NICUs,” Dr. Khurana says.

Conditions of Premature Infants on the Rise

To address the growing need and fill the gap in service, Dr. Khurana and her team launched an ROP screening program in Moradabad, Uttar Pradesh, India. Initially it was a pilot and then it expanded to include a partnership with Operation Eyesight Universal and was called the Retinopathy of Prematurity Eradication Project.  

On a mission to raise awareness and start screening for ROP

At that time, Dr. Khurana remembers that C. L. Gupta Eye Institute was not getting a lot of referrals from pediatricians to screen the eyes of premature infants for ROP. She knew that they needed to start an awareness campaign to educate doctors and pediatricians about ROP and the need to screen. “It should just happen, like a vaccine,” Dr. Khurana says.

The team started knocking on doors and going into NICUs to talk to not only doctors but also NICU managers and nurses, who are often the ones responsible for requesting ROP screenings.

Screening requires specialists and equipment often found in an eye hospital. As premature infants cannot travel and spend their first few weeks in emerging NICUs, the screening needs to take place there. However, many of the infants are fighting for their lives. “They have a lot of complications and there is a lot of priorities for doctors and stress for families,” Dr. Khurana says. “And then with all that, this issue of blindness comes up.”

There are also a limited number of eye doctors, and it can be challenging for them to travel to multiple NICUs to screen premature infants “who may or may not have an eye problem.”

An ambitious screening goal

The initial goal was to screen 500 children “which was huge,” Dr, Khurana says. To achieve this they sent optometrists to screen premature infants for ROP regularly at 40 local NICUs. Infants with ROP were referred to C. L. Gupta Eye Institute for urgent treatment.

In the first phase, the team screened 464 premature infants and saved 50 children from blindness. “It has been very satisfying for our doctors,” Dr. Khurana says.

In addition to raising awareness among medical staff, Dr. Khurana’s team started to educate the community as well. Not all parents are able to understand why screening and treatment are needed. There can be literacy and poverty issues that need to be addressed and at times, parents may deny treatment. Gender can be a factor as can birth order, if there are many children in the family.

People who can pay do, those who can pay part of the cost contribute what they can and those who cannot pay are supported by Operation Eyesight Universal. In this way, “everyone receives care and treatment.”

The second phase of the project launched on July 16, 2024, expanding beyond Moradabad to Sambhal, Bijnor, Amroha, Rampur and Baduan. Reaching these semi-urban areas was possible due to a mobile van with the required equipment, made possible through the Rotary Foundation, for onsite screening and treatment in rural and underserved areas, a tele-ophthalmology platform that allows experts to provide remote consultations, diagnoses, and treatment recommendations, an expanded network of neo-natal intensive care units in the five new regions and continued medical education to raise awareness of ROP, capacity and skills of NICU staff in the additional districts.

In December 2024, the Retinopathy of Prematurity Eradication Project ends. Services will be maintained with C. L. Gupta Eye Institute, a non-profit, covering costs for those who cannot pay, and working with NICUs.

ROP is a modern disease that requires resources

ROP is being studied and the ROP Society of India is looking at the impact of the condition on the country. As more NICUs emerge and more premature infants survive, ROP is appearing more frequently.   

Now, Dr. Khurana and her team are working to raise awareness of ROP in the community, among parents and with medical professionals. What is needed is more resources, public health support and training for doctors.  

For now, her team is small but dedicated. “It is satisfying for us to make a difference in the lives of these children and families,” she says.  

For the premature infants and their families in and around Moradabad, there is hope of a bright future. 

See how this this project works in the video Born Too Soon: Retinopathy of Prematurity Project, Moradabad, India.

Read about how this project transformed the life of Baby Aarsh and his family.

“There would be no life without eyesight,” says Vinit, the proud father of twin girls, Ayan and Vyan.  

Last summer, Vinit and his wife Anchal learned that their baby girls were born with Retinopathy of Prematurity (ROP). Together, the family has faced a challenging journey, witnessing the incredible growth and resilience of their precious daughters.  

ROP is a serious eye condition that affects premature and low-birthweight infants and is the primary cause of childhood blindness in this demographic. Vinit and Anchal know just how frightening ROP can be. 

In June 2022, during her seventh month of pregnancy, Anchal gave birth to twin girls in Moradabad, India. Both babies weighed just three pounds and were breathing rapidly. They were rushed and admitted to the Neonatal Intensive Care Unit (NICU) to receive treatment for lung infections.  

While in the NICU, the doctor treating the girls recommended that they both undergo screening for ROP at the C.L. Gupta Eye Institute, our partner hospital in Moradabad. Following the screening, both girls were diagnosed with severe cases of ROP. 

Vinit and Anchal had never heard of ROP before, nor did they have any idea how severe the condition can be. They feared their children wouldn’t be able to see. After the girls’ diagnoses, the doctor guided Vinit and Anchal through the screening process and showed them images of their daughters’ conditions. 

There are five stages of ROP and treatment no longer works in the last two stages, ultimately resulting in childhood blindness. However, if identified and screened within one month of pre-term birth, ROP in stage three is completely treatable. This is why early detection is critical. 

From the outside, nothing appeared wrong. However, when Vinit looked at the screens, he saw the severity of ROP. Both Ayan's and Vyan's screens showed blood leaking inside their eyes. The doctor explained to the parents that if the girls didn’t receive timely treatment, they would have further complications and possibly lose their vision.  

At just five weeks old, both babies received treatment at the C.L. Gupta Eye Institute. They underwent injections in both eyes, followed by laser treatment later on. Now, Vinit and Anchal take their daughters for regular monthly checkups at the hospital. 

Thanks to the generosity of our donors and the early diagnosis and treatment provided by local doctors, both girls have fully recovered and are thriving today. 

Vinit and Anchal are grateful to Operation Eyesight and the C.L. Gupta Eye Institute. "Every parent hopes the best for their baby and that they are well and grow properly," explains Vinit. "The hospital has made things very easy. Otherwise, there would be no life without eyesight." 

We began addressing ROP three years ago in the Moradabad District of the state of Uttar Pradesh, India. A local team now regularly visits 40 maternity centres in the area to examine preterm newborns, and the screening programs are working.  

As of June 2023, the program, known as “Born Too Soon”, has screened 253 premature babies, of which 49 were diagnosed with ROP and provided treatment. That is 49 infants who have had their sight preserved thanks to early intervention.  

You can help expand our Born Too Soon program and ensure more families like Vinit's experience a life free of avoidable blindness.

Please donate today.