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ISSUE 4 | VOLUME 5 | 22nd August 2016


Welcome to the fourth WSPOS newsletter of 2016.


We are well advanced in our preparations for the WSPOS Paediatric Subspecialty Day on Friday 9 September, 2016. This will precede the XXXIV Congress of the European Society of Cataract & Refractive Surgeons (ESCRS) which takes place from 10 – 14 September, 2016 at the Bella Center, Copenhagen, Denmark.  

Further information on this meeting and all of our activities are available on our website, www.wspos.org. We will also be providing regular updates in future newsletters.

We would like to present the second edition of our Country in Focus series, where we focus on Paediatric Ophthalmology practised in different countries around the world.

This newsletter also contains the 2nd case of our Global Case Report Quiz. Here we have case reports from around the world in the form of a survey. Each of these cases will be stored on the education part of the website.


As well as preparing for our own meetings, we are busy spreading the WSPOS message around the world by attending international meetings including 2 recent Symposia at the APACRS meeting held in Bali, Indonesia


We are extremely happy to announce that Cameroon & Croatia have joined us at WSPOS.


We would like to thank you again for your support of WSPOS. If you have any news that you would like included in our next newsletter, please contact us.



Dr. Daisy Godts

Dr. Dominique

Dr. Lotte Welinder





Chief Orthoptist, Antwerp University Hospital, Department of Ophthalmology, Edegem


Professor of Ophthalmology, Head of Ophthalmology Department with Paediatric Subspecialty at University Necker-Enfants Malades Hospital and Paris V Rene Descartes University in Paris, Head of CLAIROP Research, Clinical Center of Ophthalmology Rare Disease Center and of Paris V Orthoptic Department


Consultant paediatric Ophthalmologist, Department of Ophthalmology, Aalborg University Hospital, Aalborg, Denmark and Institute of Vision and Hearing, Region of Northern Jutland, Aalborg




We would like to welcome Deirdre Canning as our new WSPOS Project Manager at Agenda Communications. Deirdre has taken over from Lorraine O'Hagen who we wish the very best in her new career. Please direct any communication to Deirdre at deirdre.canning@wspos.org





Population: 11.267.910 (January 2016).
Live births per year:  122.300 (2015).
Percentage of population under 15 years: 15.6%.
Ethnicity: Belgians - 77%, Non-Belgians (French, Dutch, Poles, Moroccans, Italians, Turks, etc.) make up the remaining 33%. 
Language: Official languages are Dutch (59%), French (40%), German (<1%).
Other languages spoken are Polish, Turkish, Moroccan, Portuguese, Congolese, Spanish, Indian, Greek, Algerian, Syrian, Vietnamese, Chinese, etc.
Life expectancy at birth: Men - 78.6 years, Women - 83.5 years, Total - 81.1 years.


Healthcare system
Type: The Belgium healthcare system is divided into state and private sectors, with fees payable in both, funded by a combination of social security contributions and health insurance funds.
With mandatory health insurance, patients are free to choose their own medical professionals and places of treatment.
Patients generally pay costs upfront and are reimbursed a portion of the charges for medical and dental fees, hospital care and treatment, maternity costs and prescriptions through their health insurance fund (mutuelle / ziekenfonds).
Some alternative treatments are also reimbursable if carried out by a qualified doctor.
Many people top up their cover with private insurance to get a full refund of all medical costs.
Cost to patient to see a primary care doctor/general practitioner:
25 Euros (patient pays four to six Euros himself).
Cost to patient of squint surgery under general anesthesia:
Between 300 Euros (first operation) and 750 Euros (reoperation) per eye (patient pays nothing for the operation if he doesn’t ask for a private room and if he has public health insurance), the hospital costs will be around 85 Euros.


Paediatric ophthalmology 
Around 25 paediatric ophthalmologists (not a recognized subspecialty).


Major successes
1) Reopening of Orthoptic education in Liege, Wallonia in September 2016 (in French)
2) Screening program for amblyopia, strabismus and refractive errors


a) Screening of babies

  • In Flanders : at age 12-15 months, 24-30 months (since 2013)
  • In Wallonia : once between 18 and 47 months

b) Screening when children go to Kindergarten (more than 50 years already)

  • In Flanders in first (3 years) and second year (4 years) of kindergarten
  • In Wallonia in first (3 years) and third year (5 years) of kindergarten

c) Screening when children go to primary school

  • In Flanders in first (6 years) third (9 years) and fifth year (11 years) of primary school
  • In Wallonia in second (7 years), fourth (10 years) and sixth year (12 years) of primary school

d) Screening when children go to secondary school

  • In Flanders in first (13 years) and third year (15 years) of secondary school
  • In Wallonia in second (14 years), fourth (16 years) and sixth year (18 years) of secondary school

Major challenges
After closing the Orthoptic education in 2011 in Flanders (in Dutch) it was very difficult to start a new program again.
There are increasing numbers of elderly strabismus patients and patients with binocular vision problems.
There is a strong optometry association (±5000 optometrists) with only 75 working orthoptists and ± 1000 ophthalmologists.




Demographics Denmark is a small country of 5.7 million citizens of which 0.98 million are under the age of 15. The birth rate is 1.73 and the expected live expectancy is 80 years. Danish is the official language. 93 per cent of the population has a Western European background.


Healthcare system
Almost all paediatric health care is tax funded. It is free to see a paediatric ophthalmologist and all surgeries are free. A growing number of adults have additional private insurances. The ophthalmologists are either in public funded private practices (50% of ophthalmologists) and the rest in public hospitals. Only a small portion work solely in private set ups. Denmark has a well-developed vision screening program by school nurses and general practitioners from 5 weeks to 8 years.


The biggest advantage of our system is free care for all. The majority of paediatric cases are managed in practice. The most common diagnosis here being refractive errors (mainly hypermetropia- myopia in children is not a big problem) and amblyopia. In Denmark children under the age of 10 have to have an ophthalmological examination in order to have glasses prescribed as only ophthalmologists are allowed to use cycloplegic drops. The rest of the children are seen in tertiary settings in ophthalmological departments, in close collaboration with paediatric departments. In hospitals there are less than 20 fulltime paediatric ophthalmologists with a mixture of medical paediatric ophthalmology and strabismus. Surgical treatment of paediatric cataract, glaucoma, retinoblastoma, ROP, etc. is centralized to 1-2 centres where 2 or 3 “adult” specialists in cataract, glaucoma, tumours, vitreoretinal surgery have subspecialized in paediatric surgery. Follow up is mainly by paediatric ophthalmologists. So in Denmark, a paediatric ophthalmologist might perform strabismus surgery but is otherwise not a surgeon. This system works well as the surgical case load is low and the centralization provides a sufficient number of cases in the hands of experienced full time surgeons.  This system secures cheaper but also less specialized care for the easier cases (glasses and amblyopia not being centralized). Denmark has less than 15 orthoptists, all educated abroad.

Major challenges
The major challenge is the cost, growing expectations and possibilities and growing inequality in health. Even in this very homogenic population there are great differences in life expectancy depending on where you live. Also there is an increasing population of senior citizens with high life expectancy and thus gradually fewer tax-payers. But admittedly in a worldwide perspective our major problems are minor.




Population: 66.3 million with 2.1 million in Overseas departments (January 2015).
Live births per year:  820 000 births per year for 556 000 deaths per year (2015).
Percentage of population under 15 years: 18.66% (2015).
Ethnicity: French (91.1%). 
Language: French.

Other Language: Arabic, Portuguese, Spanish, and Chinese.
Life expectancy at birth: Men: 79 years; Women: 85 years. (One year in 20 years' women life expectancy).


Healthcare system
Type : The French healthcare system named Social Security (SS) is substantial health cover for all workers including persons assisted with a welfare system. Patients are free to choose their physician and paramedic practitioner usually within the region. In public Hospitals, consultation costs are 2/3 covered and surgery costs are fully covered by SS except private practitioner costs. In private clinics or medical office, patient pays and is reimbursed later by SS and private insurance (if subscribed). Patient can choose a practitioner with medical costs similar to public cost or practitioner with free honorarium. Private insurance subscribed by the employer or the patient, covers extra costs.
Cost to patient to see a primary care doctor/ general practitioner : 25 euros (7.5 euros is covered by private insurance subscribed or is to be paid by the patient). However many practitioners have more expensive costs that must be paid by the patient or a good private insurance.
Cost to patient of squint surgery under general anesthesia : In public set-ups, the cost is 1200 euros including outdoor surgery costs. These costs are covered by Social Security. Patients have to pay 25 euros for every day that they spend at the hospital. If they have private insurance, the insurance company reimburses them. In private practice, extra costs may be applicable & might be partially or completely covered by private insurance.


Paediatric ophthalmology :
Around 150 paediatric ophthalmologists and strabismus specialists (for 5500 ophthalmologists in France) with two national societies included in the French Ophthalmologic Society.


Major successes :
1. Fourteen University Orthoptic Departments located in all territory with doubled number of students in 10 years. Around 3500 orthoptists are practicing in France.
2. Visual screening by paediatricians, general practitioners or maternal and children protection at two months old, four months old, nine months old and 24 months old. Visual screening at kinder garden when children are 3 or 4 years old.
3. Rare Diseases Centres accredited by French Health Ministry. Six Centres are dedicated to ophthalmologic rare diseases.
4. Optometry not recognized as a visual paramedic profession.
5. Genetic research and innovative healthcare institute “Imagine” at Paris Necker specialized in rare diseases with ocular research component.

Major challenges
1. Visual screening must be improved.
2. Coordination of paediatric ophthalmologists must be improved.
3. Training programs for paediatric ophthalmologists has to be individualized.
4. Low general ophthalmologists and even more paediatric ophthalmologist to population ratio.
5. Extend orthoptists implantation for all the territory to improve visual screening in children



Dr. Monica Samant, from the Laxmi Eye Institute, in Mumbai, India, has kindly sent on the second case presentation. This case is about a 24-day old male child presented to the clinic with the parents complaining of a large left eye since birth.

We would like our members to select one of the options present at the end of the quiz. Please complete the survey and send it to us no later than the 15th of September, 2016.


We will compile the responses we receive and include them along with the opinion of a few experts in an eblast to all our members soon.


Click here to view Global Case Report Quiz


We have also compiled our members’ responses received for the first case of our series. As promised we are even providing five Experts’ Opinions for the same.

Click here to view




WSPOS had 2 sessions at the 29th Annual Meeting of the Asia-Pacific Association of Cataract and Refractive Surgeons’ 


Click here to view the programme







Friday, 9 September 2016, in Bella Center, Copenhagen, Denmark.
Preceding the XXXIV Congress of the ESCRS, from 10-14 September 2016.

Click here to view more details



We have received a list of member society meeting updates which are now listed on our website.

Click here to view



Both Cameroon & Croatia have joined us at WSPOS as Chapters with web hosting by us. 


Cameroon details

Croatia details




WSPOS has held three educational meetings since 2009 : WCPOS I held at Barcelona in 2009, WCPOS II held at Milan in 2012 and WCPOS III held at Barcelona in 2015.
Our meetings have had a combined attendance of 3536 delegates (970 from 90 countries at WCPOS I, 1330 from 105 countries at WCPOS II & 1236 from 91 countries at WCPOS III); thereby making WCPOS successively the most attended paediatric ophthalmology and strabismus meetings in the world.

WCPOS III was awarded 18 EACCME CME Credits.

The WCPOS III scientific programme offered delegates a wide spectrum of topics including Strabismus workshops mentored by the likes of E. Campos from Italy, L. Dagi from USA, J. Hancox from UK, R. Hertle from USA, J. Holmes from USA, R. Kekunnaya from India, L. Kowal from Australia, C. Murillo-Correa from Mexico, E. Wilson from USA & F. Velez form USA. The Workshop was chaired by J. Ferris from UK, M. Goldchmit from BRAZIL & D. Granet from USA.

In addition to sessions like Free Papers, Forget me nots, Wetlabs, JAMs, Controversies; WCPOS III also had a Joint session of the WSPOS & the ICOI.

Among the highlights of WCPOS III, was the Kanski Medal lecture; an award for those whose work has improved the lives of children with ocular disease. Dr. Helen Mintz-Hintner was the first Kanski medallist because of her work with anti-VEGF agents in the prevention of retinopathy of prematurity.

WCPOS also featured Oscars for its video competition and a non-accidental injury Mock Trial, where two paediatric ophthalmologists took opposing sides in the case and discussed it as if they were actually in a court of law.

Here are some snapshots of WCPOS III, Barcelona, 2015.


A Clinical Algorithm for treatment of Infantile Nystagmus Syndrome
ADS Session : Nystagmus Surgery
R. Hertle (MD., FAAO., FACS., FAAP.)
Chief of Pediatric Ophthalmology, Director at Children’s Vision
Center, Akron Children’s Hospital, Professor of Department of Surgery,
College of Medicine, Northeast Ohio Medical College, Ohio, USA


Anti-VEGF for Retinopathy of Prematurity : Better Outcomes
Kanski Medal session
H. Mintz-Hittner (MD., FACS.)
Pediatric Ophthalmologist, Memorial Hermann, Houston, Texas, USA



Strabismus Workshop with mentors from all over the world.
Clockwise from Top left: R. Kekunnaya, India & J. Holmes, USA;
E. Campos, Italy; R. Hertle, USA; M. Goldchmit, Brazil.




Click here to view the programme schedule


You can also view interviews of a few WCPOS III speakers conducted by Dr. David B Granet; kindly sponsored by the University of California, San Diego, USA. 
Click here for more






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