Dr Sirisha Senthil of LV Prasad Eye Institute is third Indian to deliver Noel Rice Lecture

New Delhi: Dr Sirisha Senthil, Head of the VST Centre for Glaucoma Care at L V Prasad Eye Institute (LVPEI), delivered the prestigious Noel Rice Lecture 2026 on “Shaping the Future of Paediatric Glaucoma: A Journey towards Personalisation and Hope!” Becoming only the third Indian to receive this honour since the lecture series was established in 2012, Dr Senthil highlighted the urgent need to move towards individualized, long-term care in paediatric glaucoma.

Dr Senthil, who has published over 179 scientific papers in leading peer-reviewed journals and authored several book chapters, addressed an audience of senior ophthalmologists and members of the UK Pediatric Glaucoma Society (UKPGS). The annual Noel Rice Lecture Series is regarded as one of the most influential platforms for sharing global advances in the management of congenital and paediatric glaucoma.

Reflecting on the evolution of care, Dr Senthil said that personalised medicine represents a fundamental shift away from rigid, algorithm-driven approaches toward treatment strategies tailored to each child. She emphasised that paediatric glaucoma can no longer be managed using a one-size-fits-all model, as every child presents a unique combination of genetic predisposition, ocular anatomy, disease behaviour, and social circumstances. According to her, the true goal of treatment in children extends beyond short-term intraocular pressure control to preserving vision over decades and enabling meaningful integration into society.

Drawing from her extensive clinical experience at LVPEI, Dr Senthil noted that years of caring for children across the full spectrum of paediatric glaucoma—from early primary disease to the most complex refractory cases—have exposed the limitations of uniform treatment pathways. She explained that closely analysing long-term outcomes from her own patients, including both successes and failures, has been critical in refining decision-making and advancing truly individualised care. She added that accurate diagnosis, critical appraisal of clinical choices, insights from research outcomes, and cumulative experience have collectively enabled clinicians to move beyond protocols. Importantly, she stressed that this work is rooted in a resource-constrained environment, making it essential that personalised care remains practical, equitable, and contextually relevant.

Addressing the challenges of delivering personalised care in India and similar settings, Dr Senthil pointed to late disease presentation, limited access to subspecialty services, and difficulties in maintaining long-term follow-up as major barriers. She explained that in such contexts, individualisation cannot depend solely on advanced technology or genetic testing. Instead, she advocated a tiered approach based on detailed clinical phenotyping and risk stratification, with selective integration of genetic insights when disease behaviour or treatment response deviates from expectations. Strengthening referral networks, leveraging tele-ophthalmology, and implementing LVPEI’s pyramidal model of care—covering referral, periodic follow-up, and rehabilitation—were highlighted as key strategies to bridge existing gaps.

Dr Senthil also spoke about the clinical and social complexities unique to paediatric glaucoma in India. She observed that many children present late, often with advanced disease or after one or more failed interventions. Management is further complicated by variable anterior segment anatomy, aggressive post-operative scarring, and the need for repeated examinations under anaesthesia. Beyond clinical factors, she underlined the significant impact of social realities, including long travel distances, financial constraints, and treatment fatigue among families, all of which directly influence outcomes and must be integrated into treatment planning.

Looking ahead, Dr Senthil expressed hope that the coming decade would be defined by earlier etiological diagnosis combined with more durable treatment strategies. She said that genotype-based risk assessment, together with safer and longer-lasting surgical or device-based interventions, could substantially reduce the number of procedures children undergo. For families, she noted, the most meaningful advances would be greater predictability, earlier recovery, smoother integration into mainstream schooling, and clearer expectations regarding long-term visual outcomes.

Highlighting the role of emerging technologies, Dr Senthil said genetic testing has transformed how clinicians understand disease mechanisms and counsel families. She explained that it allows practitioners to move beyond labelling disease to explaining prognosis, recurrence risk, and familial implications, particularly benefiting sibling screening and long-term surveillance. She added that AI-driven diagnostics offer significant promise in documentation, early detection, screening, referral, and disease monitoring, especially in regions with limited subspecialty access. However, she cautioned that these technologies must complement, not replace, clinical judgement and longitudinal patient care.

Discussing her focus on refractory paediatric glaucoma, Dr Senthil said it arose from caring for children in whom conventional surgical approaches had failed at a very young age. As a quaternary referral centre, LVPEI frequently manages the most complex cases, where standard algorithms offer limited guidance. She noted that such situations demand advanced technical expertise, careful sequencing of interventions, and long-term planning. While drainage implants can provide sustained intraocular pressure control in selected cases, she stressed the importance of considering long-term complications and the need for meticulous surgery and lifelong follow-up.

Concluding her lecture, Dr Senthil advised young ophthalmologists to embrace longitudinal thinking early in their careers. She said that paediatric glaucoma is not defined by a single surgery or clinic visit, but by care delivered over a lifetime. While technical skill is essential, she emphasised that patience, humility, continuity of care, and close engagement with families ultimately define meaningful success in paediatric glaucoma management.