Global Recognition for an Indian Glaucoma Expert
Dr. Sirisha Senthil, Head of the VST Centre for Glaucoma Care at L V Prasad Eye Institute (LVPEI), delivered the Noel Rice Lecture 2026 on “Shaping the Future of Paediatric Glaucoma: A Journey towards Personalisation and Hope!” With this honour, she became only the third Indian to present the lecture since its inception in 2012.
In addition to this distinction, Dr. Senthil has made outstanding academic contributions, having published over 179 scientific papers in leading peer-reviewed journals and authored several influential book chapters.
About the Noel Rice Lecture Series
The UK Pediatric Glaucoma Society (UKPGS) organises the Noel Rice Lecture as a prestigious annual academic event. Each year, the society invites global experts to share insights, research, and advancements in the management of congenital and paediatric glaucoma. Consequently, the lecture draws leading ophthalmologists and UKPGS members from across the world.
Legacy of Noel Rice
The lecture series honours Noel Rice, former Medical Director at Moorfields Eye Hospital, London. A pioneer in microscope-assisted eye surgery, he also introduced anti-scarring therapy using focal beta radiation—an important precursor to modern anti-scarring regimens. Moreover, he was among the first corneal specialists in Europe and devoted much of his career to the care of children with congenital glaucoma.
Personalised Medicine: Redefining Paediatric Glaucoma Care
According to Dr. Senthil, personalised medicine marks a fundamental shift in paediatric glaucoma care. Instead of rigid surgical algorithms, clinicians now adopt individualised, severity-based, and response-driven long-term strategies. In essence, the era of “one-size-fits-all” treatment is over.
Each child presents a unique mix of genetic predisposition, ocular anatomy, disease behaviour, and social context. By integrating these factors, clinicians can move beyond short-term intraocular pressure control and instead focus on preserving vision over decades and enabling children to integrate fully into society—the true goal of paediatric care.
LVPEI’s Role in Advancing Individualised Care
At LVPEI, Dr. Senthil’s approach has evolved through years of managing children across the entire spectrum of paediatric glaucoma—from early primary disease to the most complex, refractory cases. Over time, these experiences have clearly exposed the limitations of uniform, algorithm-driven care.
By critically evaluating outcomes—both successes and failures—the team has continuously refined its clinical decision-making. Accurate diagnosis, outcome-driven research insights, and cumulative clinical experience have collectively enabled a move beyond protocols toward truly individualised care. Importantly, this work unfolds in a resource-constrained setting, reinforcing that personalisation must remain practical, equitable, and relevant.
Barriers to Personalisation in Resource-Limited Settings
However, personalising care in countries like India presents significant challenges. Late presentation, limited access to specialists, and difficulty maintaining long-term follow-up often hinder optimal outcomes. In such settings, personalisation cannot rely solely on advanced technologies or genetic testing.
Instead, Dr. Senthil advocates a tiered approach based on detailed clinical phenotyping and risk stratification. Genetic testing is selectively integrated when available or when disease behaviour deviates from expectations. Strengthening referral networks, leveraging teleophthalmology, and implementing LVPEI’s pyramidal model of care—covering referral, follow-up, and rehabilitation—have played a key role in bridging these gaps.
Clinical and Social Challenges in India
In India, many children with paediatric glaucoma present late, often with advanced disease or after failed interventions. Clinically, highly variable anterior segment anatomy, aggressive postoperative scarring, and the need for repeated examinations under anaesthesia further complicate management.
Beyond medical factors, social realities significantly influence outcomes. Families frequently travel long distances, face financial constraints, and experience treatment fatigue over years of care. Recognising and addressing these social determinants remains essential to successful long-term management.
Looking Ahead: Hopes for the Next Decade
Looking to the future, Dr. Senthil hopes to see earlier etiological diagnosis combined with more durable treatment strategies. Genotype-based risk assessment, paired with safer and longer-lasting surgical or device-based interventions, could significantly reduce the number of procedures a child must undergo.
For families, the most meaningful breakthroughs would include greater predictability, earlier recovery, and smoother integration of children into mainstream schooling. At the same time, clinicians must clearly communicate expectations around disease course and long-term visual outcomes.
Promise of Genetics and Artificial Intelligence
Emerging technologies continue to offer hope. Genetic testing has transformed how clinicians counsel families by explaining not just the diagnosis, but also prognosis, familial risk, and the likelihood of future children being affected. This knowledge enables targeted screening of siblings and long-term surveillance.
Meanwhile, AI-driven diagnostics show promise in documentation, early detection, screening, referral, and monitoring disease progression—especially in regions with limited subspecialty access. Nevertheless, Dr. Senthil emphasises that these tools must support, not replace, clinical judgment and longitudinal care.
Focus on Refractory Glaucoma and Drainage Implants
As per the press release, Dr. Senthil’s focus on refractory paediatric glaucoma stems from caring for children in whom conventional surgeries have failed, often at a very young age. As a quaternary referral centre, LVPEI manages the most complex cases, where standard algorithms offer little guidance.
In such situations, clinicians must combine advanced technical expertise with strategic restraint and long-term planning. When used judiciously, drainage implants can provide sustained intraocular pressure control. However, long-term complications demand meticulous surgery and rigorous, lifelong follow-up.
Advice for the Next Generation of Ophthalmologists
Drawing from her journey, Dr. Senthil advises young ophthalmologists to prioritise thorough evaluation, sound decision-making, and continuity of care. Serving as a consistent point of contact for families remains central to effective paediatric glaucoma management.
Although long-term care can be demanding, it is also deeply rewarding. Paediatric glaucoma, she stresses, does not revolve around a single surgery or clinic visit—it unfolds over a lifetime. Ultimately, while technical skill matters, patience, humility, and sustained engagement define true success.