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

Dr Sirisha Senthil, Head- VST Centre for Glaucoma Care, L V Prasad Eye Institute presented the Noel Rice Lecture 2026 on 'Shaping the Future of Paediatric Glaucoma: A Journey towards Personalisation and Hope!' She is the third Indian to be presented with this honor, since its establishment in 2012.  Dr Sirisha Senthil has published over 179 scientific papers in esteemed peer-reviewed journals and authored numerous enlightening book chapters.

The Noel Rice Lecture series is a prestigious annual event organized by the UK Pediatric Glaucoma Society (UKPGS). As part of the series, global experts are invited to share their insights/ research/advancements in the treatment of congenital and pediatric glaucoma. The Noel Rice Lecture is attended by leading ophthalmologists and members of the UKPGS.

Noel Rice was a medical director at Moorfields Eye Hospital, London and a pioneer in the development of microscope-assisted eye surgery and use of anti-scarring therapy in the form of a focal dose of beta radiation, a precursor to modern anti-scarring regimens.  He was one of the first corneal specialists in Europe and specialized in the care of children with congenital glaucoma.

1. How does personalized medicine transform pediatric glaucoma care?

Personalized medicine in paediatric glaucoma represents a fundamental shift away from rigid surgical algorithms toward individualized approach, severity based and response based long term care. Basically—No more ONE-SIZE-FITS ALL. Every child presents a unique combination of genetic predisposition, ocular anatomy/ phenotype, disease behavior, and social context. Recognizing and integrating these factors allows us to move beyond controlling intraocular pressure at a single time point, toward preserving vision over decades and integrating them into society, which is the true goal in children.

2. How does your work at LVPEI contribute to the global shift toward individualized glaucoma treatments highlighted in the Noel Rice Lecture 2026?

At LVPEI, my approach has been shaped by years of caring for children with pediatric glaucoma across the entire disease spectrum—from early primary glaucoma to the most complex, refractory cases. Seeing these children over time has made the limitations of uniform, algorithm-driven treatment pathways very clear. Carefully evaluating the outcomes of our own cases has been particularly instructive; each success and failure has helped refine our thinking and tailor management for the next child we see. Accurate diagnosis, critical appraisal of our clinical decisions, insights from research outcomes, and the perspective gained through experience have collectively allowed us to move beyond protocols and truly individualize care. Importantly, this work is rooted in a setting with resource constrains, reminding us that personalization must not only be precise, but also practical, equitable, and relevant to our patients.

3. What are the biggest hurdles in personalizing treatments for pediatric glaucoma in resource-limited settings like India, and how can they be overcome?

One of the greatest challenges I face are real-world constraints such as late presentation, limited access to specialist care, and difficulties in sustaining long-term follow-up. In these settings, personalization cannot depend solely on advanced technology or genetic testing. Instead, we adopt a tiered approach—based on detailed clinical phenotyping and risk stratification—while selectively integrating genetic information when available, or when disease behavior or treatment response deviates from what is expected. Strengthening referral networks, leveraging teleophthalmology, and implementing our pyramidal model of care for referral, periodic follow-up, and rehabilitation, alongside cost-effective digital solutions, have been central to bridging this gap.

4. What are common challenges in treating pediatric glaucoma in India?

In India, many children with paediatric glaucoma present late, often with advanced disease or after one or more unsuccessful interventions. Clinically, management is further complicated by highly variable anterior segment anatomy, an aggressive postoperative scarring response, and the frequent need for repeated examinations under anesthesia. Beyond these medical challenges, social realities play a significant role—families may need to travel long distances, cope with financial constraints, and endure treatment fatigue over years of care. These factors have a direct impact on outcomes and must be recognized as integral components of the treatment plan and will need to be addressed as well.

5. What breakthrough do you hope will define the next decade for families affected by childhood glaucoma?

What I hope to see over the next decade is combining earlier etiological diagnosis and more durable treatment strategies. Genotype-based risk assessment combined with safer, longer-lasting surgical or device-based interventions could significantly reduce the number of procedures a child undergoes. For families, the most meaningful breakthrough would be greater predictability, earlier recovery and integrating children into regular schools—however, clearer expectations about disease course and long-term visual outcomes and the variability in the treatment outcomes have to be clearly understood.

6. How do emerging research or technologies such as genetic testing or AI-driven diagnostics present hope in the treatment of paediatric glaucoma?

Genetic testing has transformed how I understand and counsel families—it allows us to move from labelling disease to explaining the why, what and how--- of both the prognosis, and risk of subsequent children being affected and familial risk of the condition. This is particularly powerful in screening siblings, family members, and guiding long-term surveillance. AI-driven diagnostics offer additional promise in documentation, early detection, screening and referral, monitoring progression, and supporting clinical decisions, especially in regions with limited subspecialty access. However, these tools must complement—but cannot replace—clinical judgment and longitudinal care.

7. What inspired your focus on refractory glaucoma and drainage implants?

My focus on refractory paediatric glaucoma arises from caring for children in whom conventional surgical approaches have failed, often at a very young age. As a quaternary referral center, we frequently receive the most complex and challenging cases, where standard algorithms offer limited guidance. These situations demand not only advanced technical expertise, but also strategic restraint, thoughtful sequencing of interventions, and long-term planning. When used judiciously, drainage implants provide a means of achieving sustained intraocular pressure control in complex eyes. Caring for these children has reinforced for me that true success in paediatric glaucoma lies in durability and vigilant long-term follow-up, rather than in immediate postoperative outcomes alone. It is also very important to understand that the long-term complications in these children with the intraocular devices have to be considered as well and care should be taken to emphasize not only meticulous surgery but regular and long-term follow-up.

8. What is your advice to young ophthalmologists, based on your journey so far?

Thorough evaluations including using advanced evaluation technologies, appropriate decision-making and management, and serving as a consistent point of contact for the family are central to effective pediatric glaucoma care. Providing long-term care is challenging, but it is also deeply rewarding. My advice to young ophthalmologists is to embrace longitudinal thinking early in their careers. Pediatric glaucoma is not defined by a single surgery or clinic visit—it unfolds over a lifetime. Invest time in understanding disease biology, learning from long-term outcomes, and listening carefully to families. Technical skill is essential, but in pediatric glaucoma, patience, humility, and continuity of care ultimately define meaningful success.