Optometry and v 2020 Global

8/13/2019 Optometry and v 2020 Global

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Kovin Naidoo

ICEE Africa DirectorAFCO Vice-President

Optometry as part of Vision

2020: global perspective


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Global Initiative to Eliminate Avoidable

Blindness by the Year 2020

World Health Organisation- IAPB


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Present estimation:

45 million people blind

+ 135 million visually disabled

Present situation

LowVision

Blind< 6/18 - 3/60


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World Prevalence of

Blindness

0.4 - 0.6 0.6 - 1 > 1%< 0.4%Prevalences:


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Prevalence of Blindness

90%+ live in

underprivileged

communities


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The blindness rate in many developing

countries, especially in Africa, is 7 times

higher, at 1.4%, than in developedcountries


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Global Distribution of Blindness by

Cause

Cataract

42 %

Trachoma

15 %

Glaucoma

14%

Oncho.

1 %

Other

28 %Macular degeneration

Diabetic retinopathy

+Refractive errors

(uncorrected)


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Present situation

80% of blindness is avoidable

preventable

or

curable


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Leading Causes

of Preventable Blindness:

Cataract

Trachoma Onchoceriasis

Childhood Blindness Refractive Error

& Low Vision


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VISION 2020

Vision 2020 will strive to make refractive services

and corrective spectacles affordable and available

to the majority of the population through primary

health care facilities, vision screening in schools

and low-cost production of spectacles. Similar

strategies will be adopted to provide low visionservices.


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Global estimates

Magnitude of refractive errors not reliably

known

Large global variation in prevalence (by age,gender, and race)

Estimated: 2.3 billion people have refractive

error

1.8 billion have access to refractive services

500 million do not have access to services


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Sth Africa1.0% RE:10%

Cook, 1992 (n=268)

China4.4% Due to RE:10%

Shaozhen Li, 1999 (n=5342)

Australia0.15% Due to RE:25%

Taylor, 1997 (n=3268)

India2.5% Due to RE:9.6%

Dandona, 1998 (n=2522)

Saudi Arabia

0.7% RE: 5.3%

Al Faran, 1993 (n=2882)

10%+ ofWorld

Blindness

Blindness Due To Uncorrected

Refractive Errors (


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Difficulties with Current Data

Non-uniform definitions across studies Non-representative study populations

(convenience rather than population-

based)

Dissimilar demographics of study

population (age and sex)

Refraction procedures are different

(with/without cycloplegia etc)

Negrel, Ellw ein, 2001


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Uncorrected refractive error

is the major cause of:blindness following mass

cataract surgery using

standard power IOL


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Myopia with Autorefraction:

Country Comparison

Myopia with Autorefraction

4

7.3

21.6

5.6

7.4

1.2

0

5

10

15

20

25

SA Chile China Hyd Delhi Nepal

Countries

Percentage

Series1


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Low Vision

35m people worldwide have irreversiblevision loss and are in need of low visioncare.

*WHO Global Initiative: Vision 2020, Feb 1999

VISION 2020will enable access to

visual devices & low vision care at

affordable cost

Treatment:Low vision care & visioncorrection


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components

Disease control through service delivery

Human resource development

Infrastructure and technology


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Optometry a late entrant

It is only recently that uncorrected

refractive error and even more recently

low vision has achieved prominence Landmark population-based studies in

adults, children and in post-cataract

patients.


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Optometry and Public Health

Mainly private

practice

Limited discourseabout public sector

initiatives

Individual

Optometrists andgroupings efforts


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Public Health Challenges

Integration of professions

Expansion of the scope of Optometry

Consolidation of the scope of Optometry

Charity vs Public Health

Health Policy

Health Systems development and Management

Health Promotion


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Opportunity for Optometry

The realisation of the impact of

uncorrected refractive error and Low

Vision has provided the opportunity foroptometry to play a major part in

alleviating vision loss for those most in

need.


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Refractive Error and Vision

2020

WHO established a Refractive Error

Working Group (REWG), as

The REWG is now developing

international strategic plans and policies

to eliminate uncorrected refractive error.


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Definitions

Children:

-Myopia: < 0.5D

-Hyperopia: 2D


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Refractive error in Children

-Binocular vision


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Refractive exams

Children:

Exams should be carried out only by eyecare

personnel(ECP) with the appropriate skills in objective and

subjective refraction, ocular motility, basic eye examination,

ability to detect potenially blinding diseases andcommunication skills.


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Minimum Standards for

Children

-Retinoscopy plus subjective refraction,

with cycloplegia for young children as

needed. -Autorefractometry plus subjective

refraction with cycloplegia


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Refractive Correction: Priority

-High Priority: < 6/18

-Moderate Priority:


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Priority Groups

Children aged 11-15 with myopia and

people over the age of 45 years who require

spectacles for near vision


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Not Restricted to Refraction

Integrated into the eye team and blindnessprevention

Teaching eye care personnel, especially in refractionand low vision care

Providing screening and vision care services atsecondary and tertiary levels

Detection and management of potentially;blindingdiseases such as cataract, diabetes and glaucoma

Research into the understanding of global eyecareneeds and solutions,especially in vision correctionand vision care service delivery

Building models of self-sustainable eyecare.


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What is Needed?

Developed countries: optometrist to

population ratio is 1:10,000.

Developing countries the ratio is1:600,000, and much worse in many

rural areas, up to millions of people per

optometrist.


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What is needed?

Increase in the number of eyecare personnel

trained in refraction and vision correction.

Training mid-level personnel in refractivecare.

Interim measures using nurse-refractionists

or ophthalmic or optometric technicians that

refract are essential.


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One effective current model, developed by the LVPrasad Eye Institute in Hyderabad,

India, for the efficient and cost-effective delivery of

eyecare is a community eyecare team. For every 1,000,000 people the team has:

1 ophthalmologist

4 optometrists

8 eyecare workers 8 ophthalmic assistants

16 ophthalmic nurses.


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ICEE AfricaGraduation Day

Nurse Training Program


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What is needed?

Establishment of infrastructure

Development of effective models and

Programmes

Funding needed for the provision of

training and low cost spectacles.

Low Cost laboratories


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Th R l f R h


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The Role of Research

Adequate prevalence data determines

those most in need of intervention

Provide the basis from whichinterventions in the future can be

evaluated

AFRICAN VISION RESEARCH


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AFRICAN VISION RESEARCH

INSTITUTE (AVRI)

African Vision Research Institute (AVRI)addresses

the need for Africa based eye research.

Based in South Africa it will link:

Intellectuals Institutions

Organizations

Other personnel in the pursuit of solutions to the

various community eye health issues in Africa.


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Optometry can significantly contribute to

the understanding of:

Worldwide blindness and impaired vision-theburden and its effects

Health care planning

Service deliveryOutcomes of intervention.


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Self-Sustainability, Refractive

Error and Optometry

Developing the logistics and economics

of self-sustaining eyecare at the

community and institutional levels

Mobilising worldwide resources to

develop models and create the

educational and delivery infrastructurefor refractive and general vision care.


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Cross Subsidization

Spectacle supply can effectively fund more expensiveor

Intensive needs such as low vision and cataractsurgery.

Refract and supply spectacles and vision care,including the

Detection and treatment of minor problems, andreferral of those with more serious problems, at thecommunity level.

Optometry can make a major contribution insupporting eye care at this more convenient andcost-effective level.


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OPTOMETRYS RESPONSE

Public Health and DevelopmentCommittee of WCO

Vision 2020 membership OGS

Public Health Agenda

Membership in Country of Vision 2020committees

Involvement in the National Plan


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Tanzanian Opportunties

Community Optometry a model for the

world


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Preventable blindness is one of our most

tragic and wasteful global problems.

Optometry is an essential part of the teamthat will eliminate this tragedy, by

understanding global eyecare needs and

delivering effective and sustainable

visioncare to people in need, therebyensuring their fundamental right to sight.


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THANK YOU

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Optometry and v 2020 Global

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