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VISION 2020

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					Optometry as part of Vision
2020: global perspective



        Kovin Naidoo
     ICEE Africa Director
     AFCO Vice-President
World Health Organisation- IAPB




Global Initiative to Eliminate Avoidable
     Blindness by the Year 2020
         Present situation

       • Present estimation:
            – 45 million people blind
                         +
            – 135 million visually disabled



    < 6/18 - 3/60       Low       Blind
                                           < 3/60
     <0.3 - 0.05       Vision              <0.05
                                                       Best corrected VA


International classification ignores the burden of uncorrected refractive error
World Prevalence of
Blindness




Prevalences:   < 0.4%   0.4 - 0.6   0.6 - 1   > 1%
Prevalence of Blindness




       90%+ live in
      underprivileged
       communities
• The ‘blindness’ rate in many developing
  countries, especially in Africa, is 7 times
  higher, at 1.4%, than in developed
  countries
Gender is another major issue



             Men       Men
   Women     36%
    64%                Women
Global Distribution of Blindness by
Cause
               Other     Macular degeneration
               28 %
                          Diabetic retinopathy

    Oncho.                          +
     1%                     Refractive errors
                             (uncorrected)

Glaucoma
   14%
                         Cataract
                          42 %



    Trachoma
       15 %
  Present situation

80% of blindness is avoidable

         preventable
             or
           curable
Leading Causes
of Preventable Blindness:

• Cataract
• Trachoma
• Onchoceriasis
• Childhood Blindness
• Refractive Error
  & Low Vision
     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 vision
  services.
    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
  Blindness Due To Uncorrected
  Refractive Errors (<3/60)

                                                  China
                                           4.4% Due to RE:10%
                                        Shaozhen Li, 1999 (n=5342)
                                       India
 10%+ of                        2.5% Due to RE:9.6%

  World                        Dandona, 1998 (n=2522)

Blindness                      Sth Africa
                             1.0% RE:10%
                           Cook, 1992 (n=268)
                                                 Australia
      Saudi Arabia
                                           0.15% Due to RE:25%
     0.7% RE: 5.3%
                                           Taylor, 1997 (n=3268)
 Al Faran, 1993 (n=2882)
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, Ellwein, 2001
Uncorrected refractive error
  is the major cause of:
  blindness following mass
   cataract surgery using
     standard power IOL
Myopia with Autorefraction:
Country Comparison

                                 Myopia with Autorefraction

               25
                                      21.6

               20
  Percentage




               15
                                                                        Series1
               10
                         7.3                             7.4
                                                5.6
               5    4

                                                                 1.2

               0
                    SA   Chile       China     Hyd      Delhi   Nepal
                                        Countries
Low Vision
    • 35m people worldwide have irreversible
      vision loss and are in need of low vision
      care.

     Treatment:
     Low vision care & vision
     correction
     •VISION 2020 will enable access to
     visual devices & low vision care at
     affordable cost



          *WHO Global Initiative: Vision 2020, Feb 1999
   components

• Disease control through service delivery
• Human resource development
• Infrastructure and technology
   Collaborations


• has created valuable and effective
  collaborations of organisations
• WCO until 2002 was not a part of the
  International Agency for the Prevention
  of Blindness
   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.
    Optometry and Public Health

• Mainly private
  practice
• Limited discourse
  about public sector
  initiatives
• Individual
  Optometrists and
  groupings efforts
      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
    Opportunity for Optometry

• The realisation of the impact of
  uncorrected refractive error and Low
  Vision has provided the opportunity for
  optometry to play a major part in
  alleviating vision loss for those most in
  need.
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.
    Definitions

• Children:
• -Myopia: < 0.5D
• -Hyperopia: 2D
   Refractive error in Children

• -Binocular vision <6/12 is considered
  significant
• -Should only occur when appropriate
  resources for follow-up refraction and
  delivery of spectacles.
• -Visual acuity screening of children can
  be performed at community level by
  teachers, health care workers etc.
      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 and
  communication skills.
   Minimum Standards for
   Children
• -Retinoscopy plus subjective refraction,
  with cycloplegia for young children as
  needed.
• -Autorefractometry plus subjective
  refraction with cycloplegia
     Refractive Correction: Priority

•   -High Priority: < 6/18
•   -Moderate Priority: <6/12
•   -Low Priority: <6/9
•   -Children: < 6/12
•   -Adults: < 6/18
       Priority Groups

• Children aged 11-15 with myopia and
  people over the age of 45 years who require
  spectacles for near vision
     Not Restricted to Refraction

• Integrated into the eye team and blindness
  prevention
• Teaching eye care personnel, especially in refraction
  and low vision care
• Providing screening and vision care services at
  secondary and tertiary levels
• Detection and management of potentially;blinding
  diseases such as cataract, diabetes and glaucoma
• Research into the understanding of global eyecare
  needs and solutions,especially in vision correction
  and vision care service delivery
• Building models of self-sustainable eyecare.
    Optometry's Role in Correcting
    Refractive Error
• Public health optometry has not reached the
• communities that are in most need in any
  organised way.
• Develop a concerted effort to create local
  capacity in these communities, in
  collaboration with its partners in Vision 2020,
  through service delivery, by creating human
  resources and by helping to develop the
  infrastructure needed, the three cornerstones
  of the Vision 2020 programme.
    What is Needed?


• Developed countries: optometrist to
  population ratio is 1:10,000.
• Developing countries the ratio is
  1:600,000, and much worse in many
  rural areas, up to millions of people per
  optometrist.
    What is needed?

• Increase in the number of eyecare personnel
  trained in refraction and vision correction.
• Training mid-level personnel in refractive
  care.
• Interim measures using nurse-refractionists
  or ophthalmic or optometric technicians that
  refract are essential.
STRATEGIES

 Vision
  2020       Ophth., Opt.,
Specialist    Managers
    s         OphN., Oph.Tech,
              Dispensing Opt.
Mid Level
Personnel              Com
                     Worker,
 Comm.               Teacher,
  Level               PHCW
• One effective current model, developed by the LV
  Prasad 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.
ICEE Africa“Graduation   Day”
Nurse Training Program
    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
• Refraction services as an integral part
  of general health care systems and
• comprehensive eyecare.
   The Role of Research


• Adequate prevalence data determines
  those most in need of intervention
• Provide the basis from which
  interventions in the future can be
  evaluated
      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.
• Optometry can significantly contribute to
  the understanding of:
  Worldwide blindness and impaired vision-the
   burden and its effects
  Health care planning
  Service delivery
  Outcomes of intervention.
   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 infrastructure
  for refractive and general vision care.
    Cross Subsidization

• Spectacle supply can effectively fund more expensive
  or
• Intensive needs such as low vision and cataract
  surgery.
• Refract and supply spectacles and vision care,
  including the
• Detection and treatment of minor problems, and
  referral of those with more serious problems, at the
  community level.
• Optometry can make a major contribution in
  supporting eye care at this more convenient and
  cost-effective level.
   OPTOMETRY’S RESPONSE

• Public Health and Development
  Committee of WCO
• Vision 2020 membership
• OGS
• Public Health Agenda
• Membership in Country of Vision 2020
  committees
• Involvement in the National Plan
   Tanzanian Opportunties

• Community Optometry a model for the
  world
• Preventable blindness is one of our most
  tragic and wasteful global problems.
• Optometry is an essential part of the team
  that will eliminate this tragedy, by
  understanding global eyecare needs and
  delivering effective and sustainable
  visioncare to people in need, thereby
  ensuring their fundamental right to sight.
• THANK YOU

				
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posted:12/5/2011
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