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A COMPREHENSIVE REFRACTIVE ERROR TRAINING PACKAGE FOR MID- OR LOWER-LEVEL CADRES Jane Kierath1,2,3, Sonja Cronjé1,2,3, Shoshana Jackofsky2, Neilsen De Souza1,2, Brien A Holden1,2,3 and Kovin Naidoo2 UNCORRECTED REFRACTIVE ERROR Single greatest cause of global visual impairment and the Key concepts and procedures are illustrated with: giving sight ii ih ICEE REFRACTIVE ERROR TRAINING PACKAGE Figure 5: Finding the power of a person’s astigmatism second largest cause of avoidable blindness1, 2 • diagrams and pictures 50 50 • ﬂow charts 0. 0. Cause of 670 million cases of visual impairment Minus axis of cylinder 0– in line with axis of • case studies cylindrical trial lens 05 +0 5 0 • 153 million cases of uncorrected distance refractive error2,3,4 05 − examples of these are shown in Figures 1 to 6 –0 5 +0 180 180 • A further 517 million cases of uncorrected near refractive 0 0 0 error (presbyopia)5 Figure 1: How a person with presbyopia might see without and 0 0 30 30 with spectacles 15 15 Interventions to diagnose and manage it are cost-effective and 60 12 0 60 12 0 90 90 can be delivered by appropriately trained and equipped eye care personnel2,6,7 Major barrier to elimination of the problem in the developing world is the uneven distribution and unavailability of eye care Handle is twisted to get Position 2 personnel trained to provide refractive error services6,8 Sustainable service provision necessitates the training of Figure 6: How a person with low, medium and high hyperopia appropriate numbers of eye care personnel to work in areas of Presbyopia uncorrected (without spectacles): Presbyopia corrected (with spectacles): might see most need9 Near vision blurred. Near vision clear. Figure 2: Anatomical terms of location ICEE REFRACTIVE ERROR TRAINING PACKAGE Superior Superior ICEE education materials have been used to train eye care personnel in more than 30 countries across three continents Low hyperopia: Medium hyperopia: High hyperopia: for almost 10 years Inferior May have good distance vision Near vision blurred, but good Both distance and near vision Inferior and good near vision, but may distance vision blurred (near vision is worse ICEE recently identiﬁed the need for a comprehensive have eye strain and headaches than distance vision) Refractive Error Training Package Temporal Nasal Nasal Temporal Anterior Posterior Front view of the head Side view of the head The new ICEE Refractive Error Training Package: Summary sections reinforce key points: • is aimed at providing health care workers with the • Review section at the start of each unit knowledge and skills necessary to Figure 3: Flow chart for preparation and estimation of the add − prior knowledge required for the lesson − perform accurate refractions Keep all lenses from distance refraction in trial frame Remove all occluders • Summary section at the conclusion of each unit − prescribe and provide appropriate spectacles − key points learned • assumes no previous knowledge of eye care or refraction • contains 30 subject units, as outlined in Table 1 Adjust the trial frame for the person’s near PD Table 1: Subject units for ICEE Refractive Error Training Package CONCLUSION Let the person hold the near VA chart at their preferred working distance Unit Unit Topic Topic # # Training mid- and lower-level personnel to diagnose, measure 1 Introduction to the Eye 16 Retinoscopy Look at the person’s age (to choose your first trial lenses) and correct refractive error is essential to the success of 2 Optics 17 Best Vision Sphere Refraction VISION 2020 3 Eye Optics and Accommodation 18 Sphero-cylindrical Refraction The new ICEE Refractive Error Training Package provides 4 Spherical Lenses 19 Controlling Accommodation Aged 35 to 40 yrs Aged 40 to 45 yrs Aged 45 to 50 yrs Aged over 50 yrs all the resources necessary to teach a competency-based refraction course in a small group environment 5 Astigmatic Lenses 20 The +1 Test and Binocular Balance The new ICEE Refractive Error Training Package is a 6 Optical Crosses and Transposition 21 Near Refraction for Presbyopia Start with Start with Start with Start with +0.75 D +1.25 D +1.75 D +2.25 D comprehensive training package for students and teachers 7 Interpupillary Distance 22 Record Keeping and Referral Letters for both eyes for both eyes for both eyes for both eyes of refractive error, and provides a solution to the need for 8 Trial Sets and Trial Frames 23 Prescribing Spectacles refractive error training resources 9 Hand Neutralisation and Vertometry 24 Prescribing Spectacles for Presbyopia Put these lenses into the back cells of the trial frame 10 Visual Acuity 25 Prescribing Spectacles for Astigmatism ACKNOWLEDGEMENTS 11 Pinhole Visual Acuity 26 Prescribing Readymade Spectacles The Student Manual of the new ICEE Refractive Error Training Package was 12 Hyperopia, Myopia and Astigmatism 27 Adjustment and Care of Spectacles Go to: based on the original ICEE Refraction Manual. Adjusting the add power 13 Presbyopia 28 Blindness and Vision Impairment This information was previously presented as a poster at the 8th Annual General Assembly of the International Agency for the Prevention of Blindness 14 Case History 29 Establishing a Refraction Clinic (IAPB), Buenos Aires, Argentina, August 2008. 15 Introduction to Refraction 30 Managing Stock for Refraction Services Figure 4: Range of clear vision varies depending on age REFERENCES Range of Clear Vision Each unit consists of: 30cm 1. Holden BA. Uncorrected refractive error: the major and most easily avoidable cause • A comprehensive Student Manual Near Point Blur of vision loss. Community Eye Health Journal. 2007;20(63):37–39. • A Teacher’s Manual with learning activities, discussion 2. Resnikoff S, Pascolini D, Mariottia SP, Pokharela GP. Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. Bull World Health topics and simulations for hands on experience Organ. 2008;86:63–70. Preferred Working Distance • A PowerPoint presentation (optional) 3. WHO Fact File on Blindness and Visual Impairment. Available at: http://www.who.int/ • Student worksheet(s) to facilitate trainee participation and features/factﬁles/vision/09_en.html. Accessed 16 June 2008. Far Point Blur 4. Sight test and glasses could dramatically improve the lives of 150 million people with practical exercises poor vision. WHO Press Release: World Sight Day 2006 A 45 year old with a 30 cm range of clear vision • Other supporting teaching resources (such as posters) 5. Holden BA, Fricke TR, Ho SM, Wong R, Schlenther G, Cronjé S, Burnett A, Naidoo KS, where appropriate Range of Clear Vision Frick KD. Global vision impairment due to uncorrected presbyopia. Arch Ophthalmol 2008; 126(12):1731-1739. 15cm Units are largely independent – allowing ﬂexibility for different 6. Elimination of avoidable visual disability due to refractive errors. WHO/PBL/00.79 training situations and community needs 2000. Near Point 7. Global Initiative for the Elimination of Avoidable Blindness. WHO/PBL/97.61 Rev 2; Uncomplicated language is used throughout Blur 2000. • to accommodate trainees from non-English speaking Preferred Working Distance 8. The Durban Declaration on Refractive Error and Service Development. http://www. backgrounds worldoptometry.org/site/ﬁles/6628/The_Durban_Declaration_2007.pdf; 2007. • to simplify translation into other languages where needed Far Point Blur 9. Holden BA, Resnikoff S. The role of optometry in VISION 2020. Community Eye Health. 2002;15(43):33 36. 2002;15(43):33–36. A 55 year old with a 15 cm range of clear vision 1. The University of New South Wales 2. The International Centre for Eyecare Education 3. Vision Cooperative Research Centre
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