Optometry
&
Refraction
A Ugandan Experience
9 GA Hyderabad
INDIA September 2012
It’s all
about me!
Total Global Burden of URE
517million uncorrected presbyopes
+
153 million people with uncorrected distance Rx
= 670 million people
are blind or vision impaired
simply because
they don’t have
a pair of glasses
Info Prof. Kovin Naidoo
DURBAN DECLARATION &
DURBAN COMMITTMENT
It was mainly due to the WCRE’s and the presentation of relevant studies
that URE has been realised as a major cause of functional blindness and the
biggest cause of visual impairment
The results also opened the understanding that the cadre of optometrists
has to play a much greater part in identifying and correcting vision loss
The role of optometry dealing with URE as part of a comprehensive eye
care team is presently reviewed and will newly be defined
INTERNATIONAL FORA
VISION 2020 and the INTERNATIONAL COUNCIL OF OPHTHALMOLOGY
(ICO) have both recognized the importance to address impact of URE:
WHO established a Refractive Error Working Group (REWG), as part of
global VISION 2020 activities
The ICO task force on URE was formed mid 2007, only 4 months after the
1st WCRE was held in Durban – for the 1st time URE has been discussed in a
cross cutting way to enhance service delivery including also optometrists
as part of the eye care team
Pilot programmes are:
NIURE UGANDA
CVC PAKISTAN
SEHP PAKISTAN & NIGERIA
WHO PROVIDES REFRACTION SERVICES
• Ophthalmologists
(Time
, primarily Rx of eye diseases and surgeries)
• Optometrists
(Time
, specialized on URE)
• OCO & OCO/Refractionists
(Mid-level training, generalist, part timer)
• Ophthalmic Assistants
(Mid-level community training, spherical & readers)
• Orthoptists
(Therapist - squints & amblyopia, no formal refraction training)
IDENTIFIED ROLES FOR
OPTOMETRISTS in EYE CARE
• Objective and subjective refraction at 2” & 3” level - Low vision
• Paediatric refractions (time consuming, retinoscopy under anaesthesia)
• Glaucoma screening and early detection
• Identification/referral of Cataract and early detection of retinal diseases
• Diagnostic of ophthalmic medical conditions & related systemic
conditions (hypertension/diabetics)
• Detection & correction of high RE with combination of high cylinders
which OCO refractionist may not be able to handle at present
IDENTIFIED ROLES FOR
OPTOMETRISTS in EYE CARE
• Collecting data and analysis
• Research to improve eye care services
• Free ophthalmologists of work load for them be able to attend to difficult
eye conditions and required intraocular surgery in public hospitals
• Dispense contact lenses where applicable, especially for patients with
keratoconus & keratoglobus
IDENTIFIED ROLES FOR
OPTOMETRISTS in EYE CARE
• Teaching HR in refraction and clinical low vision
• Manage school screenings as part of child eye health – teachers training
• Part of comprehensive eye care team
• Develop & implement sustainable high quality optical service delivery
models
CVC – CATALYST
Services to detect and correct RE as part of a
CVC by optometrists – excellent opportunity to
also identify and refer serious eye conditions
such as cataract, glaucoma, diabetes etc.
Instant optical corrections offered by
optometrists taking care of RE incl. presbyopia
MOSTLY SEEN REFERRAL SYSTEM
Tertiary Level
Secondary Level
PHCW / VHT /
CBR - workers
Community
COMMUNITY VISION CENTRES
(Envisaged)
Secondary &
tertiary Level
Ophthalmologist, Optometrist
and paramedical staff
Community
Vision Center
Optometrist or
Refractionist
Community Based
Rehabilitators
Community
EXPERIENCE FROM UGANDA
• By 2008 only 4 Ugandan optometrists trained outside Uganda
• NIURE, in collaboration with OAU facilitating training for 50 OCOs
in refraction to brigde gap of lack of optometrists in the country
• Joint effort to get optometry profession recognized and approved
by service commission of the MoH
• Start training of optometrists at Makerere University in September
2013 – approval of training curriculum under way
• Government of Uganda has been requested to create official
positions at Regional level for optometrists
EXPERIENCE FROM UGANDA
• Setting up a National optical workshop managed by an optometrist
at Entebbe Government Hospital with coded frames
(June 2012 = 233 spectacles dispensed via trained
OCO/Refractionists placed all over the country)
• Spectacle technicians trained by optometrists (6 months
training with recognised curriculum)
• School eye health activities started in Entebbe Municipality
under the leadership of optometrists
EXPERIENCE FROM UGANDA
Conclussions and recommendations:
• Training of optometrists only with recognized curriculum
• Gov‘t recognition of profession imperative before training
• Creation of Gov‘t posting at Regional and District level
• Optometrists to be included into comprehensive eye care teams
• Stratified placement of optometrists important for accessibility
Optometrists
Association of Uganda
Optometr(y)-ists
&
Refraction
Part of comprehensive
eye care team!!!
RECOMMENDED LITERATURE
Article: The role of optometry in VISION 2020
Brien A Holden PhD DSc OAM, Scientia Professor, International Centre
for Eyecare Education (ICEE), PO Box 328, Randwick, NSW 2031,
Australia
Serge Resnikoff MD, Coordinator, Prevention of Blindness and
Deafness, World Health Organization, CH-1211 Geneva 27,
Switzerland
Article: Delivering refractive error services: primary eye care
centres and outreach
Kovin Naidoo and Dhivya Ravilla