9 GA HyderabadINDIA September 2012

Optometry &

RefractionA Ugandan Experience

It’s all about me!

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

Total Global Burden of URE

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

DURBAN DECLARATION &

DURBAN COMMITTMENT

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

Tertiary Level

Secondary Level

Community

PHCW / VHT / CBR - workers

MOSTLY SEEN REFERRAL SYSTEM

Secondary & tertiary Level

Optometrist or Refractionist

Community Based Rehabilitators

Community

CommunityVision Center

COMMUNITY VISION CENTRES (Envisaged)

Ophthalmologist, Optometrist and paramedical staff

• 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

EXPERIENCE FROM UGANDA

Part of comprehensive eye care team!!!

Optometr(y)-ists

& Refraction

OptometristsAssociation of Uganda

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