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REFRACTIVE ERROR CHANGE IN APPROACH. Overview of Refractive Error Prevalence and Delivery Models. Professor Kovin Naidoo Global Programs Director . Kocur , 2008. Refractive Error Working Group: Significant Refractive Error. < 6/12 in children in the better eye

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refractive error change in approach

REFRACTIVE ERRORCHANGE IN APPROACH

Overview of Refractive Error

Prevalence and Delivery Models

Professor Kovin Naidoo

Global Programs Director

refractive error working group significant refractive error
Refractive Error Working Group:Significant Refractive Error
  • < 6/12 in children in the better eye
  • < 6/18 in adults in the better eye.
  • Myopia >= 0.50 Ds.
  • Astigmatism >= 1.50 Dcyl
  • Hyperopia >= 2.0 Ds ( >=1.0 Ds in > 40 yrs)
  • Anisometropia >= 2.0 Ds (children)
burden of ure
Burden of URE

Resnikoff S, et al. (2008). "Global magnitude of visual impairment caused by uncorrected refractive errors in 2004. ." Bull World Health Organ 86(1): 8.

b urden of ure regions
Burden of URE - Regions

*millions

Resnikoff S, et al., 2008

global estimates
Global Estimates

Reference: Global estimates of visual impairment: 2010; Pascolini and Mariotti. BJO 2012, 96: 614 -618 December 2011

global estimates 2010
Global Estimates 2010 …
  • Major cause of VI

- Uncorrected refractive errors

43%

43 %

(123 million)

Pascolini, D. and S. P. Mariotti "Global estimates of visual impairment: 2010." Br J Ophthalmol.

presbyopia estimates
Presbyopia - Estimates
  • 1.04 billion people globally
  • 517 million of whom had no spectacles or inadequate spectacles.
  • 410 million prevented from performing near tasks in the way required.
  • 94% from less and least-developed countries

Holden, B et al., (2008) Global Vision Impairment Due to Uncorrected Presbyopia. Arch Ophthalmol. 26(12):1731-1739

slide11

14.6-66.3

7.6-49.6

15.4-47.8

17.4-43.3

26.8-39.1

25.8-39.8

29.0-35.3

Mingguang et al, 2012

slide12

0.07-98.7

2.38-92.3

1.34-93.6

0.32-95.4

1.1-87.7

4.62-63.3

0.84-39.3

Mingguang et al , 2012

slide13

0.1-98.4

0.67-93.8

0.44-86.9

0.72-91.4

2.3-89.1

0.84-69.2

4.67-50.8

Mingguang et al, 2012

international centre for eyecare education icee
International Centre for Eyecare Education (ICEE)

269 billion dollars lost productivity

>50 yrs No Producitivity

121.4 billion dollars

Smith et al, 2009

how many optometrists are there
How many Optometrists are there?

281 748

  • Global Estimate (D. Wilson et al., BHVI 2010)

281 748

Varies tremendously from country to country

    • from 0.1 per million population
    • to 600 per million population
re programs core activities
RE Programs: Core Activities

Sustainable, Accessible, Affordable

SCALABLE

advocacy
Advocacy

WHO, IAPB, NGOs

Global

Regional IAPB offices

Regional

MOH, NGOs, Professional bodies

National

Local government bodies,

Community clinic setting,

Community bodies,

Community

human resource development
Human Resource Development

Who is the refractive services workforce?

  • Individuals with clearly defined:
    • Roles and responsibilities
    • Job descriptions
    • Career structure
  • All cadres, should possess:
    • Competencies and skills
    • Complementary functions with other cadres
    • TEAM APPROACH
the strategy for eye care delivery determines where the work force operates
The strategy for eye care delivery determines where the work force operates

WHO, IAPB, NGOs

Vision

2020

Specialists – Ophthalmologists, Optometrists, Disp & Manuf technicians

Refraction

Diagnosis & Management

Training

Centre

Specialists

Optometrists, Ophthalmics Nurses

Ophthalmic technicians

Vision technicians

Screening

Refraction

Dispensing

Service Centre

Mid-level personnel

Community Worker, Teachers, Primary health care worker

Case

finding

Community Level

Vision Centre

challenges to hrd
Challenges to HRD
  • Personnel retention
  • Multi-tasking
  • Sustainability
  • Career path
  • Remote communities
  • Maintaining standards
  • Changing scope of practice
providing refractive correction
Providing refractive correction
  • Providing the refractive correction depends on local conditions and resources
  • Accessibility
    • Providing a supply chain
  • Quality
    • Equipment sourced and incorporated into service delivery programmes
    • Ready made spectacles
      • Lower cost
      • Rapid treatment
    • Adaptive Spectacles
an optical supply chain with social and economic benefit
An optical supply chain with social and economic benefit

SUPPLIER

Purchase in bulk

(no middle man)

= reduced product cost

GLOBAL

RESOURCE CENTRE

Minimum

Price

Mark Up

NGOs & PUBLIC HEALTH SECTOR

VISION

CENTRES

Cost Recovery / Minimum Markup = Affordable to Pts

PATIENTS

service delivery refractive service vision centres refraction clinics
Service DeliveryRefractive Service/Vision Centres/Refraction Clinics
  • Partnerships with governments
  • NGO led
    • Entrepreneurship
district health system
District Health System

NON- SPECIALIST

3o LEVEL CARE

SPECIALISED SERVICES

SPECIALIST & SUPER-SPECIALIST CARE (40)

CLINIC

COMMUNITY HEALTH CENTRE

DISTRICT

HOSPITAL

REGIONAL

HOSPITAL

CLINIC

PROVINCIAL HOSPITAL

COMMUNITY HEALTH CENTRE

DISTRICT

HOSPITAL

REGIONAL

HOSPITAL

CLINIC

HEALTH DISTRICT

Fig 1.

primary eye care
Primary Eye Care

Integration of primary eye care into primary health care

Strong primary health care development = strong eye care programmes

Different personnel in different contexts

Roles and tasks need to be clarified

service delivery in kzn
Service Delivery in KZN

3

4

2

3

3

2

3

2

33 optometrists

11 Districts

123 clinics

1000 000 patients

8

1

2

social entrepreneurship and public private partnership
Social Entrepreneurship and Public Private Partnership

Addressing Poverty and Eye Health through entrepreneurship and within a health systems perspective

Have to balance public protection with profitability and a purely financial model cannot be adopted

infrastructure service development
Infrastructure & Service Development

Vision Centres

  • LVPEI model
  • An eye care facility that provides a range of eye care services, including:
    • Eye examinations
    • Refraction (i.e. determining the spectacle prescription required)
    • Supply and dispensing of affordable spectacles
    • Detection of potentially blinding diseases
    • Treatment of minor eye diseases
slide37

Partnerships with private practitioners

D

  • Get private optometrists involved for our mission
  • Package of 20 to 30 affordable frames and ready-made spectacles
  • Supported by Optometry Associations
  • CPD for participating optometrists
  • Target customers: Low income consumers (working poor)
slide38

Vision screening in China

SCHOOL HEALTH AND SCHOOL EYE HEALTH

Screening in Lechang, China, 2010

strategic partnerships to support sustainability
Strategic partnerships to support sustainability

Governments

Major Development Agencies

Rural agencies

Women's Groups

Professional Associations

Business Development Units

Micro-finance Groups