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REFRACTIVE ERROR CHANGE IN APPROACH

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

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  1. REFRACTIVE ERRORCHANGE IN APPROACH Overview of Refractive Error Prevalence and Delivery Models Professor Kovin Naidoo Global Programs Director

  2. Kocur, 2008

  3. 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)

  4. Refractive Errors in Children(RESC)

  5. 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.

  6. Burden of URE - Regions *millions Resnikoff S, et al., 2008

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

  8. 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.

  9. 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

  10. 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

  11. 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

  12. 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

  13. Global Visual Impairment (<6/18)

  14. The vicious cycle of uncorrected refractive error

  15. International Centre for Eyecare Education (ICEE) 269 billion dollars lost productivity >50 yrs No Producitivity 121.4 billion dollars Smith et al, 2009

  16. 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

  17. Number of Optometrists per Million population 194 14 0.9

  18. Number of Optometrists and Ophthalmologists per Million population

  19. RE Programs: Core Activities Sustainable, Accessible, Affordable SCALABLE

  20. Advocacy WHO, IAPB, NGOs Global Regional IAPB offices Regional MOH, NGOs, Professional bodies National Local government bodies, Community clinic setting, Community bodies, Community

  21. 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

  22. Who is the refractive services workforce

  23. 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

  24. Challenges to HRD • Personnel retention • Multi-tasking • Sustainability • Career path • Remote communities • Maintaining standards • Changing scope of practice

  25. 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

  26. 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

  27. Service DeliveryRefractive Service/Vision Centres/Refraction Clinics • Partnerships with governments • NGO led • Entrepreneurship

  28. 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.

  29. 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

  30. Service Delivery in KZN 3 4 2 3 3 2 3 2 33 optometrists 11 Districts 123 clinics 1000 000 patients 8 1 2

  31. 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

  32. 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

  33. Tanzania Vision Centers

  34. Enterprise for Sight Program in South Africa

  35. 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)

  36. Vision screening in China SCHOOL HEALTH AND SCHOOL EYE HEALTH Screening in Lechang, China, 2010

  37. Strategic partnerships to support sustainability Governments Major Development Agencies Rural agencies Women's Groups Professional Associations Business Development Units Micro-finance Groups

  38. THANK YOUk.naidoo@brienholdenvision.org

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