8/13/2019 Optometry and v 2020 Global
1/48
Kovin Naidoo
ICEE Africa DirectorAFCO Vice-President
Optometry as part of Vision
2020: global perspective
8/13/2019 Optometry and v 2020 Global
2/48
Global Initiative to Eliminate Avoidable
Blindness by the Year 2020
World Health Organisation- IAPB
8/13/2019 Optometry and v 2020 Global
3/48
Present estimation:
45 million people blind
+ 135 million visually disabled
Present situation
LowVision
Blind< 6/18 - 3/60
8/13/2019 Optometry and v 2020 Global
4/48
World Prevalence of
Blindness
0.4 - 0.6 0.6 - 1 > 1%< 0.4%Prevalences:
8/13/2019 Optometry and v 2020 Global
5/48
Prevalence of Blindness
90%+ live in
underprivileged
communities
8/13/2019 Optometry and v 2020 Global
6/48
The blindness rate in many developing
countries, especially in Africa, is 7 times
higher, at 1.4%, than in developedcountries
8/13/2019 Optometry and v 2020 Global
7/48
8/13/2019 Optometry and v 2020 Global
8/48
Global Distribution of Blindness by
Cause
Cataract
42 %
Trachoma
15 %
Glaucoma
14%
Oncho.
1 %
Other
28 %Macular degeneration
Diabetic retinopathy
+Refractive errors
(uncorrected)
8/13/2019 Optometry and v 2020 Global
9/48
Present situation
80% of blindness is avoidable
preventable
or
curable
8/13/2019 Optometry and v 2020 Global
10/48
Leading Causes
of Preventable Blindness:
Cataract
Trachoma Onchoceriasis
Childhood Blindness Refractive Error
& Low Vision
8/13/2019 Optometry and v 2020 Global
11/48
VISION 2020
Vision 2020 will strive to make refractive services
and corrective spectacles affordable and available
to the majority of the population through primary
health care facilities, vision screening in schools
and low-cost production of spectacles. Similar
strategies will be adopted to provide low visionservices.
8/13/2019 Optometry and v 2020 Global
12/48
Global estimates
Magnitude of refractive errors not reliably
known
Large global variation in prevalence (by age,gender, and race)
Estimated: 2.3 billion people have refractive
error
1.8 billion have access to refractive services
500 million do not have access to services
8/13/2019 Optometry and v 2020 Global
13/48
Sth Africa1.0% RE:10%
Cook, 1992 (n=268)
China4.4% Due to RE:10%
Shaozhen Li, 1999 (n=5342)
Australia0.15% Due to RE:25%
Taylor, 1997 (n=3268)
India2.5% Due to RE:9.6%
Dandona, 1998 (n=2522)
Saudi Arabia
0.7% RE: 5.3%
Al Faran, 1993 (n=2882)
10%+ ofWorld
Blindness
Blindness Due To Uncorrected
Refractive Errors (
8/13/2019 Optometry and v 2020 Global
14/48
Difficulties with Current Data
Non-uniform definitions across studies Non-representative study populations
(convenience rather than population-
based)
Dissimilar demographics of study
population (age and sex)
Refraction procedures are different
(with/without cycloplegia etc)
Negrel, Ellw ein, 2001
8/13/2019 Optometry and v 2020 Global
15/48
Uncorrected refractive error
is the major cause of:blindness following mass
cataract surgery using
standard power IOL
8/13/2019 Optometry and v 2020 Global
16/48
Myopia with Autorefraction:
Country Comparison
Myopia with Autorefraction
4
7.3
21.6
5.6
7.4
1.2
0
5
10
15
20
25
SA Chile China Hyd Delhi Nepal
Countries
Percentage
Series1
8/13/2019 Optometry and v 2020 Global
17/48
Low Vision
35m people worldwide have irreversiblevision loss and are in need of low visioncare.
*WHO Global Initiative: Vision 2020, Feb 1999
VISION 2020will enable access to
visual devices & low vision care at
affordable cost
Treatment:Low vision care & visioncorrection
8/13/2019 Optometry and v 2020 Global
18/48
components
Disease control through service delivery
Human resource development
Infrastructure and technology
8/13/2019 Optometry and v 2020 Global
19/48
8/13/2019 Optometry and v 2020 Global
20/48
Optometry a late entrant
It is only recently that uncorrected
refractive error and even more recently
low vision has achieved prominence Landmark population-based studies in
adults, children and in post-cataract
patients.
8/13/2019 Optometry and v 2020 Global
21/48
Optometry and Public Health
Mainly private
practice
Limited discourseabout public sector
initiatives
Individual
Optometrists andgroupings efforts
8/13/2019 Optometry and v 2020 Global
22/48
Public Health Challenges
Integration of professions
Expansion of the scope of Optometry
Consolidation of the scope of Optometry
Charity vs Public Health
Health Policy
Health Systems development and Management
Health Promotion
8/13/2019 Optometry and v 2020 Global
23/48
Opportunity for Optometry
The realisation of the impact of
uncorrected refractive error and Low
Vision has provided the opportunity foroptometry to play a major part in
alleviating vision loss for those most in
need.
8/13/2019 Optometry and v 2020 Global
24/48
Refractive Error and Vision
2020
WHO established a Refractive Error
Working Group (REWG), as
The REWG is now developing
international strategic plans and policies
to eliminate uncorrected refractive error.
8/13/2019 Optometry and v 2020 Global
25/48
Definitions
Children:
-Myopia: < 0.5D
-Hyperopia: 2D
8/13/2019 Optometry and v 2020 Global
26/48
Refractive error in Children
-Binocular vision
8/13/2019 Optometry and v 2020 Global
27/48
Refractive exams
Children:
Exams should be carried out only by eyecare
personnel(ECP) with the appropriate skills in objective and
subjective refraction, ocular motility, basic eye examination,
ability to detect potenially blinding diseases andcommunication skills.
8/13/2019 Optometry and v 2020 Global
28/48
Minimum Standards for
Children
-Retinoscopy plus subjective refraction,
with cycloplegia for young children as
needed. -Autorefractometry plus subjective
refraction with cycloplegia
8/13/2019 Optometry and v 2020 Global
29/48
Refractive Correction: Priority
-High Priority: < 6/18
-Moderate Priority:
8/13/2019 Optometry and v 2020 Global
30/48
Priority Groups
Children aged 11-15 with myopia and
people over the age of 45 years who require
spectacles for near vision
8/13/2019 Optometry and v 2020 Global
31/48
Not Restricted to Refraction
Integrated into the eye team and blindnessprevention
Teaching eye care personnel, especially in refractionand low vision care
Providing screening and vision care services atsecondary and tertiary levels
Detection and management of potentially;blindingdiseases such as cataract, diabetes and glaucoma
Research into the understanding of global eyecareneeds and solutions,especially in vision correctionand vision care service delivery
Building models of self-sustainable eyecare.
8/13/2019 Optometry and v 2020 Global
32/48
8/13/2019 Optometry and v 2020 Global
33/48
What is Needed?
Developed countries: optometrist to
population ratio is 1:10,000.
Developing countries the ratio is1:600,000, and much worse in many
rural areas, up to millions of people per
optometrist.
8/13/2019 Optometry and v 2020 Global
34/48
What is needed?
Increase in the number of eyecare personnel
trained in refraction and vision correction.
Training mid-level personnel in refractivecare.
Interim measures using nurse-refractionists
or ophthalmic or optometric technicians that
refract are essential.
8/13/2019 Optometry and v 2020 Global
35/48
8/13/2019 Optometry and v 2020 Global
36/48
One effective current model, developed by the LVPrasad Eye Institute in Hyderabad,
India, for the efficient and cost-effective delivery of
eyecare is a community eyecare team. For every 1,000,000 people the team has:
1 ophthalmologist
4 optometrists
8 eyecare workers 8 ophthalmic assistants
16 ophthalmic nurses.
8/13/2019 Optometry and v 2020 Global
37/48
ICEE AfricaGraduation Day
Nurse Training Program
8/13/2019 Optometry and v 2020 Global
38/48
What is needed?
Establishment of infrastructure
Development of effective models and
Programmes
Funding needed for the provision of
training and low cost spectacles.
Low Cost laboratories
8/13/2019 Optometry and v 2020 Global
39/48
Th R l f R h
8/13/2019 Optometry and v 2020 Global
40/48
The Role of Research
Adequate prevalence data determines
those most in need of intervention
Provide the basis from whichinterventions in the future can be
evaluated
AFRICAN VISION RESEARCH
8/13/2019 Optometry and v 2020 Global
41/48
AFRICAN VISION RESEARCH
INSTITUTE (AVRI)
African Vision Research Institute (AVRI)addresses
the need for Africa based eye research.
Based in South Africa it will link:
Intellectuals Institutions
Organizations
Other personnel in the pursuit of solutions to the
various community eye health issues in Africa.
8/13/2019 Optometry and v 2020 Global
42/48
Optometry can significantly contribute to
the understanding of:
Worldwide blindness and impaired vision-theburden and its effects
Health care planning
Service deliveryOutcomes of intervention.
8/13/2019 Optometry and v 2020 Global
43/48
Self-Sustainability, Refractive
Error and Optometry
Developing the logistics and economics
of self-sustaining eyecare at the
community and institutional levels
Mobilising worldwide resources to
develop models and create the
educational and delivery infrastructurefor refractive and general vision care.
8/13/2019 Optometry and v 2020 Global
44/48
Cross Subsidization
Spectacle supply can effectively fund more expensiveor
Intensive needs such as low vision and cataractsurgery.
Refract and supply spectacles and vision care,including the
Detection and treatment of minor problems, andreferral of those with more serious problems, at thecommunity level.
Optometry can make a major contribution insupporting eye care at this more convenient andcost-effective level.
8/13/2019 Optometry and v 2020 Global
45/48
OPTOMETRYS RESPONSE
Public Health and DevelopmentCommittee of WCO
Vision 2020 membership OGS
Public Health Agenda
Membership in Country of Vision 2020committees
Involvement in the National Plan
8/13/2019 Optometry and v 2020 Global
46/48
Tanzanian Opportunties
Community Optometry a model for the
world
8/13/2019 Optometry and v 2020 Global
47/48
Preventable blindness is one of our most
tragic and wasteful global problems.
Optometry is an essential part of the teamthat will eliminate this tragedy, by
understanding global eyecare needs and
delivering effective and sustainable
visioncare to people in need, therebyensuring their fundamental right to sight.
8/13/2019 Optometry and v 2020 Global
48/48
THANK YOU
Top Related