RE in District Comprehensive Eye Care

1
RE in District Comprehensive Eye Care
World Congress on Refractive Error Service
Development
Hasan Minto LV RE Advisor Sightsavers
International
2
Introduction

• Magnitude
• Need
• Service delivery
• Infrastructure
• Technology
• Human resource
• Output
• Linkages

3
Key Characteristics of Secondary Level

• Has a defined geographical area
• Needs assessment easy
• Administration feasible decentralization,
  devolution, etc.
• Common social and cultural perspectives
• Language barriers are very few

4
Key Characteristics of Secondary Level

• Coordination and cooperation is smooth at
  horizontal and vertical levels
• Partnerships are innovative and dynamic
• Monitoring is feasible and logistically
  manageable
• Impact is visible and learning is flexible

5
A Case Study of MIEPDistribution by Diagnosis
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Comparison of Presenting and Corrected Distance
Visual Acuities
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Population needing refraction and spectacles in a
total population of 1 millionAnnual Workload

• Children
• 16,000 refraction and spectacles / year
• Adults
• 24,000 refraction and spectacles / year
• Presbyopia
• 35,000 refraction and spectacles / year

8
Strategic Needs

• Primary level
• detection and referral of persons with visual
  impairment
• Vision screening training of PHC workers
• Secondary level
• Refractive (LV) services at district eye units
• Link to affordable and quality optical care
• Sustainable strategies for screening of and
  provision of spectacles to 11-15 yrs and
  presbyopes

9
Secondary Services

• Diagnosis
• Refraction
• Prescription of spectacles
• School and community screening
• Referral
• Outreach

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Placing

• As part of a multi-disciplinary setting
• As part of an eye unit
• As a stand alone facility
• Government
• NGO
• Private

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District Ophthalmologist 1
District Level Eye Care
Refractionist 1
Institution Based Refraction Low Vision
Ophthalmic Technicians 3
Community Health Workers
Community Based Refraction Screening
Community
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Service Delivery

• Community workers including primary health care
  workers, teachers, social workers and families
  are first contact for vision assessment and
  referrals
• Ophthalmic Technicians (OTs) and refractionists
  are based in district/sub district eye
  units/rural health centres

13
Infrastructure

• Institutionalised Service providers
• A refraction room in the hospital/ rural health
  centre
• Basic equipment for refraction correction i.e.
  ophthalmoscope, trial frame set
• Spectacles frames and lenses for dispensing
• Readymade spectacles
• Motorbike or vehicle for outreach services
• Non Institutionalised Service Providers
• Optical shop/lab outlet
• Dispensing unit

14
Equipment

• Retinoscope
• Trial lens set
• Trial frame
• Cross cylinder
• Vision drums
• Auto-refractor?

15
Human Resource and Management

• Optometrist
• Refractionist
• Ophthalmic technician/nurses
• Opticians/optical technicians
• Building capacity at local level for referrals
• Primary health care workers
• School teachers
• Social workers
• Community organizations
• Other service providers

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Training Needs

• Training in retinoscopy
• Subjective refraction
• Screening for eye diseases like cataract,
  glaucoma, diabetic retinopathy
• Primary eye care
• Dispensing
• Communication skills
• Management skills

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Output

• One refractionist can do 30 refractions / day
  manually 302012 7200 / year
• The number can go up-to 50 with auto-refractor
  502012 12000 / year
• Presbyopia can be corrected at community level by
  fieldworkers with minimum training and readymade
  spectacles

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Output

• One optical technician can fit 20 pairs of
  spectacles a day manually 202012 4800
• Or 40 pairs with auto-edgers 402012 9600
• 50 of the prescriptions can be dispensed from a
  range of readymade spectacles

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Vertical and Horizontal Linkages

• Vertical between primary, secondary and
  tertiary eye care
• Horizontal with health care, education,
  community, and private sector

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Advocacy

• Involving the local community in screening
• Training opportunities for opticians
• Encouraging the promotion of cost effective
  spectacles
• Promoting outreach screening camps
• Developing district networking and linkages
  between and among service providers
• Influencing the local health and district
  administration for cushion of funds

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Tertiary Unit
School and Community Screening for Refractive
Errors and Low Vision
Education and Rehabilitation
Cataract Glaucoma Low Vision
Optical services
Social Justice
District Eye Unit
Diagnosis and treatment
Prevention
PEC
Vitamin A Deficiency Refractive Errors Low Vision
Vitamin A Deficiency Corneal Ulcer Trauma
RHC BHU
22
Conclusions

• This is the need per million population
• Children
• 16,000 refraction and spectacles / year
• Adults
• 24,000 refraction and spectacles / year
• Presbyopia
• 35,000 refraction and spectacles / year
• How are we going to address this?
• Do we have any starting point?