Addressing Refractive Errors and Low Vision

It is only recently that uncorrected refractive errors have achieved prominence as a major cause of functional blindness and significantly impaired vision.  Optometrists have had little opportunity to take part as the front liners in the elimination of one of the major causes of visual impairment targeted by Vision 2020. The need to mobilize optometrists to deal with uncorrected refractive errors has been accompanied by the possibility of better integration of optometry into prevention of blindness in general, with some major benefits with some optometrists willing to:

• Teach eye care personnel in refraction and low vision care
• Provide screening and vision care services to school children
• Detect and refer cases like cataract, glaucoma, and diabetic retinopathy to ophthalmologists
• Build economic and logistical models of self-sustainable eye care

Refractive errors can account for twice as many blind-person-years compared to cataract, due to the earlier age of onset.   While refractive error is amongst the most common cause of visual impairment, it is also the easiest to ‘cure’. Refractive error can be simply diagnosed, measured and corrected, and the provision of spectacles is an extremely cost-effective intervention, providing immediate correction of the problem.

Throughout the world optometry has been the major provider of vision correction, but usually from a private practice setting. In the Philippines, public health optometry has not reached the communities that are in most need in any organized way.  

It is not the lack of optometrists, in fact there are more optometrists than ophthalmologists in the country, but the lack of drive to bring optometry to the community; this is the main reason for high rates of vision problems due to uncorrected refractive errors.  

A problem too is that many organizations accept donated lenses and glasses from abroad given to communities for free.  Unfortunately these do not fit, are not suitable, and while these organizations give impressive figures of glasses dispensed, recipients do not use them as they do not fit.

It should not be necessary for any child to struggle in school with uncorrected refractive error. Nor should any older person be called upon to spend thirty or forty years without glasses, to see, to read, or sew, or to manage a job. Optometry and the optical industry should be able to find the financial resources to give this simplest gift of sight.

a)     AT BASE

We have found an optometrist to do school, church, and community based screenings.  The system worked well in the first few months and then the good thing came to end.   Finding more optometrists to continue is a challenge.  We now also have engaged ophthalmologists to help us. 

Screenings were done in:

• 20 public schools around Negros Occidental
• 2,021 children were screened
• 401cases were referred to our partner eye doctors
• 394 students were provided eye glasses and the project is on-going.  

 b)  OUTREACH

With our established partnership with very few but committed optometrists in some provinces we have been able to help address refractive errors in children and adults.  Good sign is that it continues to increase each year:

2008		2009
Spectacles dispensed
7,696		16,757	Adults
1,221		3,368	children
Referrals to optometrists
10,602	20,412		Adults
4,730	10,631		children