9 GA Hyderabad INDIA September 2012

1. It’s all about me! Optometry & Refraction A Ugandan Experience 9 GA Hyderabad INDIA September 2012

2. 517million uncorrected presbyopes+ 153 million people with uncorrected distance Rx = 670 million people are blind or vision impaired simply because they don’t have a pair of glasses Info Prof. Kovin Naidoo Total Global Burden of URE

3. DURBAN DECLARATION & DURBAN COMMITTMENT It was mainly due to the WCRE’s and the presentation of relevant studies that URE has been realised as a major cause of functional blindness and the biggest cause of visual impairment The results also opened the understanding that the cadre of optometrists has to play a much greater part in identifying and correcting vision loss The role of optometry dealing with URE as part of a comprehensive eye care team is presently reviewed and will newly be defined

4. INTERNATIONAL FORA VISION 2020 and the INTERNATIONAL COUNCIL OF OPHTHALMOLOGY (ICO) have both recognized the importance to address impact of URE: WHO established a Refractive Error Working Group (REWG), as part of global VISION 2020 activities The ICO task force on URE was formed mid 2007, only 4 months after the 1st WCRE was held in Durban – for the 1st time URE has been discussed in a cross cutting way to enhance service delivery including also optometrists as part of the eye care team Pilot programmes are: NIURE UGANDA CVC PAKISTAN SEHP PAKISTAN & NIGERIA

5. WHO PROVIDES REFRACTION SERVICES • Ophthalmologists • (Time , primarily Rx of eye diseases and surgeries) • Optometrists • (Time , specialized on URE) • OCO & OCO/Refractionists • (Mid-level training, generalist, part timer) • Ophthalmic Assistants • (Mid-level community training, spherical & readers) • Orthoptists • (Therapist - squints & amblyopia, no formal refraction training)

6. IDENTIFIED ROLES FOR OPTOMETRISTS in EYE CARE • Objective and subjective refraction at 2” & 3” level - Low vision • Paediatric refractions (time consuming, retinoscopy under anaesthesia) • Glaucoma screening and early detection • Identification/referral of Cataract and early detection of retinal diseases • Diagnostic of ophthalmic medical conditions & related systemic conditions (hypertension/diabetics) • Detection & correction of high RE with combination of high cylinders which OCO refractionist may not be able to handle at present

7. IDENTIFIED ROLES FOR OPTOMETRISTS in EYE CARE • Collecting data and analysis • Research to improve eye care services • Free ophthalmologists of work load for them be able to attend to difficult eye conditions and required intraocular surgery in public hospitals • Dispense contact lenses where applicable, especially for patients with keratoconus & keratoglobus

8. IDENTIFIED ROLES FOR OPTOMETRISTS in EYE CARE • Teaching HR in refraction and clinical low vision • Manage school screenings as part of child eye health – teachers training • Part of comprehensive eye care team • Develop & implement sustainable high quality optical service delivery models

9. CVC – CATALYST Services to detect and correct RE as part of a CVC by optometrists – excellent opportunity to also identify and refer serious eye conditions such as cataract, glaucoma, diabetes etc. Instant optical corrections offered by optometrists taking care of RE incl. presbyopia

10. MOSTLY SEEN REFERRAL SYSTEM Tertiary Level Secondary Level PHCW / VHT / CBR - workers Community

11. COMMUNITY VISION CENTRES (Envisaged) Secondary & tertiary Level Ophthalmologist, Optometrist and paramedical staff Community Vision Center Optometrist or Refractionist Community Based Rehabilitators Community

12. EXPERIENCE FROM UGANDA • By 2008 only 4 Ugandanoptometriststrained outside Uganda • NIURE, in collaborationwith OAU facilitatingtraining for 50 OCOs in refractiontobrigdegap of lack of optometrists in thecountry • Joint efforttogetoptometryprofessionrecognizedandapprovedbyservicecommission of the MoH • Start training of optometristsat Makerere University in September 2013 – approval of trainingcurriculumunderway • Government of Uganda hasbeenrequestedtocreateofficialpositionsat Regional level for optometrists

13. EXPERIENCE FROM UGANDA • Setting up a National opticalworkshopmanagedby an optometristat Entebbe Government Hospital withcodedframes • (June 2012 = 233 spectaclesdispensed via trained • OCO/Refractionists placed all overthecountry) • Spectacletechnicianstrainedbyoptometrists (6 months • trainingwithrecognisedcurriculum) • School eye healthactivitiesstarted in Entebbe Municipality • undertheleadership of optometrists

14. EXPERIENCE FROM UGANDA • Conclussionsandrecommendations: • Training of optometristsonlywithrecognizedcurriculum • Gov‘trecognition of profession imperative beforetraining • Creation of Gov‘tpostingat Regional andDistrictlevel • Optometriststobeincludedintocomprehensive eye careteams • Stratifiedplacement of optometristsimportant for accessibility

15. Optometrists Association of Uganda Optometr(y)-ists & Refraction Part of comprehensive eye care team!!!

16. RECOMMENDED LITERATURE Article: The role of optometry in VISION 2020 Brien A Holden PhD DSc OAM, Scientia Professor, International Centre for Eyecare Education (ICEE), PO Box 328, Randwick, NSW 2031, Australia Serge Resnikoff MD, Coordinator, Prevention of Blindness and Deafness, World Health Organization, CH-1211 Geneva 27, Switzerland Article: Delivering refractive error services: primary eye care centres and outreach Kovin Naidoo and Dhivya Ravilla

17. Thank you for your kind attention