Considerations in integrating optometry into regional

VISION 2020 plans

Meeting needs of the population

• Magnitude of the needs not well-understood; however, presbyopia is universal.

• Other refractive errors (myopia, hyperopia) not as common in Africa as in Asia, Europe.

• Convenience and affordability important to rural Africans (part of comprehensive approach)

Meeting needs of the population…..therefore:

• A population based approach is necessary (few rural people needing optometric services will come to the “big city”)

• A comprehensive approach is necessary (a “one-stop shop”)

• Nevertheless, we must recognize that we cannot reach everyone who needs the service (75% a reasonable target?)

Integrating refractive services into regional VISION 2020 plans

• Part of cost recovery & sustainability programme of DRS programme

• Paying salary of community optometrist based upon sales would be in conflict with salary structure for other eye care staff and cause conflict

• How do we manage in areas where there are no optometrists?

Paying for refractive services

• Capacity and willingness to pay are important considerations in pricing

• People want spectacles of good quality and appear to be willing to pay for them

• Offering spectacles free-of-charge undermines willingness to pay and discourages sustainability of programme

• How do we deal with short-term “want to do good but clueless as to the issues” visitors?

Obtaining spectacles

• Sourcing ready-made spectacles

• How do we deal with donated spectacles?

• How do we manage patients who require specially made spectacles?

Management and accounting

• Need for setting up an account in the hospital for eye care related activities

• Funds generated from spectacles, cataract surgeries, eye drops are mixed together but need to be accounted separately.

• Allocating funds for purchase of spectacles and cases

• Building skills in management and accounting important

Refractive needs of children should be addressed

separately

• Screening of secondary schoolchildren should be viewed as a separate activity and done at a school

• Children love an eye examination but few actually need it (glasses as a status symbol?)

• Low vision needs difficult to assess in the field

Potential research questions

• Who actually pays for the spectacles? (person needing them, family members?)

• Is there any gender disparity in purchase of spectacles (among those who need them)?

• How do presbyopic spectacles change quality of life and visual function of the elderly? What are the most important tasks?