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A team approach to providing refractive error services.

Naidoo K, Govender P - Community Eye Health (2014)

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Affiliation: Global Programmes Director: Brien Holden Vision Institute, Durban, South Africa.

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Worldwide, there are over 640 million people who are vision impaired, simply because they do not have access to a simple eye examination and a pair of spectacles... With 43% of vision impairment being due to uncorrected refractive error, it is no wonder that there have been increased efforts to improve service delivery in this area... However, a recipe for successfully and predictably ‘scaling up’ (expanding) programmes to provide eye examinations and spectacles to everyone in need has thus far remained elusive... There have been different configurations used when expanding refractive error services, some of which have seen optometrists and refractionists integrated as core members of the eye care team, and others in which they have worked outside this team... In a team approach (Figure 1), personnel at the community level – such as community health workers – can conduct health promotion and screening activities to encourage individuals to seek eye examinations for refractive error... For example, as optometry is increasingly being integrated at regional and district hospitals, there is an opportunity to shift tasks like refraction, low vision, ocular disease screening, pre-operative assessment and post-operative follow-up examinations to optometrists (or to ophthalmic technicians or ophthalmic nurses, where they are available)... A team approach and task shifting requires the eye care system to provide the appropriate training required by different health workers so that a good quality service can be provided at all levels, and more patients can be seen... It consists of two programmes: a conventional four-year BSc optometry degree that trains individuals for public and private sector deployment. an optometric training diploma which is delivered over 3 years and allows graduates to provide refractive services and eye care in the public sector, where the need is greatest... Ideally, decisions should be informed by evidence-based, context-specific research to determine feasibility and impact... One example is the ‘Giving Sight to KZN’ project supported by Standard Chartered Bank... This involved the integration of refractive error services into the district health system in KwaZulu-Natal, South Africa... Whatever the situation, we should not compromise on a team approach and should instead actively seek integration with other components of the health system... The very success of our efforts depends on this.

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Figure 1. One example of how members of a refractive error team could work together
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Figure 4: Figure 1. One example of how members of a refractive error team could work together

Mentions: In a team approach (Figure 1), personnel at the community level – such as community health workers – can conduct health promotion and screening activities to encourage individuals to seek eye examinations for refractive error. It will also detect those who need to be referred. At the primary level (eye clinic), personnel such as nurses can screen and separate refractive from non-refractive patients (the pinhole is particularly useful in this respect), and provide presbyopic correction for those whose vision impairment is not caused by distance refractive error or ocular disease. At the secondary level, comprehensive refractive examinations should be provided by optometrists, ophthalmic clinical officers and other mid-level personnel trained for this purpose. Ophthalmologists should be deployed at this level in cases where they are the primary refractive personnel in the country. At the tertiary level, pre- and post-operative refraction of patients, management of conditions such as keratoconus, and other medical-related contact lens fitting can be provided by optometrists in a co-management agreement with ophthalmologists. These personnel will also work closely with specialised clinics such as advanced low vision services or rehabilitation services.


A team approach to providing refractive error services.

Naidoo K, Govender P - Community Eye Health (2014)

Figure 1. One example of how members of a refractive error team could work together
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4194845&req=5

Figure 4: Figure 1. One example of how members of a refractive error team could work together
Mentions: In a team approach (Figure 1), personnel at the community level – such as community health workers – can conduct health promotion and screening activities to encourage individuals to seek eye examinations for refractive error. It will also detect those who need to be referred. At the primary level (eye clinic), personnel such as nurses can screen and separate refractive from non-refractive patients (the pinhole is particularly useful in this respect), and provide presbyopic correction for those whose vision impairment is not caused by distance refractive error or ocular disease. At the secondary level, comprehensive refractive examinations should be provided by optometrists, ophthalmic clinical officers and other mid-level personnel trained for this purpose. Ophthalmologists should be deployed at this level in cases where they are the primary refractive personnel in the country. At the tertiary level, pre- and post-operative refraction of patients, management of conditions such as keratoconus, and other medical-related contact lens fitting can be provided by optometrists in a co-management agreement with ophthalmologists. These personnel will also work closely with specialised clinics such as advanced low vision services or rehabilitation services.

View Article: PubMed Central - HTML - PubMed

Affiliation: Global Programmes Director: Brien Holden Vision Institute, Durban, South Africa.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Worldwide, there are over 640 million people who are vision impaired, simply because they do not have access to a simple eye examination and a pair of spectacles... With 43% of vision impairment being due to uncorrected refractive error, it is no wonder that there have been increased efforts to improve service delivery in this area... However, a recipe for successfully and predictably ‘scaling up’ (expanding) programmes to provide eye examinations and spectacles to everyone in need has thus far remained elusive... There have been different configurations used when expanding refractive error services, some of which have seen optometrists and refractionists integrated as core members of the eye care team, and others in which they have worked outside this team... In a team approach (Figure 1), personnel at the community level – such as community health workers – can conduct health promotion and screening activities to encourage individuals to seek eye examinations for refractive error... For example, as optometry is increasingly being integrated at regional and district hospitals, there is an opportunity to shift tasks like refraction, low vision, ocular disease screening, pre-operative assessment and post-operative follow-up examinations to optometrists (or to ophthalmic technicians or ophthalmic nurses, where they are available)... A team approach and task shifting requires the eye care system to provide the appropriate training required by different health workers so that a good quality service can be provided at all levels, and more patients can be seen... It consists of two programmes: a conventional four-year BSc optometry degree that trains individuals for public and private sector deployment. an optometric training diploma which is delivered over 3 years and allows graduates to provide refractive services and eye care in the public sector, where the need is greatest... Ideally, decisions should be informed by evidence-based, context-specific research to determine feasibility and impact... One example is the ‘Giving Sight to KZN’ project supported by Standard Chartered Bank... This involved the integration of refractive error services into the district health system in KwaZulu-Natal, South Africa... Whatever the situation, we should not compromise on a team approach and should instead actively seek integration with other components of the health system... The very success of our efforts depends on this.

No MeSH data available.


Related in: MedlinePlus