Strategies needed to meet the global challenge of uncorrected refractive error
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SAN FRANCISCO — Active outreach, education and ensuring that spectacles are available at an affordable cost are key strategies to address the challenge of uncorrected refractive error globally, according to a speaker.
Effective coverage begins with “proactive discovery, not just sitting in your clinic, but going out and finding patients, leaving no child or patient behind,” M. Scott Hickman, MD, MSc, said at the American Academy of Ophthalmology meeting.
Based on The International Agency for the Prevention of Blindness definition of blindness, which is vision of 20/400 or worse, there are currently 43 million people with blindness globally. Of this group, 3.7 million are blind due to uncorrected refractive error and 1.5 million are children. If individuals with moderate to severe visual impairment, defined as visual acuity worse than 20/70 but greater than or equal to 20/400, are included, the number grows to 157 million people with uncorrected refractive error, of which 22 million are children.
“One thing I don't think we talk enough about is the economic cost of vision loss, of the global potential productivity loss of uncorrected refractive error — $244 billion, and the cost of correcting that is $28 billion,” Hickman said.
During the presentation, a pre-recorded video from Shalinder Sabherwal, MD, showcased the strategy implemented by an eye hospital network comprised of a tertiary care hospital in Delhi, seven surgical centers in north India, and 74 primary eye care centers.
Sabherwal discussed the story of Vikas, a child studying in a school in an urban area around Delhi. Poor vision was heavily impacting his school performance, but his parents could not afford to take him to an ophthalmologist.
“Because his story is not unique ... we conduct school screening programs. Primary screening of vision is done by screeners trained on using Peek Acuity, a validated Android app. Any child detected with vision less than 20/30 in either eye is examined by an optometrist in school, who is part of the team,” Sabherwal said.
Children detected with simple refractive errors are dispensed glasses in school, while those requiring cycloplegic refraction or further examination are referred to the nearest primary eye care center. Children requiring a surgical opinion are examined by a pediatric ophthalmologist visiting at the vision center periodically, and only those requiring vision therapy or surgery are referred to the surgical center.
Last year 200,000 children were examined via the screening program, 90% of which had never been screened earlier.
“Coming back to Vikas, he was detected with astigmatism, which after correction gave him a vision of 20/30. In fact, his smiling face says it all,” Sabherwal concluded.
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Hickman MS, et al. Refractive error challenges and opportunities. Presented at: American Academy of Ophthalmology meeting; Nov. 3-6, 2023; San Francisco.
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