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Up Front | Oct 2008

International Council of Ophthalmology: Task Force on Uncorrected Refractive Errors

Ophthalmologists should play an active role in reducing the magnitude of uncorrected refractive errors.

Ophthalmologists have the primary duty of providing patients with the best possible visual function. However, a recent review of the prevalence of visual impairment and blindness (using the definition of presenting vision instead of BCVA) uncovered the actual magnitude of uncorrected refractive errors in patients today.

In March 2007, the first International Congress on Uncorrected Refractive Errors was held in Durban, South Africa, with approximately 650 participants. The resulting Durban Declaration recognized that 153 million people worldwide have an uncorrected refractive error (not including presbyopia). The declaration further recommended working together to develop comprehensive eye and health care services; correct refractive errors; and provide good quality, affordable glasses to patients with untreated refractive errors. It emphasized the need to prioritize communities, countries, regions, and individuals in the greatest need, including school-age children and adults above 45 years, especially women.1

The International Council of Ophthalmology (ICO) endorsed the Durban Declaration at its meeting in Cape Town, South Africa, and constituted its own task force on uncorrected refractive errors in 2007.2 The objective of the task force was to strengthen the involvement of the ophthalmic community and other professions to meet this huge challenge. The task force membership includes ophthalmologists, researchers, and program managers with fairly equal representation worldwide. The task force set the following terms of reference:

  • Identify the magnitude of uncorrected refractive errors and the unmet need for refractive services geographically;
  • Provide guidelines to operationalize the concepts of the Durban Declaration;
  • Review existing models for meeting the public needs;
  • Develop and promote successful models of service delivery and their adoption and implementation in different countries; and
  • In collaboration with other stakeholders, define and promote guidelines for curriculum development for training in refraction.

The task force has held two formal and one informal meeting to prepare a 5-year strategic plan highlighting the roadmap to guide the ophthalmic profession.

Data collection. Data are lacking on the severe magnitude of uncorrected refractive errors and the lack of services to correct them. The World Health Organization (WHO) recently published data suggesting that 153 million people over the age of 5 years are visually impaired as a result of uncorrected refractive errors.3 Of these people, 8 million are blind. However, there is a need to complement these data. We must disaggregate the numbers and provide a comprehensive analysis of the infrastructure and human resources available in each country.

Advocacy. The unmet challenge of uncorrected refractive errors must be a high priority on the agendas of supranational, regional, and national ophthalmic societies. Dedicated sessions at ophthalmic congresses must address the issue of uncorrected refractive errors, and ophthalmologists must be willing to provide leadership roles in advocating for policy formulation, human resource development, and service provision. Research must be an integral part of the national comprehensive eye care programs.

Pilot program development. Pilot programs for human resource development, service delivery, advocacy, public health education, research, and sustainability must be implemented. Such programs are key to surmount the needless burden of uncorrected refractive errors. Our profession must develop programs in collaboration with other sectors and organizations that expand upon the culturally acceptable and sustainable models of service delivery. Such programs should be replicated in all parts of the world so that service is available as early as possible.

Human resource development. One of the key areas addressed in our 5-year strategic plan is human resource development. We must focus on standardizing the core curricula for all cadres and identify the relevant training institutions that offer such training. Those ophthalmologists playing a leadership role can provide a platform for networking, thus bringing stakeholders together to comprehensively develop human resources and address the issues of curricula and cadre development.

Public health education. One area needing considerable work is educational material. A lot of material is already available, and the task force is in the process of compiling and standardizing materials for worldwide dissemination. Such materials should be available at hospitals and universities in departments of ophthalmology, ophthalmic clinics, and at other primary eye care locations. It is the prime responsibility of ophthalmologists to educate their patients on the availability of screening and correction of refractive errors.

Sustainability. The task force will develop guidelines on sustainability, allowing affordable service delivery for patients who may not be able to pay for services on their own. Sustainability will be addressed comprehensively as we look at issues of technical, professional, leadership, and financial sustainability. Guidelines will be tested in pilot programs.

Research. Research—especially in the form of operational research—must be carried out on the costs, quality of life, barriers to spectacle wear, and cost effectiveness of such initiatives to correct refractive errors.

With some of the strategies mentioned in this article, we hope that ophthalmologists will welcome an active role in reducing the magnitude of uncorrected refractive error. It will take the entire eye care profession—cataract surgeons, refractive surgeons, retina specialists, glaucoma surgeons, optometrists, and opticians alike—to provide diagnostic and corrective services for patients with uncorrected refractive errors. This service must become, if it has not already, an integral part of comprehensive eye care services.

The magnitude of patients with an uncorrected refractive error is overwhelming, and the developmental, economic, and quality-of-life implications are far-reaching. As leaders of the vision care profession, ophthalmologists worldwide must address the concerning topic of uncorrected refractive errors and provide enlightened leadership in meeting the challenge of correcting these errors.

Mohammed Babar Qureshi, BMBCh, DOMS, MSc, is the Chair of ICO's Task Force on Uncorrected Refractive Errors, and the CEO and Executive Director of Comprehensive Health and Education Forum International. Dr. Qureshi may be reached at tel: +92 91 5851186; fax: +92 91 5700365; e-mail: mbqureshi1@gmail.com.