Speaker: Ophthalmic professions must address uncorrected refractive error together
ORLANDO, Fla. – Optometrists, ophthalmologists, optical technicians and orthoptists must work together to address the problem of uncorrected refractive error around the world, Kovin Naidoo, OD, MPH, PhD, FAAO, said here at the American Academy of Optometry’s plenary session.
The event focused on the World Health Organization’s recently released World Vision Report, and Primary Care Optometry News was a sponsor.
“We know there’s marginalization, either consciously or unconsciously, by ophthalmologists and optometrists about political battle,” said Singapore-based Naidoo, Essilor’s senior vice president for vision impact for philanthropy, former CEO of the Brien Holden Vision Institute and an editor of the World Vision Report.
“We don’t engage orthoptists and optical technicians,” he continued. “We should be looking at whether we should bring in our optical colleagues as part of our fraternity. We’ve adopted an adversarial approach. We need a new system in the way we see eye care.”
Naidoo said he has lived and worked in the developing world, but was trained as an optometrist in the U.S.
“I’ve seen both sides,” he said. “ My biggest pain about all of the work we’ve done in this space is that we fail to bring these different things together. We tend to want to be in different camps.”
He said the WHO report quantifies vision impairment due to refractive error based on a visual acuity cutoff of less than 6/12.
“This report states the number of people suffering from uncorrected refractive error in 2018 is 2.7 billion people, based on a 6/9 visual acuity cutoff to establish a needs-based model,” Naidoo said. “The WHO report doesn’t say we don’t address others’ needs, but we need to target people who cannot function or work because their vision is so bad.”
Globally, the relevance of optometry in public health systems is lacking, he said.
“There’s marginalization, pockets of success, but lack of scale,” he said.
The public health system of a country does not necessarily comprise only government components, Naidoo said.
“Private optometry, which is the majority of our profession in the developed world, is very much a part of the public health system,” he said.
Challenges include a limited number of optometrists, difficulties in producing optometrists, maldistribution and scope of training, he said.
Naidoo said optometrists in Kenya were opposing the training of some rural care givers.
“I asked the optometrists if they would go into these areas to provide care,” he said. “They said no, so let’s train people to increase access to services.”
The expertise of optometrists in the U.S. “is a huge public benefit to the world if we can export that in an effective way,” Naidoo said.
With uncorrected refractive error as the second leading cause of blindness, optometry has, “an opportunity to change the numbers like no other profession in the world,” Naidoo said.
By 2050 half of the world’s population will be myopic, with 10% of those people having high myopia.
“That is in your hands and my hands,” he said, and it covers all aspects of eye care.
“It’s about research, clinical services with myopia control, it’s about public health ensuring there’s access,” Naidoo said. “You have to get to that kid quickly. Access is important. The quicker they get the prescription, the quicker we can control the myopia group.”
He noted that the government in Taiwan is instituting laws requiring schoolchildren to have 2 hours a day outdoors.
“It’s creating a new advocacy option to place optometry on the center stage of eye care for us to make a difference to our world,” Naidoo said.
“In the modern world, there will be two major public health issues, myopia and diabetes,” he continued. “Diabetes is growing; it’s tracking myopia. Myopia is firmly in our hands. Diabetes impacts our patients in significant ways and will add to the blindness and vision impairment data unless we ensure the scope of care you provide is the scope of care every poor person in the world is getting access to – dilated fundus exams during intervention, exams on a regular basis.”
School eye health has been on the global health and education agendas, Naidoo said.
“One of the biggest budgets Essilor spends is to support school eye health programs and to support optometrists to do programs in the U.S. for children who cannot afford eye care,” he said. “This is an agenda that the world report is talking about, and you and I are involved in this.”
We need to think differently to support the need around the world, Naidoo said.
“We need to connect primary vision care providers to qualified optometrists and ophthalmologists who remotely oversee the refraction process in real time,” he said. “Using a telerefraction platform with a table/mobile phone, they have a trial lens set, an objective measurement device and an acuity chart. Technology doesn’t have to be our enemy; it can be an opportunity. Local people could have local businesses providing these services.”
Naidoo concluded: “Optometry should review the report as an opportunity, not a challenge.” – by Nancy Hemphill, ELS, FAAO
McMahon T, et al. Plenary session: Today’s research, tomorrow’s practice, WHO World Vision Report, opportunities for optometry to make an impact. Presented at: American Academy of Optometry meeting; Orlando, Fla.; October 23-27, 2019.
Disclosure: Naidoo is employed by Essilor.