This lack of practitioners is the main reason for high rates of vision problems due to uncorrected refractive error in developing countries. However, in developing countries the ratio is 1:600,000, and much worse in many rural areas, up to millions of people per optometrist.
In most developed countries the optometrist to population ratio is approximately 1:10,000.
The opportunity now is for optometry to develop a concerted effort to create local capacity in these communities, in collaboration with its partners in Vision 2020, through service delivery, by creating human resources and by helping to develop the infrastructure needed, the three cornerstones of the Vision 2020 programme. Despite this, on their own initiative, thousands of private optometrists worldwide have regularly visited communities in need to provide vision care and dispense spectacles. Public health optometry has not reached the communities that are in most need in any organised way. Throughout the world optometry has been the major provider of vision correction, but usually from a private practice setting. Refractive error can be simply diagnosed, measured and corrected, and the provision of spectacles is an extremely cost-effective intervention, providing immediate correction of the problem. The good news is that while refractive error is amongst the most common causes of blindness and visual impairment, it is also the easiest to ‘cure’. Optometry's Role in Correcting Refractive Error The burden of refractive error is set to grow alarmingly due to an increase in myopia in both the developed and developing world, especially in urbanised East Asians, such as the Chinese populations in Hong Kong, Singapore and Taiwan. The burden even reaches to developed countries, with uncorrected refractive error causing 25% of all blindness (<6/60) in an Australian adult population and 56% of visual impairment (<6/12). 5 What is also disturbing is the amount of this refractive error that is uncorrected on presentation – 46% in Chile, 92% in Nepal, 58% in China, 86% in rural India. 6 For visual impairment in children (≤ 6/12 in the better eye), refractive error is responsible for 55% in Chile, 86% in Nepal, 93% in China, 70% in rural India, 7 and 83% in urban India. Studies have shown that refractive error in children causes up to 62.5% of blindness (≤ 6/60 in the better eye) in Chile, 3 22% in Nepal, 4 77% in urban India, 5 and 75% in China. The need is very great for both children and adults. The duration of the effect is also significant – refractive error can account for twice as many blind-person-years compared to cataract, due to the earlier age of onset. The most common cause of visual impairment, and the second leading cause of treatable blindness, 1 uncorrected refractive error has severe social and economic effects on individuals and communities, restricting educational and employment opportunities of otherwise healthy people. Visually disabling refractive error affects a significant proportion of the global population, occurring in both genders, in all ages and in all ethnic groups. The need to mobilise optometry to deal with uncorrected refractive error has been accompanied by the possibility of better integration of optometry into prevention of blindness in general, with some major benefits in areas such as: The realisation of the impact of uncorrected refractive error has provided the opportunity for optometry to play a major part in alleviating vision loss for those most in need. It is only recently that uncorrected refractive error has achieved prominence as a major cause of functional blindness and significantly impaired vision, as a result of landmark population-based studies in adults, children and in post-cataract patients.Īpart from individuals who have taken an active role in the elimination of diseases such as onchocerciasis or have been in cataract teams, optometrists have had little opportunity to take part in the front line elimination of four of the major, preventable blindness-producing conditions targeted by Vision 2020.
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