Barbara Boughton

November 05, 2009

November 5, 2009 (San Francisco, California) — Using a combination of autorefractors and ready-made glasses, researchers at the Bascom Palmer Eye Institute at the University of Miami in Florida have developed a simple, efficient, rapid, and low-cost method to screen people in developing countries for refractive errors. If adopted, the method could benefit millions worldwide, said researchers here at the American Academy of Ophthalmology Joint Annual Meeting With the Pan-American Association of Ophthalmology (AAO-PAAO).

Refractive errors are a leading cause of poor vision in developing countries, and worldwide more than 314 million people have visual impairment that is less than or equal to 20/60 in their best eye, said Thomas Shane, MD, from the Bascom Palmer Eye Institute. More than 50% of those with such visual impairments have no access to eyeglasses, he added.

Seeking a simple low-cost solution that would not require trained ophthalmologists or opticians, Dr. Shane decided to combine the use of portable autorefractors with vision charts and inexpensive ready-made glasses that cost just $8 each.

In the space of 5 days, researchers were able to screen 385 patients, 12 years and older, in a rural Mayan village in the Toledo district in southern Belize, and provide ready-made spectacles for 62 people with bilateral refractive error and astigmatism of 1 diopter or less in at least 1 eye. In less than a minute per patient, the autorefractors can assess vision and report new lens prescription. Results indicated that visual acuity in those outfitted with glasses improved an average of 4 lines and the average visual acuity in the best eye was 20/25 after treatment.

"The combination of autorefractors with ready-made glasses is a new method that we tried in an effort to bring down cost, time, and training involved for screening patients for refractive error," Dr. Shane said. Of the 79 patients with refractive errors in the study population, 78% were able to be treated with ready-made glasses. The rest had astigmatism of greater than 1 diopter, which could not be treated with ready-made lenses.

The advantages of the method developed by the researchers at the Bascom Palmer Eye Institute include its low cost and efficiency and the fact that advanced training isn't needed. In countries where ophthalmologists and opticians are in short supply, local healthcare workers could perform the screenings in community clinics. The use of ready-made glasses with contemporary frames also increases patient compliance. By contrast, donated glasses are often outdated and damaged and are less preferred by patients, Dr. Shane said. There is also considerable cost involved with collecting, cataloguing, and warehousing thousands of donated glasses.

"This is a problem that we can solve cheaply and easily," Dr. Shane said. As well as helping to solve the problem of vision impairment in many communities, it could also give a boost to local economies by employing greater numbers of healthcare workers, he said.

"The concept of screening patients in their home environments and providing them with inexpensive glasses is a wonderful way of helping large numbers of people," said Bronwyn Bateman, MD, professor of ophthalmology and pediatrics at the University of Colorado School of Medicine in Denver, and a former president of the PAAO. "It's an approach that could be easily tried in very poor countries where people don't even have enough money to take the bus to the city for medical care," she said. "Hopefully, an organization like [the United States Agency for International Development] might support this kind of program," she said.

Although the method developed by the Bascom Palmer Eye Institute researchers would be helpful in developing countries, it might not be suitable for underserved areas in the United States because of issues involving liability and standard of care, since healthcare workers would not be conducting complete eye exams on patients, Dr. Shane said. Dr. Bateman agreed: "It would be cost-effective, but people might feel that it's not first-grade treatment, and that would be a sensitive issue."

The study was funded by the Bascom Palmer Eye Institute. Drs. Shane and Bateman have disclosed no relevant financial relationships.

American Academy of Ophthalmology Joint Annual Meeting With the Pan-American Association of Ophthalmology (AAO-PAAO): Abstract PO476. Presented October 26, 2009.