Refractive Error: The African Situation Daveena Brain: ICEE Africa Program Manager

AFRICA

Issues confronting Africa Data Human Resources Infrastructure Access to technology and spectacles

Difficulties with Current Data Non-uniform definitions across studies Non-representative study populations (convenience rather than population- based) Dissimilar demographics of study population (age and sex) Refraction procedures are different (with/without cycloplegia etc) Negrel, Ellwein, 2001

Negrel et al. (1995) Blindness in Benin Population based study: 7047 examined Prevalence of blindness: 0.6% 9.6% of blindness is due to refractive errors

International Centre for Eyecare Education 0.7% Blindness < 3/60: Low vision (best acuity 6/24 - 3/60): 1.4% (11% due to RE) AFRICA: The Gambia Faal et al., 1989 Need for BasicEst. no. of people Ophthalmic Servicesin need of treatment Cataract surgery5,500 Eyelid surgery4,600 Need spectacles (distances)4,600* Medical eye treatment83,000 Other surgical or medical treatment6,500 Need for BasicEst. no. of people Ophthalmic Servicesin need of treatment Cataract surgery5,500 Eyelid surgery4,600 Need spectacles (distances)4,600* Medical eye treatment83,000 Other surgical or medical treatment6,500 * Does not include presbyopes who may need spectacles for close work, or those needing glasses after cataract surgery.

Ethiopia Zerihun & Mabey(1997) Population based: 7423 examined Blindness: 0.85% Low Vision(<6/18-3/60): 1.7% 28.8% of low vision due to RE

Refractive Errors study in Urban schools in Moshi (B. Shilio) <6/9 11.8% <6/12 2.2% <6/18 1.9% < 6/18-6/60 1.6% < 6/ %

DISEASES CATARACT REFRACTIVE ERRORS TRACHOMA VIT A DEF ONCHOCERCIASIS DIABETIC RETINOPATHY GLAUCOMA OTHER DISEASES % < 5 % % % South Africa

Blindness =1.0% Low vision = 1.4% FACTORS AFFECTING BLINDNESS PREVALENCE INKwaZulu, SOUTH AFRICA Cook et al, ,090 screened 268 full exam 10% of blindness due to refractive errors Only 11.8% of people with RE had spectacles

REFRACTIVE ERROR STUDY IN CHILDREN(AFRICA) Purpose: assess the prevalence of vision disorders in children 5-15 years(5599 enumerated) address the issue of access of care in several settings

4890 Children Examined Urban to semi urban area Myopia: 2D

Myopia vs Hyperopia: RESCA

PROJECTIONS FOR AFRICA

People needing Spectacles 10% of population 70.2 million need correction 7.2 million have correction 63 million do not have correction in Sub Saharan Africa

Projected Situation for Tanzania Population 35, Estimated refractive error 3.5 million Children % population, 15.9mill –Est Myopia – 636,000 –Est Hyperopia – 413,400 Estimated presbyopia 8,4 million

HUMAN RESOURCES

WHO Provides the Services? Ophthalmologists Optometrists Ophthalmic Nurses Ophthalmic Assistants

REFRACTIONISTS: SUB-SAHARAN AFRICA * Population703m1400m Eye Exams Needed (10%) 70.3m140m Refractionists needed (1: ) 70,000140,000 Current7,00011,000 Extra needed63,000129,000

AFRICA: The Needs by 2020 Need : 129,000 refractionists

Tanzania Has the largest percentage of Optometrists in the public sector of any country in the world The infrastructure present at KCMC means that significant advances and improvements in eyecare for the people of Tanzania can be achieved

Spectacles

SPECTACLES Inaccessible Complicated delivery systems Expensive

SPECTACLES: NEEDS LOW COST READY MADES DECENTRALISED OPTICAL LABS COLLOBARATIVE BUYING TO REDUCE COSTS: –ICEE/SIGHTSAVERS MODEL

The ICEE Response Community Optometrist Model: Unique due to number of public sector optometrists Refraction Training Train the Trainer Low Cost Spectacles Research: understand the problem and develop alternative approaches –Situational Analysis

THANK YOU

Hyperopia with Autorefraction: Multicountry

Myopia with Autorefraction: Country Comparison

Number of Ophthalmologists and OMAs Optometrists: –SA: 2100 –Nigeria: 1100 –Tanzania: 350 –Ghana: 75 –Kenya: 10 –Zimbabwe: Ophthalmologists(47/million pop/21 countries x 703 million) 3620 OMAs(103/20x703 M) Extra 250 per year

WEST AFRICA OPHTHALMOLOGISTS OPHTHALMIC NURSES/ASSISTANTS NO OPTOMETRISTS

OPTOMETRISTS Untapped Resources Need to bring them into the system

Current Programs Nigeria: 600 optometrists and 200 ophthalmologists South Africa: 2000, only 30 in the Public sector Tanzania: 170 optometrists, 30 Ophthalmologists Other countries with programs: Ghana, Sudan

What is Needed? Flexible Approach: Mobilise all e Utilise available resources Integrate into a longterm strategy Multiple Approaches Affordability Comprehensive Eye Care plan Sustainability