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More than 80 delegates from around the world gathered in London recently for a one-day conference tagged on to the annual general meeting of charity Vision Aid Overseas. Speakers from the UK and Africa delivered a variety of messages under the umbrella of 'eye care and primary health development' but including themes ranging from clinical communication skills and technology advances in education, to the delivery of eye care in difficult to reach parts of Africa.
Innovations
Professor David Thomson (City University and Thomson Software Solutions) began his discussion of innovation in optometric education by establishing a fact that kept recurring throughout the day - that the most common cause of poor vision throughout the world was uncorrected refractive error.
Professor Thomson stated that the goal for any optical education must be to develop sustainable and appropriate eye care services. He then described the state of optometry training in the UK and suggested that the current state of affairs was expensive and in future universities were likely to be more focused on either teaching only or research only.
He said there might be moves to all-year-round teaching and a two-year degree. This would likely involve more technology (online resources for example) and leave less redundant elements in the syllabus. Among the many drivers for a more efficient teaching and training model for future eye care practitioners was the demographic time bomb of an increased proportion of the population over a certain age and therefore more likely to have eye disease.
He listed the advantages of distance learning:
? Low cost (after initial development) ? Delivery by small staff team (remotely)
? Minimal facilities required
? Accessibility from anywhere
? Study tailored to individual circumstances.
However, there were disadvantages such as:
? Lack of interaction (so less effective for teaching concepts)
? Unsuitability for teaching practical skills
? Possibility of domestic distractions and so self-discipline and motivation required
? Lack of support
? Dependence on technology
? Modality was new and largely unproven.
Global sight loss
Dr Robert Lindfield (London School of Hygiene and Tropical Medicine) developed the theme of global causes of blindness. He said the most common cause of blindness globally was cataract (51 per cent of cases reported in 2010), with uncorrected refractive error contributing to just 3 per cent of the cause. However, if one considered visual impairment (the cases where a reduction in vision prevented someone from undertaking activities they would have been able to with full vision), uncorrected refractive error was now the greatest cause, contributing to a massive 42 per cent of visual impairment, as compared with 33 per cent as a result of cataract. In total there were 1.17 million people blind from refractive error, and 118.5 million visually impaired from refractive error.
Interestingly, global figures differed markedly from UK figures, as age-related macular degeneration accounted for just 1 per cent of global visual impairment. This was, of course, because of the higher impact globally of infective causes and conditions of earlier onset. The highest prevalence of uncorrected refractive error was in China (4.43 per cent prevalence), as compared with 4.07 per cent for India and 1 per cent for Africa.
Dr Lindfield revealed the startling figure that there were an estimated 410 million people globally who experienced disability due to presbyopia, and 94 per cent of them lived in low to middle income countries. There were an estimated 10 million smart phones in Uganda among the 35 million population - presbyopia was a significant threat.
View from Africa
Consultant primary care optometrist and immediate past president of the African Council of Optometry Dr Uduak Udom gave a useful overview of eye care in Africa. Sub-Saharan Africa was still the poorest region of the world, with the highest proportion of the population subsisting on less than $1.25 per day. She cited Kofi Annan who stated that 'the biggest enemy of health in the developing world is poverty'. For this reason, voluntary healthcare services in the developing world were indispensable. However, the nature of these services was important. Problems arose if care was not integrated. There was also a tendency for a 'hit and run' approach, whereby service was provided for a short time only. This lack of sustainability not only limited access to healthcare but might exacerbate problems as people awaited a future provision rather than accessed care when needed.
Another important point was that eye care programmes needed to involve the recipients, improve education at site, and be sustainable. New and ready-made glasses at subsidised cost were preferred to recycled spectacles for better value and 'self-respect'.
Dr Godwin Ovenseri-Ogbomo (Cape Coast University) looked at effective strategies on the ground and emphasised the importance of a continued and sustainable approach employing local resource.
The event was rounded off by Bill Harvey (Optician clinical editor) who reviewed the ways non-verbal information was conveyed in any clinical interaction and reminded the audience of the very variable nature of interpretation depending on cultural and social background. ?
This was a successful conference that hopefully will become a regular event. ?