Refraction services in Outreach Programmes

Objectives To provide comprehensive eye care in outreach To extend refraction services even in rural areas To explain and prescribe appropriate glasses for the patients identified with Refractive error according to the patients age & occupation Correction of refractive error can help the people irrespective of age, literacy, rural or urban in order to improve the quality of life

Why should we do refraction? Type of camp Common age group No.of persons need eye glasses per 100 OP Comprehensive eye camp 50 and above 20 Workplace screening camp 30 and above 40 School screening camp 6 - 15 5 out of 100 children At least 50 out of 100 children identified by teachers On an average 15 persons need eye glasses out of 100 in community

Manpower requirement/ Competency of Refractionist Type of camp Expected no.of Outpatients No.of refractionists are posted Comprehensive eye camp 200 OP 2 Refractionist (1 senior and 1 junior) Workplace screening camp 200 Employees 2 Refractionists (2 seniors) School screening camp 200 Child (identified by teachers) 3 Refractionists (3 seniors – preferably from paediatric department) A trained refractionist (2 years and above) can do quality refraction on 60 to 70 Outpatients in a duration of 9 am to 2 pm

Requirements for Refraction Instruments and Equipment Cubicle (Rods and pipes to make cubicle structure, Black cloth for making dark room) Snellen chart (6 meters or 3 meters) Trial (Lens) set Trial frame Streak Retinoscope Inter Pupillary Distance ruler Electrical accessories 6 meters rope – to measure the distance Furniture and electrical connectivity are provided by camp sponsors in all the camps

Setting up Refraction Services Ensure there should be a dark room facility available Otherwise, a cubicle is set with dark cloth for refraction test as shown in the video clip Chart should have good illumination, bright, clear and position Distance between patient and chart should be 6 meters Cubicle should have adequate space ‘as patients waiting area’ – chairs for at least 10 patients Additional space is required for dilatation services Refractionists should set up the entire service with the help of medical team members or volunteers

Refraction Process Check the name, address, age and occupation Ask and listen to patient complaints Torch light examination for visible abnormalities Measure the VA with and without eye glasses (may be done in Vision Test) Measure the power if the patient is currently using eye glass Use Streak Retinoscope to identify refractive error Use trial lens to identify the right correction for refractive error. Prescribe power glass based on age and occupation - duly signed by Ophthalmologist or recognized technician Counsel the benefit of using eye glasses and guide the patient for optical Dilate refraction should be done for the first time users, patients below 35 years and the patients who are suggested by Doctors

MLOPs contribution in Screening Camp: Flow of Activities Minutes and % in total duration Visual Acuity 3 6% Case History 5 10% Intra Ocular Pressure 2 4% Refraction 10 20% Final by Doctor Optical sales Fitting the lens 15 30% Spectacle delivery Duration for Refraction and Spectacles dispensing services 50 100% About 95% of Refraction services is handled and managed by MLOPs in Outreach

Quality Assurance in Refraction The refraction reading should be written clearly in the case sheet. Quality retinoscopy – Details regarding shadow (IMC, Lens changes and Opacity) Duration of present glass and its power and present condition Have to mention the occupation in the case sheets IPD (Inter Pupillary Distance) measurement Prescribe glass according to their job If there is a change in power compare the PG with current PG Avoid overwriting

Role of Refractionist in outreach Aware of camp’s expected workload Ensure adequate number of supplies are taken in working condition Present at right time before departure Good relationship with optical technician to ensure that the patients received glasses with right specification and they are satisfied Coordination and relationship with Doctors to ensure that the patients got clarity on the conditions like GP requirement, IMC, Dilate RR, high astigmatism, etc. Ensure there is a good team work. Help in bottle necks in patients flow. Get the help of volunteers to facilitate reading ‘E’ chart in case of illiterate patients A senior technician can be a role model / trainer for the juniors for improving their skill

At the completion of Camp Dismantle the cubicles and other accessories Collect case sheets from OP, Counseling, Optical and Doctor table Segregating the case sheets based on Refraction done Refractive error Glass prescribed Same PG, Lens change, Immature cataract and Normal cases Return camp things to the stores in the same working condition Provide all related statistics to refraction and outreach departments for reports and analysis - standard format

Thank you