1. Refraction services in Outreach Programmes

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Thank you