1. Considerations in integrating optometry into regional VISION 2020 plans

2. Meeting needs of the population Magnitude of the needs not well-understood; however, presbyopia is universal. Other refractive errors (myopia, hyperopia) not as common in Africa as in Asia, Europe. Convenience and affordability important to rural Africans (part of comprehensive approach)

3. Meeting needs of the population…..therefore: A population based approach is necessary (few rural people needing optometric services will come to the big city) A comprehensive approach is necessary (a one-stop shop) Nevertheless, we must recognize that we cannot reach everyone who needs the service (75% a reasonable target?)

4. Integrating refractive services into regional VISION 2020 plans Part of cost recovery & sustainability programme of DRS programme Paying salary of community optometrist based upon sales would be in conflict with salary structure for other eye care staff and cause conflict How do we manage in areas where there are no optometrists?

5. Paying for refractive services Capacity and willingness to pay are important considerations in pricing People want spectacles of good quality and appear to be willing to pay for them Offering spectacles free-of-charge undermines willingness to pay and discourages sustainability of programme How do we deal with short-term want to do good but clueless as to the issues visitors?

6. Obtaining spectacles Sourcing ready-made spectacles How do we deal with donated spectacles? How do we manage patients who require specially made spectacles?

7. Management and accounting Need for setting up an account in the hospital for eye care related activities Funds generated from spectacles, cataract surgeries, eye drops are mixed together but need to be accounted separately. Allocating funds for purchase of spectacles and cases Building skills in management and accounting important

8. Refractive needs of children should be addressed separately Screening of secondary schoolchildren should be viewed as a separate activity and done at a school Children love an eye examination but few actually need it (glasses as a status symbol?) Low vision needs difficult to assess in the field

9. Potential research questions Who actually pays for the spectacles? (person needing them, family members?) Is there any gender disparity in purchase of spectacles (among those who need them)? How do presbyopic spectacles change quality of life and visual function of the elderly? What are the most important tasks?