1. Missionary Vision Care Refractive Error Assessment Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

2. Missionary Vision Care Refractive Error Assessment Objective Methods – limited communication Retinoscopy Auto-refractor Subjective Methods – extensive communication Trail lens set Foropter (Phoropter) Focometer Near-point card for presbyopia Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

3. Missionary Vision Care Refractive Error Assessment Objective Methods Retinoscopy equipment and process http://eyeontechs.com/new/?p=308 (retinoscopy simulator) http://eyeontechs.com/new/?p=308 Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

4. Missionary Vision Care Refractive Error Assessment Objective Methods Retinoscopy assessment – Acquired skill – takes practice! – Limited by cataracts and other conditions – Sphere and astigmatic capable – Complex cases may stump you – May want a subjective confirmation – Little patient cooperation/communication needed Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

5. Missionary Vision Care Refractive Error Assessment Objective Methods Auto-refractor equipment and process Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

6. Missionary Vision Care Refractive Error Assessment Objective Methods Auto-refractor equipment and process http://kendall-optometry-ministry.com/kendall-optometry/ Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

7. Missionary Vision Care Refractive Error Assessment Objective Methods Auto refractor assessment – Mixed reviews from the field – Requires a large inventory, re-cycled glasses – Requires support staff – Low cost if equipment loaned – Low skill requirement but high information yield– “point and shoot” high-tech solution. – Requires little patient cooperation/communication Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

8. Missionary Vision Care Refractive Error Assessment Subjective Methods – all require a much higher degree of patient cooperation/interaction Trail lens set Foropter (Phoropter) Focometer Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

9. Missionary Vision Care Refractive Error Assessment Subjective Methods Trail lens set - equipment and process Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

10. Missionary Vision Care Refractive Error Assessment Subjective Methods Trail lens set assessment – Trail and error bracketing process (0.25-0.5 dia) – Sphere and Astigmatic capable – Slower than other methods – Low-tech: no electronics – Requires full patient cooperation/communication Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

11. Missionary Vision Care Refractive Error Assessment Subjective Methods Foropter (also spelled Phoropter) Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

12. Missionary Vision Care Refractive Error Assessment Subjective Methods Foropter Method #2 Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

13. Missionary Vision Care Refractive Error Assessment Subjective Methods Foropter methods assessment – Trail and error bracketing process (0.5 diopter) – Sphere and Astigmatic capable – Quicker than trial lenses – Low-tech: no electronics – Requires full patient cooperation/communication Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

14. Missionary Vision Care Refractive Error Assessment Subjective Methods Focometer - equipment and process Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

15. Missionary Vision Care Refractive Error Assessment Subjective Methods Focometer methods assessment – Continuous RE increments (0.25 diaopter) – Sphere and Astigmatic capable – Quicker than trial len but slower than foropter – Low-tech: no electronics – Requires full patient cooperation/communication Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

16. Missionary Vision Care Presbyopia Assessment (technically not RE) Subjective Methods Near-point card Age-guided trial and error method Mono or biometric approach Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

17. Missionary Vision Care RE Assessment Considerations – Duration of trip – Comfort level with the method – Degree of personal interaction desired – Cost of equipment and supplies – Glasses available to dispense – Support staff available – Experience: start simple and move up Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

18. Missionary Vision Care Vision Clinic End Results Hugs and smiles! Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

19. Missionary Vision Care Practical Considerations for Primary Vision Care Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

20. Missionary Vision Care Practical considerations for Primary Vision Care Biometrics vs. monocular exam Improvement vs. Optimization Glasses Dispensing Training and Supply Options Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

21. Missionary Vision Care Practical considerations for Primary Vision Care Biometrics vs. monocular exam – two schools of thought Which one is correct? Can you do harm? Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010 Eyes are often the sameEyes may be very different I want to see more patients to help more people I want to do the best I can on every patient The time invested only yields incremental improvements I’m happy to invest time to provide optimal correction I only have single vision, fixed frame glasses. I have the ability to build the needed glasses.

22. Missionary Vision Care Practical considerations for Primary Vision Care Biometric blending – Subjective best vision with both eyes Disregards astigmatism Disregards anisometropia (different refracting powers) Best chance of causing imbalance – Subjective or Objective assessment with tables Start with more positive, blend toward more negative Disregards astigmatism Avoids imbalance Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

23. Missionary Vision Care Practical considerations for Primary Vision Care Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

24. Missionary Vision Care Practical considerations for Primary Vision Care Improve vs Optimize – two schools of thought Which one is correct? Can you do harm? Are you missing opportunities to witness? Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010 Any improvement is a blessing The Lord’s service requires my very best effort. I want to see more patients to help more people I want to do the best I can on every patient The time invested only yields incremental improvements I’m happy to invest time to provide optimal correction I have an abundance of glasses to give away. I have the ability to build the needed glasses.

25. Missionary Vision Care Practical considerations for Primary Vision Care Jesus’ example? He certainly ministered to large groups, but His relationship-building touches were 1:1 – Matt 8: 14-16 = Healing Peter’s mother-in-law, then minister to ALL brought – John 3 = Nicodemus – born again; John 4 - Samaritan woman – living water – Luke 8:43 = Jairus’ daughter, but stopped in the crush, to find the woman. Her faith had healed her. – Mark 10:46 = Jericho, Blind Bartimaeus - one out of a multitude; spiritual sight – Luke 19 = Bethany on His way to the cross – Zacchaeus, stopped to be his guest Lesson: Jesus wasn’t in a hurry & He didn’t try to heal everyone. Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

26. Missionary Vision Care Practical considerations for Primary Vision Care Dispensing Glasses – Objectives – Best available fit : lenses and frames – Function before fashion (mirror?) – PD (pupillary distance) and optical center Induce prism/distortion The higher the strength the more important this is – System of organizing inventory to expedite, simplify and avoid errors. Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

27. Missionary Vision Care Practical considerations for Primary Vision Care Dispensing Glasses – Option 1 – Re-cycled: Lion’s Club with Salvation Army Assorted lenses and frames of all kinds Sorting, organizing and matching fit a challenge Least expensive supply, but large inventory required and greatest amount of preparation. Link with an inventory management system (Holland) Potential for optimal fit – sphere, cylinder and add power (bifocals) Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

28. Missionary Vision Care Practical considerations for Primary Vision Care Dispensing Glasses – Option 2 – Fixed lens, single-vision plus and minus Generally of lower quality (imports) May have the ability to swap out lenses Biometric blending approach – error potential Generally 1.0 diopter increments Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

29. Missionary Vision Care Practical considerations for Primary Vision Care Dispensing Glasses – Option 3 – Custom, single-vision plus and minus Generally of higher quality (imports) Option of pre-fitted or build your own Mono-optical approach – reduced error potential +10 to -10 range, 0.25 to 0.5 diopter increments Frame and lens style options Left/right or interchangeable lenses Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

30. Missionary Vision Care Practical considerations for Primary Vision Care Dispensing Glasses – Option 4 – Custom, single-vision +/- with cylinder Generally of higher quality (imports) Custom build frames and lenses Mono-optical approach – reduced error potential +4 to -4 range, 0.25 to 0.5 diopter increments Frame and lens style options Fully interchangeable lenses (reduced inventory) Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

31. Missionary Vision Care Practical considerations for Primary Vision Care Dispensing Glasses Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

32. Missionary Vision Care Practical considerations for Primary Vision Care Training Options (handout) – Eye Doc in a Box (Dr. David Curtis) Exceptional in basics, optics, foropter emphasis – InFOCUS/Visual Compassion (Dr. Joey Dollak) Exceptional in retinoscopy, biometric blending – Kendall Optometry Minisitry (Holland Kendall) Exceptional in auto-refractor, integration software to make use of recycled glasses Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

33. Missionary Vision Care Practical considerations for Primary Vision Care Material suppliers (handout) – Peachtree Optical (Mr. Jay Biggs) Custom missionary field kits, interchangeable +4.0 to -4.0 lenses for multiple frame sizes and styles – Good-Lite Company (Mr. Joe Villari) Vast supply of charts, equipment and supplies for missionary vision care. – InFOCUS/Visual Compassion (Mrs. Diane Baker) Retinoscopes, Focometers, lens and frame selections Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

34. Missionary Vision Care Tips for planning and conducting vision clinics Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010

35. Missionary Vision Care Tips for planning and conducting vision clinics – Connections on the ground – a must! – Organize/ Communicate, Organize/ Communicate, repeat – KISS approach – stay in your comfort zone – Arrive 2 days ahead of team for set-up – Limit the number of patient records allowed/day – Leave your watch at home – Involve others – you can’t do it all yourself – It will not go the way you plan – that’s OK! – Leave room for God – Pray! Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010