Abstracts & presentations

Sunday 8th August 2004

Monday 9th August

Ethical issues concerning the delivery of vision care to poor and disadvantaged populations, specially developing countries

Prof. Norman Bailey
University of Houston, USA

No abstract available.

> the presentation is not available

Can we really provide mass vision correction by letting people do it themselves

Prof. Joshua Silver
University of Oxford and Adaptive Eyecare Ltd., UK

We have been working on a simple and inexpensive method of vision correction which should obviate the need for large numbers of highly trained personnel. Though globally applicable, this method has an immediate application in the developing world. The method utilises an adaptive lens and effectively piggy-backs on the eye-brain adaptive optical system. We have tested the concept in several developing world countries and are about to deploy a mass-produced device. Some results of our field research and some projections will be presented.

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Joshua Silver is a Professor of Physics at the University of Oxford in England. He is an atomic physicist and has done all the usual things atomic physicists do, and he also taught Physics at New College, Oxford as a Fellow for the past 25 years. However, he is also a bit of a thinker, and has invented a few things over the years. He got interested in lenses, the focal length of which can be easily altered (adaptive lenses) in the mid-80s, and this led him by a sort of "back-door" into vision and vision correction. He has carried out and published some work on self-vision correction using so-called adaptive spectacles, and shown that this is likely to be a promising technology for mass vision-correction at very low cost.

The dynamics of effective distribution of affordable eyewear

Prof. Dan Sheni
President of the World Council of Optometry, South Africa

Eye wear is a multimillion euro industry and several companies are involved in it. Affordable eyewear is not a new concept but the design is new. To compete effectively in the global market and still provide affordable eyewear to the needy population, one must have an effective distribution network. This paper discusses options for distribution of affordable eyewear at the international, national and local levels. Factors that could influence the cost and acceptance of the eye wear are also mentioned. The paper concludes that the cost of affordable eye wear should not be more than 1/10th of the average monthly income of the target population.

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Professor DDD Sheni is an optometrist with a masters and doctorate in physiological optics from University of Waterloo Canada. He was the first African to have a PhD in optometry.
Prof. Sheni invented an instrument to measure fusional limits, for which he obtained a patent. He has 24 years of teaching experience in optometric schools in three different nations. He has published several papers in international acclaimed journals.
Prof. Sheni is currently the president of the World Council of Optometry. He has been a Fellow of the American Academy of Optometry since 1981. He is also a Fellow of the South African Optometric association and a Fellow of the Nigerian optometric association.

Preventing blindness due to refractive errors in Nigeria

Dr. Faustina Idu and Dr. Uduak Udom
University of Benin and Nigerian Optometrist Association, Nigeria

Visual impairment is a global problem which is more pronounced in developing nations. Nigeria, located in West Sub-Saharan Africa, has a population of 125 million. 72% of this are classified poor, with over 35% of the population living below the US$1 per day poverty level, particularly more pronounced in the rural areas. The following factors play a major role in causing visual impairment: low education, poor socioeconomic status, unscientific cultural beliefs & practices, and poor environmental status. Refractive errors are easily corrected with the use of spectacles and low vision aids, but there is lack of access to affordable spectacles in a country with a gross per capita income of $290, where an eye examination plus a moderate pair of glasses would cost about $200. The two major refractive disorders impacting most on the quality of life and education are myopia and presbyopia, apart from aphakia. In a survey, aimed at determining the impact of vision correction on quality of life of recipients, vision testing and correction was carried out in 2 different rural communities, Onna and Edo, located in the south-east and mid-west of Nigeria respectively. The population included students, farmers, watch repairers, tailors, commercial vehicle drivers, teachers and traders. In Onna, a population of 996 (422 males and 574 females) within the age range of 28 to 62 were tested. 58% of these had refractive errors, 50% of which were given free spectacles. In Edo, a population of 573 (205 males & 368 females) within the age range of 11 to 83 were tested. 67% had refractive errors, and 90% were given free spectacles. Follow up revealed that 68% of the recipients who got spectacles, interviewed one month after, expressed tremendous improvement on quality of life, having returned with good vision to their jobs of sewing, shoe mending, watch repairs, driving, teaching, reading their bibles, able to sing from hymn books in church, plus studies at the adult education centres. 24% reported headaches while using their reading glasses - mainly from uncorrected astigmatism - and 8% expressed complete dissatisfaction. The survey results clearly show that vision correction, if made available and affordable in a country like Nigeria, will significantly impact positively on the quality of life of those who cannot afford the services. This will be achieved by: 1) enhancing employment and employability; 2) reducing poverty by increasing income earning opportunities; and 3) facilitating participation in socio-political processes, thereby preventing social exclusion.

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Dr. Faustina Idu was born on the 1st of May 1964. She obtained a Bachelor of Science degree in Optometry from the University of Benin, Benin City, Nigeria in 1985. She also obtained the Doctor of Optometry OD degree and a Master of Science degree in Medical Physiology from the same University in 1998 and 2001 respectively. Dr. Idu is a member of Faculty of the Department of Optometry, University of Benin, Nigeria where she is involved in teaching and researches in Basic Vision Sciences and General Optometry. She is involved in public health and charity organizations where she joins in vision screening and distribution of spectacles and visual aids to the lessed priviledged. She is a member of executive of Women Optometrists in Nigeria.

Tackling the challenge of presbyopia at the community level - the story of Scojo Foundation

Mr. Graham Macmillan
Director, Scojo Foundation, USA

There are over 1.3 billion people, aged 35 and up, who suffer from an easily correctable condition - presbyopia. In the West and more affluent urban centers, presbyopia is easily overcome by purchasing a pair of simple reading glasses available in pharmacies, grocery stores, and even bookstores. Today, however, most people in developing countries do not have access to affordable reading glasses. Without having a simple pair of reading glasses, a person’s livelihood becomes negatively affected because he or she can no longer see clearly. People such as tailors need them to thread a needle; mechanics need them to diagnose a problem in an engine; bookkeepers need them to distinguish a three from an eight. Without clear vision, these people are greatly challenged to remain economically productive members of their communities while maintaining a decent quality of life.

Scojo Foundation was founded three years ago to broaden global access to affordable reading glasses by increasing the number of people with access to reading glasses, creating jobs for local entrepreneurs, and facilitating access to comprehensive eye care services. Scojo Foundation’s model, developed and tested in India, El Salvador and Guatemala, trains local women entrepreneurs in two days to screen members of their local communities and sell them high-quality, affordable reading glasses. In addition to dispensing reading glasses, Scojo’s women entrepreneurs also are trained to refer patients with more complex eye problems to institutions that are able to provide more in-depth eye examinations. What is truly unique in Scojo’s model is the ability of the women entrepreneurs to double their monthly income selling these reading glasses to their family, friends, and neighbors. Furthermore, Scojo Foundation is able to capture enough resources through the sales of these glasses to sustain its activities. It is truly a win-win scenario for all involved.

This presentation will articulate the impact of presbyopia on people living in the developing world while explaining the innovative model Scojo Foundation has developed to create local markets for reading glasses by overcoming barriers of product quality, affordability, and, most importantly, accessibility.

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Graham Macmillan, Director, is responsible for the day-to-day management of Scojo Foundation. Mr. Macmillan has over seven years of experience managing international development programs, most recently with Helen Keller International as Director of Business Development for the ChildSight program. He is also a partner at Lane’s End Stables, LLC, a family-owned equestrian enterprise in New Jersey. Mr. Macmillan received his Bachelor of Arts in International Studies and History from Colby College and his Master of Science in Management of International Public Service Organizations from New York University’s Robert F. Wagner School for Public Service.

Instant eyeglasses from Eye Deal Eyewear

Mr. David Dunaway
Executive Director of InFocus, USA

Instant Eyeglasses is a term used by Eye Deal Eyewear of Sarasota, Florida, USA to describe the combination of round frames with round lenses that snap into the frames without edging. Three features of Instant Eyeglasses are notable. First, in remote settings where people are unable to affordably travel for the purpose of attaining more fashionable frames (or any kind of eye care), round frames are generally accepted. Second, the round frames allow an eye care worker to assemble glasses with astigmatic correction on the spot. Finally, the manufacturing process employed by Eye Deal produces lenses that have acceptable optical characteristics at a very low price.

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David W. Dunaway is the Executive Director of InFOCUS. He earned a Bachelor’s degree from Texas A&M University and a Master’s degree in Public Administration from The University of Houston. He specialized in disease control while earning a Master of Public Health degree from the University of Texas School of Public Health.

Dunaway founded Lori Nayanjyot, Pvt. Ltd., an Indian company providing primary eye care and new prescription eyeglasses through a network of mobile and fixed-location providers. He co-founded Houston Optical and Ophthalmic Technologies (HOOT). HOOT works to improve equipment manufactured by low-cost suppliers so that it will be acceptable on world markets. He has served for 10 years as the Associate Director of the Committee for Rehabilitation Aid to Afghanistan. In that capacity, he raised almost three million dollars for development projects. Mr. Dunaway has advised 11 Chinese Provincial Ministers and Assistant Ministers of Health on primary eye care systems. He is an authority on developing country water and wastewater systems and has served as a volunteer for the International Medical Corps.

Use of spherical lenses for adult refugees on the Thailand-Burma border

Dr. Jerry Vincent
International Rescue Committee, Thailand

The International Rescue Committee’s Border Eye Program supports eyeglass distribution in 10 remote refugee camps scattered over several hundred kilometers of the Thailand - Burma border. We have trained refugee health workers to conduct basic subjective refractions in adult patients and dispense spherical lenses as needed. These services are provided in each camp at weekly eye clinics which provide single vision spherical lenses in half-diopter steps from +1.00 D to +4.00 D and from -1.00 D to -2.50 D.

In 2001, these eye clinics documented 9,238 patient contacts and distributed 7,219 eyeglasses. Of the lenses given, 6,534 (91%) were plus power and 685 (9%) were minus power. Of the plus lenses used, 5,504 (84%) were given for presbyopia, 404 (6%) were given for hyperopia, and 625 (10%) were given without the reason being documented. We found a need for lens powers higher than we provide in only 92 cases during the year, and as anecdotally we have found very little astigmatism in this population, our small range of spherical powers covers most lens needs for this population. An external evaluation confirmed that eyeglass recipients are appreciative of the improved vision provided by our program.

We purchase these eyeglasses locally at costs of $1.00 - $2.00 per pair. Taking into account all program and administrative costs related to the eyeglass distribution, our total cost per eyeglass recipient in 2001 was just under $4.50.

Our program provides a basic, appropriate and acceptable level of vision correction at a very reasonable cost for over 200,000 refugees and displaced persons who would otherwise not have access to care. With nearly one billion people estimated to be in need of vision correction, simple and low cost methods, such as we present here, are needed to serve marginalized populations in resource poor settings.

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Jerry Vincent completed his Doctor of Optometry degree from the University of Houston in 1984. Between 1984 and 1990, Jerry held optometric faculty positions in Nigeria, Puerto Rico and Houston. He was involved in numerous humanitarian eye missions in Latin America, and completed a Masters in Public Health degree from the University of Texas.
Since 1990, Dr. Vincent has been based in Southeast Asia, working to assure eye care for refugee, displaced and war affected populations. Currently Dr. Vincent works for the international Rescue Committee, where he provides primary eye care and blindness prevention related technical support to refugee health programs in over 20 countries.
Jerry is a frequent speaker and lecturer for students and professionals in optometry, public health and refugee relief. He has worked in a variety of eye related programs and academic positions in Africa, Latin America and the Caribbean. Then he completed a Master's in Public Health and the University of Texas, and since 1990, I have been based in Asia, working with Refugee, Displaced and War-Affected populations.

The partnership for child development and FRESH: focusing resources on vision

Dr. Helen Roberts
The Partnership for Child Development, UK

The Partnership for Child Development is an academic based research organisation, with offices in the Department of Infectious Disease Epidemiology, Imperial College. We deliver technical support to donor agencies and NGO’s in the field of child health. We are an information network through web-based services, for documents relating to child health and we monitor and evaluate school based health services. As such we are also one of the supporting partners of FRESH: Focusing Resources on Education and School Health, a framework for school health and nutrition programming. The aim of this presentation is to describe how FRESH works and how the flexible nature of this framework allows it to be synergised to fit many problems. To illustrate this, our deworming interventions in Zambia will be used and a new programme we are starting in Eritrea will show how other problems, including vision, can be targeted within the FRESH framework.

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Dr. Helen Roberts is presently the scientific coordinator for the Partnership for Child Development andresponsible for developing training courses in school health and nutrition programming. She has a BSc in Zoology from Imperial College, a PhD in Parasitology from Imperial College and over 12 years experience in parasitology research, both laboratory and field based, in the UK, Australia and South America.

Strategies for the provision of refraction, corrective eyewear and primary care for the vast population of medically under-served in Tanzania

Dr. Valerian Lyimo
Tumaini University School of Optomertry, Tanzania

Although excellent resources available for vision care in Tanzania have evolved over the past few decades, approximately 80 per cent of the nation's 30 million population remain disenfranchised with limited or no access to refraction and affordable spectacles. With an optometry school, in excess of 200 optometrists in practice, a major factory capable of producing finished lenses and spectacles, there is a potential for delivery of adequate service. Under the leadership of the Tanzania Ministry of Health, in order to develop a plan for implementation of the World Health Organization Vision 2020 goals for vision care (refraction and eyeglasses), new service modalities had to be considered.

Ad hoc vision "screening" camps, volunteer projects (such as Vision Aid Overseas or Lions Eyeglass Distribution, and outreach vision screening programs were considered inadequate to meet the need. Permanent, community-based vision care programs are considered the solution. Among the approaches tried to implement these in Tanzania have been the ICEE (International Center for Eye Care Education ) community outreach vision care projects and InFOCUS community-based Vision Stations, both in collaboration between optometry and other non-governmental development agencies committed to rural and congested urban population health status improvement.

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Dr Lyimo graduated at the school of Optometry at the Tumaini University at the Kilimanjaro Christian Medical centre, back in 1982. Then the following year he attended a special orientation optometry program at the City University in London under a close supervision of the late Professor Dunn. Back in Tanzania he was assigned to teach at the school of optometry. After five years of teaching Dr. Lyimo was sponsored by World Health Organisation (WHO) to undertake an OD special program at the University of Houston Texas, under very close supervision of Professor Ian Berger. Then he joined a Health Education Masters Program at the University of Texas Southern University also in Texas and graduated in 1993.He returned to Tanzania and continued teaching at the School of Optometry. In 1998 Dr. Lyimo was sponsored by the International Association of Contact Lenses Educators (ICEE) to undertake teachers training in contact lenses in South Africa, this program was run at three universities namely; Rand Africaan, University of Durban Westville (now University of Kwazulu Natal) and the University of the North, where he was privileged to work closely with the Current WCO President, Professor Shenni. Currently he Dr. Lyimo teaches at the Tumaini University School of Optometry. He is also the current President of the Tanzania Optometric Association.

Is there a need for astigmatic lenses in the developing world?

Mr. Anthony Carlson and Prof. William Harris
Rand Afrikaans University, South Africa

To what extent do spherical compensations satisfy the visual needs of people in the developing world? While the answer is Yes in many cases there are certainly people who would benefit by having astigmatic compensations. This paper will examine the issues.

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Qualified as an optical technician, Mr. Carlson was involved in the wholesale side of the optical industry for approximately 15 years. He started at RAU in 1988. He then did the British dispensing course (ABDO) and qualified as dispensing optician. Mr. Carlson then studied Optometry and is now a qualified optometrist. He is involved in the Optometric Science Research Group at RAU that is headed by Prof Harris. His main interests are the optics of ophthalmic lenses and community optometry. He was involved in some field trips with Adaptive Eyecare headed by Prof Josh Silver.

The prospects of affordable astigmatic spectacle lenses

Prof. William Harris and Mr. Anthony Carlson
Rand Afrikaans University, South Africa

It goes without saying that compensation of the spherical part of refractive errors is important in developing societies. But that ignores astigmatism. This paper will explore the possibility of providing affordable astigmatic compensation. Because of the nature of astigmatism the challenge is considerable. The presentation will begin by defining astigmatism. It will then describe two broad possibilities for compensation of astigmatism, surface deformation and rotation of lens pairs. The latter will be treated in more detail. Some examples will be shown.

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WF Harris is Professor in the Department of Optometry and Chairman of the Optometric Science Research Group. He holds a PhD in biophysics from the University of Minnesota. Currently his research interests concern astigmatic visual optics and he is the author of 200 odd peer-reviewed papers. He is a Fellow of the American Academy of Optometry. He is a recipient of the Garland W Clay Award of the FAAO and of the Peter Abel Award of the German Association of Contact Lens Specialists. He is a Fellow of the Royal Society of South Africa.

Adaptive Eyecare - a development perspective

Mr. Julian Lambert
Senior Health Adviser, Department For International Development (DFID), UK

No abstract is available.

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World-wide distribution of refractive errors and what to expect at a particular location

Dr. Ian Berger and Dr. K. Mistry
InFocus, USA

The incidence of refractive errors has generally been considered to be distributed in adults to conform to a binomial variation curve, or as a "normal" distribution. Indeed, as Baldwin showed in 1964 with a comparison of six studies on large populations a "family" of normal distributions, but with means shifted towards hyperopia for youths. Studies by Hirsch, Sorsby, Morgan and Blum revealed that the leptokurtotic curve toward hyperopia during the preschool years tends to become symmetrical at the age of 10 to 11, and to skew toward myopia thereafter.

As for the actual incidence of refractive errors, great variation has been observed among almost any categorization of human beings. In a classic study of the incidence of myopia among 11 different racial groups in Hawaii by Crawford and Hammar in 1949, the percent myopic ranged from 17 percent in Chinese to 3 percent in Polynesians. Even using "intellectual" grouping, Ware in 1913 found only 3 of 1,300 military school students compared with 32 of 127 students at Oxford who had myopia greater than one diopter.

Recent studies have continued to show variations among groups, such as reported this year in the Archives of Ophthalmology that data from 29,281 people in the US, Western Europe and Australia over 40 years of age showed a prevalence for hyperopia (+ 3D or greater) of 9.9 percent, 11.6 percent, and 5.8 percent, respectively, and for (myopia - 1D or less) 25.4 percent, 26.6 percent and 16.4 percent. Kassa and Alene found only 7.6 percent of 1,134 pre-school and school children with spherical refractive errors in two rural Ethiopian towns. Of particular interest, the Dandona et al study in 1999 of refractive errors in an urban population in southern India showed, among observations of all types of refractive errors, about 13 percent with astigmatism. They concluded that if the data were extrapolated to the 255 million urban population of India, among those greater than 15 years of age an estimated 30 million people would have myopia, 15.2 million hyperopia, and 4.1 million astigmatism, not concurrent with myopia or hyperopia. Indeed, InFOCUS teams in the process of training village-based primary health care staff to establish local community based vision stations have found pockets (10 percent or more) of astigmatism among villagers with greater than - 2 D cylinder and as much as - 10 D cylinder at higher rates than for spherical refractive errors. This was particularly evident in meso-American northeast Mexican, Guatemalan and southern Nicaraguan populations. Anticipating a supply of corrective eyewear should take into account the possible need for cylindrical correction, rather than just spherical equivalent.

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Kavita Mistry is a Therapeutic Optometrist practicing in Corpus Christi, Texas, who is periodically engaged with epidemiologic research, primary eye care training workshops, and ophthalmic preventive eye health education in conjunction with the InFOCUS Center for Primary Eye Care Development, an international non-profit program working in partnership with the World Health Organization.
Dr. Mistry was trained first in microbiology and genetics, graduating (Magna Cum Laude) from the University of Wales in Great Britain. She then earned degrees in Optometry (O.D.) from the University of Houston and International Health from the University of Texas (M.P.H.).
Born in Kampala, Uganda, Dr. Mistry is familiar with the struggle of developing countries and poor populations throughout the world to gain an adequate standard of health care, and has proven her concern with distinguished work in many countries, including Uganda, Tanzania, Nigeria, Burkina Faso, India, Guatemala and Mexico. Among the many honors she has received for her dedication include her "Recognition for International Eye Care Development" from the Universidad Autonoma de la Laguna in Torreon, Mexico.
In the United States, besides being an active participant with the American Optometric Association program Vision USA, Dr. Mistry serves on the Advisory Boards of Head Start, the Coastal Bend AIDS Foundation, and InFOCUS.

Dr. Ian Berger studied Mathematics / Premedical at St. Lawrence University, New York; Biophysics at The Rockefeller University / Adelphi University, New York; Institut de Bessis, Paris; Karlsberg Laboritorium, Copenhagen. He also studied Medicine / Public Health at Yale University, New Haven and Public Health at University of Texas, Houston.
Dr. Berger is currently President of InFOCUS (Interprofessional Fostering of Ophthalmic Care for Underserved Sectors) and Director of InFOCUS Center for Primary Eye Care Development, Houston, Texas. He is also a Senior Lecturer (Preventive Medicine) at the University of Dar es Salaam, Dar es Salaam, Tanzania and a Visiting Associate Professor (International Health and Optometry) at the University of Houston, Texas. Dr.Berger is also Adjunct Professor (International Health) at the University of Texas Health Science Center, Houston, Texas

South African children with oculo-cutaneous albinism need affordable vision correction

Prof. Alabi Oduntan
University of the North, South Africa

Oculo-cutaneous albinism is a common condition in Sub-Saharan Africa, especially at the Southern regions, and individuals with the condition generally have significant refractive errors. This paper presents the refractive status of South African children with oculo-cutaneous albinism, with the aim of highlighting the magnitude of the errors and the need for affordable vision care for the children.

Attempt was made to measure refractive errors for 153 South African children with oculo-cutaneous albinism aged between 7 and 16 years (mean = 10.29 ± 2.2 years) using retinoscopy and subjective refraction. Due to high sensitivity of the children to the retinoscopic light, the objective values were considered less reliable, hence the values presented here are those of the subjective findings. Myopia was present in 63.18%, while hyperopia occurred in 35.4% and emmetropia occurred in 1.42% of the children. The spherical equivalent powers of the refractive errors ranged from -12.00 D to + 2.75 D for the right eye and -8.00D to +3.25 D for the left eye (Mean = 1.46 ± 2.3 D and -1.36 ± 2.3 D for the right and left eye respectively).

Many of these children have significant refractive error requiring spectacle correction to improve their vision. However, many of them are from poor families where they cannot afford the average cost of spectacles. Like their normally pigmented counterparts, these children will greatly benefit from affordable eye care services, unfortunately such services are not currently available in South Africa.

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Professor Alabi O. Oduntan, B.Sc. (Hons), PhD. (Optometry); affiliation: University of the North, South Africa

Update and models of humanitarian eye care delivery

Dr. Harry I Zeltzer
Executive Director of VOSH/International, USA

Dr Zeltzer will discuss new methods and organizational changes that will achieve those goals.

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Harry I Zeltzer OD, DOS (Hon), FAAO has practiced public health optometry since 1985. He is the executive director of VOSH/International, an organization committed to meet the challenges of VISION 2020.

Impact of NGOs on eye care in Nigeria

Dr. Okechukwu Aloysius Anyanwu
Nigerian Optometric Association
(presented by Dr. Ian Berger)

According to the World Bank, an NGO is a non-profit making, voluntary, service-oriented/development-oriented organization, either for the benefit of the members or of other members of the population; a social development organization assisting in the empowerment of the people, etc. However, these organizations have influenced largely on the general well-being of developing countries in Africa and beyond in many aspects of human endeavor, eye-care is one of the beneficiaries.

These agencies are usually relief and welfare in definition, and acts very well in shortages of goods and services. They are immediate in time frame, special in scope. These explain why they are specific in nature, orientation and logistics. As laudable as these agencies may be in terms of service, there is a yearning demand to shift from this approach to a more systematic systems of development and strategic management. A shift from donation of spectacles, basic eye examinations and treatment in specific communities to a more planned sustainable coordinated eye-care that ensures availability, accessibility, and affordability as articulated by vision 2020 - the right to sight.

This presentation will X-ray all these, and in the end attempt to proffer solution in terms of public enlightenment, training, development of human and material resources that would go a long way to working out a pattern of cooperation with the NGOs on one hand, benefiting communities and the government on the other hand.

Finally, government, both nationally and internationally have roles to play when one considers the enormous cost of blindness. A concerted effort as in that of AIDS would also improve eye-care in poor communities.

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The real issues pertaining to eye care in India

Dr. Ajeet Bhardwaj
OPTIQUE Eye, Ear and Speech, India

India has 12 million people which is 25% of global blindness. 50% of those who need vision correction are not even aware.

Ironically 80% of this can be prevented. We always say that it is the infrastructure, resources and lack of Eye care professional which is the cause on increasing blindness in India.

"What are the real issues? His presentation will highlight the real issues pertaining to eye care in India.

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Ajeet Bhardwaj is an optometrist graduated from All India Institute of Medical Sciences (AIIMS), New Delhi, India. He worked in Nigeria for 8 years as a consultant Optometrist within a chain of Eye Hospitals and Optical services and returned to India to establish his own practice. He has four Optometry practices in New Delhi and is involved with various national and international optometry organizations.
Currently he is the President of National association called NAIO (National Association of India Optometrists) in India. Dr. Bhardwaj is also the President of APCO (Asia Pacific Council of Optometry) which is dedicated to improvement of optometry education in the Asia Pacific Region. He is in the Governing Board member of World council of Optometry and the Director of VOSH-India and Clinical Director of Special Olympics Opening Eyes program in India. He is the Chairman of sight first program of Lions International program in New Delhi and coordinates various Eye camps in and around Delhi.