2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61728-0.pdf

Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010

https://research-information.bris.ac.uk/ws/files/259213304/PIIS0140673620309259.pdf

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

https://hull-repository.worktribe.com/preview/1797952/1-s2.0-S0140673618322797-main.pdf

Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)61766-8.pdf

A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010

Worldwide, there are over 640 million people who are vision impaired, simply because they do not have access to a simple eye examination and a pair of spectacles.1 With 43% of vision impairment being due to uncorrected refractive error,1 it is no wonder that there have been increased efforts to improve service delivery in this area. However, a recipe for successfully and predictably ‘scaling up’ (expanding) programmes to provide eye examinations and spectacles to everyone in need has thus far remained elusive. There have been different confi gurations used when expanding refractive error services, some of which have seen optometrists and refractionists integrated as core members of the eye care team, and others in which they have worked outside this team. Regardless of the confi guration, we believe that a team approach to refractive error care will create a collaborative and enabling environment which will ultimately benefi t patients. In a team approach (Figure 1), personnel at the community level – such as community health workers – can conduct health promotion and screening activities to encourage individuals to seek eye examinations for refractive error. It will also detect those who need to be referred. At the primary level (eye clinic), personnel such as nurses can screen and separate refractive from non-refractive patients (the pinhole is particularly useful in this respect), and provide presbyopic correction for those whose vision impairment is not caused by distance refractive error or ocular disease. At the secondary level, comprehensive refractive examinations should be provided by optometrists, ophthalmic clinical offi cers and other mid-level personnel trained for this purpose. Ophthalmologists should be deployed at this level in cases where they are the primary refractive personnel in the country. At the tertiary level, preand post-operative refraction of patients, management of conditions such as keratoconus, and other medical-related contact lens fi tting can be provided by optometrists in a co-management agreement with ophthalmologists. These personnel will also work closely with specialised clinics such as advanced low vision services or rehabilitation services. A team approach to refractive error care ensures that eye health workers all identify themselves as part of a team. Each team member’s role must be clearly defi ned by the needs of the health system within which they work, while maintaining their primary professional role. Consideration must be given to the complementary nature of the job of each member and their inter-dependency in the team.1 Adopting a team approach to eye care helps to optimise staff experience, knowledge and skills. For example, as optometry is increasingly being integrated at regional and district hospitals, there is an opportunity to shift tasks like refraction, low vision, ocular disease screening, pre-operative assessment and post-operative follow-up examinations to optometrists (or to ophthalmic technicians or ophthalmic nurses, where they are available). This will free ophthalmologists to focus on surgery and the management of disease. Some aspects of refractive services may be ‘task shifted’ to others, e.g. nurses screening for myopia, hyperopia and presbyopia. Prescribing presbyopia spectacles for individuals who have good distance vision and no obvious pathology could take place at this level, and appropriate referral protocols should be defi ned. A team approach and task shifting requires the eye care system to provide the appropriate training required by different health workers so that a good quality service can be provided at all levels, and more patients can be seen. One example of a fl exible training approach is provided by the Regional School of Optometry in Malawi, set up by a partnership comprising the Brien Holden Vision Institute, SightSavers and Optometry Giving Sight. It consists of two programmes:

/pdf/a-team-approach-to-providing-refractive-error-services-3vp79f2ebd.pdf

A team approach to providing refractive error services.

Myopia is already a major public health challenge. In 2015, an estimated 480 million people worldwide were considered blind or visually impaired because they did not have access to spectacles,3 making myopia the leading cause of visual impairment and blindness worldwide. By 2050,2 myopia is expected to affect 5 billion people, which is half of the projected global population at that time. This will place an even greater burden on health services to provide spectacles and to prevent and manage the conditions associated with high myopia.

Myopia: a serious condition that needs our attention.

Prevalence of Refractive Error and Spectacles Coverage in Zoba Ma’ekel, Eritrea

/pdf/addressing-the-burden-of-uncorrected-refractive-error-in-1nh7ako9vc.pdf

Addressing the Burden of Uncorrected Refractive Error in Mozambique

The global prevalence of blindness and vision impairment due to uncorrected refractive error amplifies the need for the delivery of refractive services. Effective strategies need to be employed in order to ensure that they leave an impression on the landscape of refractive error blindness and vision impairment. The approaches must be systematic and evidence-based. Recent studies which plot the refractive error challenges impress upon practitioners across the eye health gamut the need to effect change immediately in an effective, sustainable and equitable manner.

Innovative Approaches in the Delivery of Eye Care: Refractive Errors (Including Presbyopia)

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