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Background: Refractive errors are the commonest cause of vision impairment in Pakistan, but control efforts are hampered by a paucity of data for planning. To address these information gaps, a study design was developed to look at both the demand and supply sides. The objectives were to review the available human resources, determine the methods of provision of refractive services, determine the level and gaps in infrastructure available for refractive services, estimate the number of refractions provided and identify the training needs for these services. Methods: Stakeholder consultation between the National Steering Committee for Prevention of Blindness and the Pakistan Association of Opticians, to agree on objectives and method, desk research study, two population-based studies and situation analysis of refractive services provided by public and private sectors. Results: The prevalence of visually disabling refractive errors (visual acuity less than 6/12) is about 3.7% and rises with each decade after 30 years, mostly due to presbyopia. Over 6 million refractions are done annually by 868 ophthalmologists in the private sector, 235 hospitals, 1352 of the 2049 opticians and less than 200 optometrists. More than 2 million pairs of spectacles are dispensed per year. The training needs identified by opticians include optometry, refraction and contact lenses (65%), fitting of lenses and "edging" (57%), powering of lenses (45%), low vision (38%) and artificial eyes (35%). Conclusions: One of the strategies to control refractive errors is training and widespread deployment of optometrists/refractionists in public and private sectors. The current training programs cannot address the need; new programs must be set up, and existing programs must increase their intake. New programs are required for training dispensing opticians. [ABSTRACT FROM AUTHOR]

Contact lens (CL) complications account for 2.2-10.0% of patients attending ophthalmic Accident and Emergency (A&E) units. A survey was conducted to evaluate disease severity among CL wearers attending the Oxford Eye Hospital A&E Unit. CL wearers without a medical indication for CL wear completed a short questionnaire eliciting CL type and wear schedule. Subsequently, A&E Senior House Officers indicated the diagnosis and whether, in their opinion, the patient could have been managed by their optometrist or contact lens practitioner. Approximately halt ot the CL wearers (321/653, 49%) presented with CL related disorders, but only 16% (53/321) of these had potentially sight-threatening disease. More than a third of these patients were deemed to be inappropriately attending (125/321, 39%). presenting with minor problems such as corneal abrasions, CL handling difficulties and CL solution 'accidents'. Better patient instruction, together with encouragement to consult their optometrist or contact lens practitioner first if problems occur, would greatly reduce the burden of A&E attendance by CL wearers with minor complaints. [ABSTRACT FROM AUTHOR]

The article provides information on how to use the presbyopic contact lens safely. The author advises the opticians to explain the lens wearer regarding the predictable problems, which includes the initial reduction in comfort caused by the lenses usually being larger or thicker, and how to position the head and the eyes to make the most effective use of the lenses. The author also advises to avoid bifocals for first-time contact lens wearers and ensure that the patient is markedly presbyopic.