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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]

An alternative to the use of printed grading scales for assessing the severity of contact lens-induced ocular pathology is to use computer-generated grading morphs. This technique involves manipulation of a continuously variable movie sequence until this matches the severity of the condition being observed. To validate the use of computer morphs, nine experienced optometrists were each invited to grade - to the nearest 0.1 increment - an image of each of 16 contact lens complications, using printed scales (Efron Grading Scales for Contact Lens Complications) and computer morphs (Efron Grading Morphs). This entire procedure was repeated approximately 2 weeks later, yielding a total data base comprising of 576 individual grading estimates. Good accuracy was achieved using computer morphs, as evidenced by the similarity between the mean of the test and retest grading estimates for the printed scales (2.8 ± 0.7) and the computer morphs (2.6 ± 0.8) (F[SUB1.8] - 2.7, p - 0.14). There was no difference in median reliability between the printed scales (±0.41) and the computer morphs (±0.43) (Z - 0.1, p - 0.95). Computer rnorphs are thus considered to have been validated in view of their accuracy and reliability compared with printed scales. In addition, computer morphs offer considerable utility in terms of computer-based clinical record keeping, teaching and learning. and clinical research. [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 several updates related to the eye care industry. According to the article, Eye-care firm, Alcon Inc., has asserted that its fourth-quarter earning rose on higher sales of prescription drugs. In addition, Essilor of America Inc., leading manufacturer of ophthalmic lenses, has announces the availability of its Thin&Lite high-index product. Furthermore, the Canadian Association of Optometrists have also revealed that their Motion M-409 bill was passed unanimously in the Parliament.

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.