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To assess clinical competency of 1-year trained vision technicians (VTs) in detecting and referring causes of visual impairment in India.Eye examination results and management plans for 328 patients examined by 24 VTs in 24 vision centers of LV Prasad Eye Institute in Andhra Pradesh were compared with those of a standard optometrist who examined the same patients. Eye examinations included retinoscopy and subjective refraction, slit lamp examination, applanation tonometry and undilated direct ophthalmoscopy. Data were analyzed for level of concordance in retinoscopy, spectacle prescription, disease detection and referral.VTs demonstrated moderate to good levels of agreement in refraction, disease detection and referral. Sensitivity and specificity for ocular pathology identification were 77.4% (95% confidence interval, CI, 69.4-84.2%) and 86.6% (95% CI 81.1-91.1%), respectively. The highest sensitivity was demonstrated in detecting significant cataract (91.5%) and refractive error (83.0%). VT spectacle prescriptions were accurate 76% of the time for mean spherical equivalent and 65% of the time for astigmatism. VT sensitivity in detecting posterior segment abnormalities was low (18.5%) resulting in failure to detect retinal conditions such as diabetic retinopathy and maculopathy. Despite lack of recognition of the specific pathology, referral decisions were correct in 78.4% of cases.VTs in India competently detect and manage or refer the two most common causes of visual impairment; uncorrected refractive error and cataract. Over two-thirds of patients received accurate and appropriate services from VTs, suggesting that they are a useful and competent cadre for rural and remote eye care.

Purpose: The aim was to develop and validate an instrument to measure job satisfaction in eye‐care personnel and assess the job satisfaction of one‐year trained vision technicians in India. Methods: A pilot instrument for assessing job satisfaction was developed, based on a literature review and input from a public health expert panel. Rasch analysis was used to assess psychometric properties and to undertake an iterative item reduction. The instrument was then administered to vision technicians in vision centres of Andhra Pradesh in India. Associations between vision technicians’ job satisfaction and factors such as age, gender and experience were analysed using t‐test and one‐way analysis of variance. Results: Rasch analysis confirmed that the 15‐item job satisfaction in eye‐care personnel (JSEP) was a unidimensional instrument with good fit statistics, measurement precisions and absence of differential item functioning. Overall, vision technicians reported high rates of job satisfaction (0.46 logits). Age, gender and experience were not associated with high job satisfaction score. Item score analysis showed non‐financial incentives, salary and workload were the most important determinants of job satisfaction. Conclusions: The 15‐item JSEP instrument is a valid instrument for assessing job satisfaction among eye‐care personnel. Overall, vision technicians in India demonstrated high rates of job satisfaction. Refereed/Peer-reviewed

Background Selection of a standard professional is crucial for assessing the clinical performance of other eye-care personnel. This paper describes the selection considerations and the clinical competency assessment of two optometrists required to select a ‘standard optometrist’ (SO) for evaluating the clinical performance of vision technicians in India. Methods Two optometrists were short-listed from 21 optometrists who responded to an advertisement to be selected as a SO for the assessment of the performance of 24 vision technicians in rural vision centres. Each candidate optometrist performed a routine eye examination on 40 randomly selected, newly registered subjects in a tertiary hospital clinic. Their non-cycloplegic retinoscopic findings were compared with those of an experienced optometrist, while disease diagnoses were compared with the findings of an ophthalmologist. Results A comparison of retinoscopic findings showed that optometrist A produced retinoscopic values within ±0.50 D agreement for the spherical equivalent (SE) 100 per cent of the time, while optometrist B obtained agreement 91.3 per cent of the time. Similarly, optometrist A's limits of agreement (SE = -0.63 to +0.45 D) and reproducibility limits (SE = 0.78 D) were better than those of optometrist B (SE = -0.98 to +0.70 D and SE =1.18 D, respectively). Optometrist A demonstrated 89.2 per cent sensitivity in detecting ocular pathology compared to 76.3 per cent by optometrist B. Conclusions Optometrist A achieved consistent and reproducible retinoscopic findings as well as higher sensitivity in detecting ocular pathology and was selected as the SO for a study to assess the clinical performance of one-year trained vision technicians. The concept of a SO calibrated against an ophthalmologist for disease detection and diagnosis and an experienced optometrist for retinoscopy is a useful approach for the evaluation of eye-care personnel.

Many programs aimed at mitigating the problem of uncorrected refractive error and the resulting avoidable blindness use recycled (donated) spectacles as a seemingly inexpensive expedient. This article analyses the costs and benefits of recycled spectacles and compares them with alternative methodologies. Although well intentioned, it is argued that recycled spectacles will neither suit many of those affected by uncorrected refractive error nor provide a cost saving solution to the problem. Although this is not the first argument against the use of recycled spectacles, there has been no accurate costing of their delivery. This article assesses the real cost of delivery of recycled spectacles.The useable quantity of recycled spectacles was determined by examining two separate batches of donated spectacles. These data were used in the calculation of the cost of delivery. The metric used for comparison was only cost (i.e., it was a cost minimization analysis) because it was deemed that recycled spectacles and ready-made spectacles were the same mode of correction fundamentally.Only 7% of the 275 recycled spectacles analyzed were suitable for use. The relatively small proportion of useable spectacles contributed to the high societal cost of delivering recycled spectacles, which was found to be U.S.$20.49, more than twice the cost of supplying ready-made spectacles.Recycled spectacles are not a cost-saving method of correcting refractive error and should be discouraged as a strategy for eliminating uncorrected refractive error in developing countries.

Background: Discrepancies exist in optometric education, practice and regulation across the Asia–Pacific region and the competence of optometric practitioners in adopting new lens technologies may vary widely. Over the past 10 years, a continuing professional development program, Varilux Academy Asia–Pacific (VAAP), was implemented and conducted in countries across the Asia–Pacific region to improve practitioners' understanding of optometric fitting principles, with special emphasis on progressive addition lenses (PAL). The aim was to demonstrate the effectiveness of VAAP and to compare the competence of practitioners across the Asia–Pacific region in new lens fitting technologies. Methods: From 2002 to 2008, all VAAP participants from 12 countries across Asia–Pacific were invited to complete a pre- and a post-program competency test and a post-program survey. Results: A total of 5658 practitioners were trained, and 69.9 per cent (n = 3,957) of participants completed the pre- and post-program competency test; 80.9 per cent (n = 4,580) of participants completed the post-program survey. There was a significant improvement in competency after VAAP (mean change = 19.4 per cent ± 3.3, p < 0.01). Before VAAP was conducted the mean competency score was significantly lower in developing countries compared with developed countries (mean score of developed countries = 50.6 ± 10.3, mean score of developing countries = 45.0 ± 7.8, p < 0.05). After VAAP, these differences were not significant. Confidence in fitting PAL improved by 27.1 per cent. Most participants (91.6 per cent) intended to fit more PAL and 96.8 per cent of participants rated the program as excellent or good. Conclusion: Our findings highlight the need for further continuing education of practitioners across the Asia–Pacific region. The results of the training course indicate that, across Asia–Pacific, continuing education courses in ophthalmic optics and dispensing encompassing modern lens design and best practice fitting principles are warranted.

Objectives To evaluate the personal and community burdens of uncorrected presbyopia. Methods We used multiple population-based surveys to estimate the global presbyopia prevalence, the spectacle coverage rate for presbyopia, and the community perception of vision impairment caused by uncorrected presbyopia. For planning purposes, the data were extrapolated for the future using population projections extracted from the International Data Base of the US Census Bureau. Results It is estimated that there were 1.04 billion people globally with presbyopia in 2005, 517 million of whom had no spectacles or inadequate spectacles. Of these, 410 million were prevented from performing near tasks in the way they required. Vision impairment from uncorrected presbyopia predominantly exists (94%) in the developing world. Conclusions Uncorrected presbyopia causes widespread, avoidable vision impairment throughout the world. Alleviation of this problem requires a substantial increase in the number of personnel trained to deliver appropriate eye care together with the establishment of sustainable, affordable spectacle delivery systems in developing countries. In addition, given that people with presbyopia are at higher risk for permanently sight-threatening conditions such as glaucoma and diabetic eye disease, primary eye care should include refraction services as well as detection and appropriate referral for these and other such conditions.