VOSH/Southeast established a standing committee at its Board meeting on August 6, 2011 to oversee further work in Haiti. This committee was established as a result of a very successful VOSH/SE supported vision clinic in the Cite Soleil section of Port-Au-Prince in July, 2011. This
week long clinic utilized low-tech refraction methods andspherical spectacles. Dr. Bob Barr and other experienced lay members of VOSH/SE spent a few hours training non-professional Haitian volunteers in establishing visual acuities, operating the I-Test basic refractor and dispensing spectacles. The Haitian volunteers were able to accomplish most of the clinic's work after this training. The success of this approach indicates a methodology which can succeed in providing vision care to a huge percentage of the Haitian population which has no other access to better sight. Read the full report on the procedures and success of this recent clinic.
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Summary
of Haiti Mission – Eye Program
WinterPark
Presbyterian Church/VOSH SE
July 9-16,
2011
Purpose of Program:
The Eye Program portion of the mission
to Haiti was intended to investigate the potential for non-medical
trained mission workers to perform the following tasks:
Perform a basic refractive
screening using the I-Test or similar device to determine a
satisfactory spherical equivalent refraction.
To provide a functional pair of
eyeglasses for distance vision and/or near vision based on the
spherical equivalent refraction results.
Screen for significant eye
disease, trauma, or neurological problems using simple external eye
examination techniques and an Eye Triage Atlas.
Investigate the possible
establishment of a formal health referral network utilizing existing
health care providers and facilities in the area.
Program Implementation:
The Eye Program was conducted in
cooperation with Haiti Outreach Ministries (HOM) in Port Au Prince,
Haiti. The mission compounds in Cite Soleil and Blanchard were
utilized for two days each. The setup was the same at each site.
The patients proceeded through stations in the following order:
Visual Acuities – The patient
was asked to read a distance wall chart with each eye. A brief
history was taken at this station.
Refraction – The patient was
next sent to this station where they were given a distance spherical
equivalent refraction on each eye using the I-Test device. Local
volunteers from the mission were trained to perform this test. We
had three I-Test devices available for this station.
Dispensing – The patients were
sent to this station to receive the glasses based on the I-Test
results. The near Add was determined using an age table. A range
of powers were shown as necessary to achieve the best vision at
distance and near. The best glasses determined were dispensed as
single vision distance or near. A limited number of bifocals were
available. The available lens powers ranged from +4D to -4D.
Health Screening – Patients that
could not respond to properly to the I-Test or who were found to
have a significant eye or vision problem were sent to this station.
An optometrist performed Retinoscopy, lens rack refraction, external
eye health screening, and direct ophthalmoscopy as needed. There
was a very limited supply of medications and artificial tears
available, as this was primarily a refractive training mission.
Observations and
Outcomes:
Types of Refractive Errors
Observed
There were about 120-140 patients
examined each day.
The vast majority had hyperopic
prescriptions, including the children screened.
Astigmatism was found to be
typically less than -1D when present based on retinoscopy findings .
There were three myopes found
ranging from -12D to -18D.
There were a small number of
pseudophakes , but no aphakes.
Performance of Mission
Volunteers on Refraction and Dispensing
We had 4 young volunteers to
perform the refraction screening using the I-Test device.
Written instructions were provided
in both English and French.
The volunteers were asked to read
through the instructions and practice on each other before beginning
the clinic. They had no more than 30 minutes to review and
practice.
All volunteers were found to be
highly capable of performing the required steps and achieving a
useable result on most patients seen.
Final visual acuities were not
reliable, but this was a problem regardless of who was performing
the tests.
A high percentage (~80%) of
patients screened were provided with a prescription using the
I-Test.
Dispensing of prescriptions also
went well with the volunteers. They proved capable of demonstrating
the eyeglasses using the I-test as the initial prescription. They
were also able to determine the reading glasses using the I-Test
results combined with the Age Table for Adds.
Ocular Disease and the Value
of the Eye Triage Atlas
The second goal of the Eye Program
was to determine if non-medical volunteers could screen for
potentially vision threatening eye conditions.
On the first day, 6 of the 16
conditions illustrated in the Atlas were seen in the clinic.
The volunteers were soon able to
recognize conditions such as pterygia and cataracts and match them
to the images in the atlas.
With more exposure to a variety of
conditions, the non-medical volunteers would have been capable of
identifying most of the conditions presented in the Atlas.
Assessment of Clinical
Screening Devices , Techniques, and Patient Responses
The I-Test proved to be an easily
useable tool for rapid screening of eyeglass prescriptions by
non-medical volunteers.
The eyeglass dispensing techniques
were quickly mastered by the non-medical volunteers.
The Eye Triage Atlas proved highly
effective in assisting with screening of vision threatening eye
conditions by non-medical volunteers.
The Blumenator illuminated hand
magnifiers were useful for examining the cornea for fluorescein
staining due to infection or injury. The white light version was
useful for visualizing cataracts. These instruments would better
serve trained observers and would be of minimal benefit to the
non-medical volunteers.
The instructions and techniques
described in the handouts for the use of the I-Test were very
effective. The determination of near Add using the Age Table
increased the efficiency o f the I-Test screening.
The attempt to use the pinhole to
determine if significant astigmatism was interfering with the final
spherical equivalent acuity proved a failure due to communication
issues. There were also very few patients with significant
astigmatism in the population screened.
Communication was a major problem.
Visual acuities were very unreliable due to a combination of a lack
of understanding and a desire on the patient’s part to
intentionally read poorly in order to get a pair of glasses.
Creole is a descriptive language
and does not lend itself to easy translation when asking yes/no or
better/worse questions. A conversation typically ensues, often
confounding our interpreters in figuring out what is being said.
There also appeared to a
significant level of dementia in the older population, making
coherent responses difficult to obtain. These patients could only
be satisfied using a tedious trial and error approach in presenting
eyeglasses.
There was an almost complete lack
of referral sources for urgent and emergency eye care needs. There
were some potential resources available, but there was no
established network to be able to obtain medical care. The
potential to establish these networks definitely exists, but it will
take a concerted effort to make this a reality.
Conclusion:
All goals set out in this program were
achieved to some degree. The potential to have non-medical
volunteers provide basic refractive screenings, eye health
screenings, and dispense satisfactory eyeglasses was proven as highly
possible. Professional contacts were made and fact-gathering proved
encouraging towards the development of a formal health care referral
network within the communities served in this mission.
This results of this program
demonstrated the potential to provide at least minimal eye care to
this greatly underserved population utilizing local personnel and
resources to the greatest extent.
Submitted by: Robert D. Barr, OD,
FAAO August 6, 2011
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