Where do you donate frames? [Archive] - OptiBoard Discussion Forums

xmattMPHx

10-24-2006, 10:27 AM

Globally accepted eye health care principles sounds like UN speak.

I'm not sure if it is "UN speak" but it is public health speak. ;)

When it comes down to helping people here and now nothing beats the Lions Club and Unite For Sight and similar organizations. When they hit the ground in third world countries the help is immediate and not some document from a bureaucrat on the banks of the East River in NYC. Sorry to be so cynical, but as a Lions Club member who recycles thousands of eyegalsses each year for our club and our district I will continue to do so. When the folks in Ecuador or Russia get glasses to read or knit or sew they are better off than before. Incidentally the Lions Club International sets up clinics all over the world for eye surgeries, eye health and eyeglass making for the locals to learn and help their own.

I don't deny that the Lions Club does a lot of good in the world. My main contention is that if we want refractive error care to become more mainstream in the public health community, if we want to offer better and more sustainable care to the people we desire to help we must follow the globally accepted principals of VISION 2020 - Human resource development, infrastructure development, and disease control. Within disease control is a five step process for treating refractive error.

1. Screening of individuals to determine who will benefit from refractive error correction;
2. Refraction to determine an appropriate prescription;
3. Manufacturing of low cost spectacles;
4. Dispensing of appropriate spectacles to those who require them;
5. Follow-Up to take care of needed spectacle repairs or re-dispensing (WHO. (1997). Global Initiative for the Elimination of Avoidable Blindness. WHO/PBL/97.61.).

The most overlooked parts of this five step process in current refractive error care in developing countries are 3 and 5. In addition the WHO describes the collection and distribution of used spectacles as a well-intentioned but not a cost-effective strategy. They raise quality control concerns, as well as concerns with patients not receiving spectacles that are correct for their refractive error. Importantly, the WHO refractive error work group points out that the use of recycled spectacles is not helpful in the development of a sustainable refractive error eye care system as it creates a dependence on outside sources.(Elimination of avoidable visual disability due to refractive errors: World Health Organization. WHO/PBL/00.79, 1-54.) There have been no studies conducted to discuss the efficacy/efficiency/appropriatness of the vision camp model of care in developing countries.

Again I have nothing but respect for the dedication of the Lions to the elimination of avoidable blindness but it is time to change our methods and build human resources and infrastructure in partnership with developing country governments rather than conduct vision camps.

I hope that the Lions are at the Inaugural world congress on refractive error and service development in Durban, South Africa this March to share their experiences and help develop more appropriate refractive error care. (http://www.icee2007.org.za/)

FVCCHRIS

10-24-2006, 01:17 PM

They aren't working in accordance with globally accepted eye health care principles. I was trying not to specifically state that these organizations are hindering the development of eye health care in developing countries but... they are. ;)

How would you respond then to Optigrrl's original question about where to send her donated eyeglasses?? Are you suggesting we no longer accept donations, instead telling our patient's their charitable offer is now deemed a hindrance by the W.H.O. ?? :confused:

nickrock

10-24-2006, 01:34 PM

You can always donate to the closest Optometry school, they usually have a club or organization that participates in medical missions. Pacific University, for example, has the Amigos Club that takes donations.

http://opt.pacificu.edu/test/amigos/index.htm :)

xmattMPHx

10-24-2006, 01:35 PM

How would you respond then to Optigrrl's original question about where to send her donated eyeglasses?? Are you suggesting we no longer accept donations, instead telling our patient's their charitable offer is now deemed a hindrance by the W.H.O. ?? :confused:

Yes

k12311997

10-24-2006, 01:35 PM

I hate to throw in with xMatt but give a man a fish he eats once teach a man to fish he eats forever.

Now before everyone jumps on me we do collect donated glasses and we do take them to the lions club.

No matter how personally vested you are in these projects you need to be able to see the wisdom of creating these systems in third world countries not just importing them from the developed world. To some extent charity breeds dependance. why create a health system? the americans will come and take of us.

Jacqui

10-24-2006, 01:54 PM

I hope that the Lions are at the Inaugural world congress on refractive error and service development in Durban, South Africa this March to share their experiences and help develop more appropriate refractive error care. (http://www.icee2007.org.za/)

I wish I could be there too.

CME4SPECS

10-24-2006, 01:57 PM

Any time there is a disaster in the USA, people are in need. I gave 200 frames to Katrina last year.

Jacqui

10-24-2006, 02:10 PM

Any time there is a disaster in the USA, people are in need. I gave 200 frames to Katrina last year.

Thank You, from one of the volunteers that was there.

xmattMPHx

10-24-2006, 02:22 PM

Any time there is a disaster in the USA, people are in need. I gave 200 frames to Katrina last year.

I thank you as well. Please don't misunderstand me. You donated new frames to an organization that had no choice but to use established health systems. I would hope that we desire to do the same overseas as well.

CME4SPECS

10-24-2006, 02:36 PM

I thank you as well. Please don't misunderstand me. You donated new frames to an organization that had no choice but to use established health systems. I would hope that we desire to do the same overseas as well.

I hope that some how those frames made it to those that needed them.

Fezz

10-24-2006, 02:47 PM

Xmatt-
I understand where you are coming from, but I look at it a bit differently. We can not even get these countries to grow food correctly, practice "safe sex", educate themselves, all of this after how many years of help. How can we expect them to follow proper eyecare? Give me a break. I believe that the Utopian idea is great, but it ain't happening. This is not a attack on you personally, just open discussion. I add, I am glad that we live in a country were we can openly debate and discuss such things!:cheers:

FVCCHRIS

10-24-2006, 02:51 PM

xmattMPHx

10-24-2006, 02:59 PM

I understand where you are coming from, but I look at it a bit differently. We can not even get these countries to grow food correctly, practice "safe sex", educate themselves, all of this after how many years of help. How can we expect them to follow proper eyecare?

Thanks for the comment. There is some great work being done in the refugee camps in Thailand using refugees to conduct very basic refractive exams and then dispense ready-made spherical equivalent specs. (see http://www.theirc.org/) Dr. Jerry Vincent should have some more details of this program in print soon.

I think a lot of us are aware of the unique program the Scojo Foundation is doing. Unfortunately I don't think there is any study in print re: their work. Hopefully soon. (see http://www.scojofoundation.org/)

A lot of interesting work occurring all over the globe. Hopefully the conference in South Africa should lead to more good refractive work.

When it comes to public health work I am an optimist. I have to be - it's a requirement of the degree. :p

Fezz

10-24-2006, 02:59 PM

FVCCHRIS-
I agree. I believe we should help here first! I take a hard stand on that. Wifey and I just had the "discussion" about coats to Afghanastan thru her church. I asked if the local down and out kids, womens centers, etc, already had all the coats they could use! :shiner: Why send coats and shoes half way around the world when our local shelters and group centers are in such need? Not a very popular opinion I know, but...I feel how I feel.

xmattMPHx

10-24-2006, 03:08 PM

I'm sure the major drug manufacturing firms around the world will be pleased to hear that donating free AIDS medicines to poor countries or any prescription meds to even uninsured Americans here at home can come to a swift conclusion, free donations of course being a detriment to people's future well being.

I'm not sure that this is the point. In order to distribute "free" medications there usually needs to be a health infrastructure in place. Distributing recycled spectacles usually takes place "under the radar" without the use of local professionals or infrastructure. This is a detriment to the health system not necessairly the patient - although I would argue that vision camps are often a detriment to the patient as well.

Many public health initiatives are now adding in a component of cost recovery even in the poorest countries. Medications are donated (think of Ivermectin for Oncho.) because they are beyond the reach of the national health system. Spectacles can be created for much less money than drugs.

I am not saying that the US should be doing all the work nor do I think that they are. I can't convince you that we should continue to do work overseas. I view my place in the world from a public health perspective. It is my desire to leave the world a better place than I found it - in my opinion that can only be accomplished via "teaching".

Thanks for your comments - I really enjoy reading other perspectives.

Jubilee

10-24-2006, 06:59 PM

As a person who has gone on optical missions and has worked with the Lion's Club and the Gift of Sight program for optical based missions.. let me tell you a few things about how this is done.

When deciding on a location for an international mission, the mission leaders, and the Lion's Club both from the US and the country of the possible site investigate local and state laws and are in contact with government officials. NONE of this work goes on under the radar. How can you with optical missions that help 30-50 THOUSAND people in a matter of 10 days?

When I was on my missions, we had the Civil Defense, the local Nursing School, Teachers, Missionaries, along with the Lion's Club volunteers helping to not only help people through the process but to ensure our safety as well.

Lions Club members are shown how to screen people to see if a "vision" problem existed. We had a surgeon with us who did cataract surgeries, and local health officials were shown how to do follow up care. We not only had thousands upon thousands of recycled eyeglasses, we also had readers and sunglasses to give away as well. I also was in charge of a project to make glasses for children if we didn't have the appropriate rx in a frame to fit.

Some of the missions in Mexico now have functional labs to edge finished lenses for the thousands of people who need only single vision correction.

When I was in Chile, the nearest "eye doctor" was over 250 miles away from the desert town I was in. People don't have the money to travel, or to pay for the eye care. The time and expense involved made it IMPOSSIBLE for most. Are you saying we should tell these people they don't deserve anything, or even better yet "You deserve better care than we can provide so we aren't going to do anything but lobby for a better healthcare and vision care system for you.."

They need the help NOW. Not 10 years from now.In order for those people to develop the skills necessary to examine and fabricate glasses, don't they need to be able to see?

How about countries where they only work in spherical equivalents? Aren't the people there missing part of the acuity they could have? But that is ok...

I agree that we need to help these people develop their own system of care. But while this is in development, they need the recycled donations to get them there.

A far as your 5 step approach:

1) Screening is done to see who would benefit
2)Refractions are done, along with eye health check
3) Glasses given from either donated or manufactured stock
4) Dispensed based upon the rx guide. While it may not be spot on, many are close and you can't say that correcting to -3.50 is worse than no correction for someone who is a -4.25 sph.
5) Local Lions are shown how to repair and unused donations are left with them for future replacement purposes.

The work for the US will be in a different post.

Cassandra

Grubendol

10-24-2006, 07:01 PM

We do through VOSH. One of our doctors here travels all over the world providing for third world patients and that's where they go.

Jubilee

10-24-2006, 07:28 PM

Now for those of you who are asking why worry about international initiatives when we have so many here who still need help...

APATHY.

To those who do volunteer and donate that is awesome. Your contributions are very importants and appreciated.

However I have been trying to investigate some things for my local Prevent Blindness chapter about optical charities and for the most part it seems there is only apathy.

Maybe the idea of going abroad is more appealing than helping the locals here at home. Maybe people are just too busy with work, home, and business that they can't be bothered to take time out to even answer a poll about volunteering, let alone spend a couple of hours at a heath fair or school doing vision screenings.

In my community children seem to be able to receive care no problem. If they aren't covered by Medicaid, then Sight for Students, the Gift of Sight program, and many other charities are willing to step in.

However for adults, the options aren't there. We have local Lion's Clubs spending $400 or more a month buying discount vouchers to help a few people a month. In my experience, the wait to be able to utilize their program for glasses was typically 3 months. Even with an Optometry school nearby, we can get exams donated no problem.. but not materials.
Medicaid will only take in adults who are either disabled/chronically ill and/or make less than $12000 a year.

Well how are these adults supposed to get jobs, get skills, and take care of themselves and their family without being able to see? Comeon, you gotta be able to see the fryer in order to take the basket out... Or tell which icon is on the screen for the cash register.. Not to sound cruel, but I know a lot of you will say they need to get a job. IF they are employed, then they need to find a second one. but HOW can they if they can't even see the fricken application to fill out?

I am trying to work with my local labs to develop a system for low cost glasses to try and support the work done by Prevent Blindness and the Lion's Club. I was hoping to get more ideas/information from the members of the optiboard to find out what encourages or prevents people from volunteering or donating to these charities, but the interest didn't seem to be there period.

Cassandra

Judy Canty

10-24-2006, 09:30 PM

GOS Kenya '93 and a Lion, and I'm with Cassandra on this one.

Jacqui

10-24-2006, 09:36 PM

We work with a program that is sponsered (funded?) by the local Community Action Agency, It provides low cost or free eyeglasses to low income school age children. Dr.'s provide low, low cost exams, we supply lenses at cost, frames are either donated or discontinued models. Did about 275 this fall.

Jubilee

10-25-2006, 12:16 AM

May I ask for more specifics on your program Jaqui? I am interested in setting up similar programs here in Indiana, and while the Lion's Club seems to have some money for low cost, the Prevent Blindness program doesn't :(

Though people can help with our Ebay Auction! http://www.missionfish.org/NPMMF/nphomepage.jsp?NP_ID=3715

I understand that if we are discussing wholesale costs, that this may need to be taken in private. I am in discussions with a couple of local labs, and was hoping to get another lab's point of view and what made it profitable (either monitarily or other) so I can lend another aspect to my presentation that I am developing for a personal meeting.

Thanks!
Cassandra

xmattMPHx

10-25-2006, 09:50 AM

Thank you Cassandra for the insight into your missions. Not many of us have the opportunity to work on missions of such a grand scale. To be clear: I am an optometrist, I have gone on missions. It was while on these missions that I came to question the overall impact of our work. This questioning led me to pursue my Master of Public Health in Global Health. I now approach these questions from a different perspective.

I'll admit that you have helped many people. That high myope who received her first pair of glasses, the elderly presbyope who can now contribute to the family by sewing or sorting rice. Your exam and spectacles helped those individuals but they did not help the community.

The fact of the matter is that VISION 2020 is the guiding document for prevention of visual impairment organizations in global health. This is undisputed. VISION 2020 encourages governments to develop a plan of action on how they are going to combat preventable blindness. They are to develop priorities but with concentration on human resource development, infrastructure development and disease control (there are five priority diseases of which refractive error is one). If we as western vision professionals continue to work outside of VISION 2020 we will never find acceptance as public health entities. We will have no say in the development of global priorities.

Vision camps do not address HR, or infrastructure needs. Training one or two or even 10 or 15 people to do follow up does not lead to sustainbable eye health care. It should no longer be our goal to do missions and count the number of people seen. It should be our goal to count the number of people trained. All around the world lay people are trained to deliver babies, to treat disease, to educate their peers on safe water issues, and more. Why can they not be trained to conduct basic vision tests which will end with a prescription and a place to purchase/receive specatcles? Why can we not set up retail ventures (much like safe water ventures) with low cost quality specs? This not only gets people into spectacles but it generates revenue for an impoverished individual.

When I was in Chile, the nearest "eye doctor" was over 250 miles away from the desert town I was in. People don't have the money to travel, or to pay for the eye care. The time and expense involved made it IMPOSSIBLE for most. Are you saying we should tell these people they don't deserve anything, or even better yet "You deserve better care than we can provide so we aren't going to do anything but lobby for a better healthcare and vision care system for you.."

They do deserve better care and that better care can begin today. They simply need our help. A refractionist can be trained in two weeks. That training can lead to refractive error care and referrals to tertiary care if necessary. Think of all the money that is put into missions each and every year. Why can that money not be spent on infrastructure, and human resource development?

You rightfully question spherical equivalents. There are studies ongoing to determine the appropriateness of that type of correction. If the studies come out negative that care will end. Why are there no studies on the efficacy of vision camps despite their long history?

You and I agree that infrastructure development needs to occur but I disagree that recycled spectacles are necessary as a temporary fix. They have been used for 30 plus years. It's time to move past recycled spectacles and into the world of quality, accurate, low cost new spectacles.

I also disagree that vision camps address the WHO's five step process. Step 3 calls for the manufacturing of local spectacles not donations of recycled spectacles and step five calls for all individuals to have access to repairs and replacement spectacles. This can't occur through donated recyecled specs.

Thank you again for the work you do. We disagree on how to get where we need to get but I appreciate the work that you do. Keep an eye on the literature. I have a feeling that the global refractive care community is in for a big change - please join it.

Jubilee

10-25-2006, 11:57 PM

So what is the plan?

Yes, optical missions on a large scale such as those done with partnerships involving the Lion's Club, Gift of Sight, and many optical vendors such as Sola, Essilor, and Cannon are expensive...but not nearly as much as setting up a permanent clinic/lab.

Using the current methods, the costs undertaken by the charitable companies are airfare, shipping, bribe money, and room and board type expenses. The location is donated, the facility covers the water/electricity for the duration, and all equipment is brought in with us.

Is the goal to actually set up wholesale labs in these countries to manufacture lenses? Who is going to cover the cost of the lenses? I don't forsee any of the lens companies donating hundreds of thousands lenses to have on hand to make up new ones.

How about frames? Are we going to get manufacturers to donate discontinued product? or are donated used ones sufficient for this part of the process?

While we could train someone how to cast/generate/and edge lenses... is the idea to have a wholesale lab type situation where one main lab handles all the lab work and distributes it to the referring locations, or is the idea to have several smaller labs producing the glasses? Who is going to cover the cost of the equipment that this will require? Who is going to cover the maintenance and eventual repair that all machinery require? How is the lab going to pay for materials for processing, not to mention the utilities like electricity and water? In the current donation of used materials, the cost of the glasses themselves are free.. even if we were able to use cheap reduced cost materials, I doubt that you will get the costs for producing a complete pair of glasses for under $8-10 and that is even too high for the amount of people that need help in these countries.

I am not saying that this couldn't be done... however I don't forsee this happening anytime in the next 5 years. Especially when other needs such as AIDS medicines, Vaccines, and such that CAN NOT be handled through used material donations need more funding than what they currently receive. Please share with us the steps that are being taken now, and a time line for goal completion so we can see just how feasible it is, and maybe lend a hand to a good cause.

Cassandra

xmattMPHx

10-26-2006, 10:25 AM

You ask excellent questions Cassandra. There are no easy answers though.

You ask me to provide a timeline and the steps being taken. I wish it were that easy. There is no one solution to the problem of blindness (specifically refractive error blindness in our discussion). Each country needs to come up with its own solution. That is what is currently being done. They still depend on outside help to some degree.

What is known is that the vision camp model is the worst solution as it necessitates outside care and leaves no infrastructure or human resources behind. Public health is all about evidence so as different organizations try different things in different places they will study the efficacy and efficiency of their care. If it works it can be tried elsewhere, if it doesn't - back to the drawing board.

Will every country develop labs? Perhaps. What if the epidemiological data shows that 80% of the need is presbyopic correction - could we then just use ready-mades? There are still more questions than answers unfortunately. Hopefully more answers will become available this March in South Africa (http://www.icee2007.org.za/) when the organizations working on this problem get together to share their success and failures.

The fact remains that the vision camp model is working outside of the larger global health field and the energy and expertise of the people involved is thus under utilized.

walleye

10-27-2006, 08:23 AM

The discourse between Jubilee and xmattMPHx is interesting. I totally agree with Cassandra. The infrastructure is already there for self-sustained eye care in the third world countries through the Lions Clubs. Every month I get a magazine detailing several new clinics opening in India, or Africa, etc.
The main mission of the Lions Clubs International is to prevent blindness as was tasked to Melvin Jones (the founder) by Helen Keller. There are 1.3 million members in something like 45,000 clubs all over the world. Their Sight First Program has already donated over $200 million to mostly sight saving initiatives. Around 90% plus of the money raised by the Lions Clubs goes to helping others and not for administration.

Cost recovery?,develop priorities?, human resource development?,infrastructure development? The ideas sound great but for countries to take this initiative is a stretch. The corruption of third world governments is appalling. And like Cassandra mentions there are so many other immediate priorities like treating AIDS.

By the way, what would it cost me to fly round trip to Durban, South Africa, stay at a hotel and meals for 3-4 days? Multiply that by the number of attendees and the total cost for the conference may be between $500,000 and $1,000,000. I would rather donate that trip money to the Lions Club to start a wholesale opitcal lab in Ghana.

Fezz

10-27-2006, 09:50 AM

xmattMPHx

10-27-2006, 09:53 AM

All,
Thank you for what has been a very thoughtful, informative and enjoyable discussion. Your desire to put your professional skills to use in the developing world is encouraging and touching.

Walleye,
Thanks for the input. It is news to me that the Lions club has developed the necessary infrastructure for self-sustained eye care in "the third world countries". It is exciting news if it is accurate.

I appreciate what appears to be unnecessary expense in the Durban conference. Public health initiatives need to be based on sound data. If the data is not there who knows if the initiative was successful or not? This conference will bring together those working in refractive error care to discuss epidemiology, projects and programs that have been successful and hopefully develop some partnerships for the road ahead which will decrease costs (why try what someone else already did?), and hasten progress.

Does Ghana have a need for a wholesale lab? Do they have the necessary refractionists? Do they have a distribution network for frames and lenses? Do they have a price structure that is sustainable and affordable? Do the people there accept spectacles? Do they have access to the distribution network? I ask these questions to point out that it is not so easy as to just plop down a lab/a vision camp/anything you can think of. It requires work, investigation, studies, etc. It is a slow and painful process but in the end the decisions that are made, what is developed will remain with the country for ever - barring disaster.

I am fully aware that some governments are corrupt. Not all, but some. Work should begin with governments who are looking out for their people and have some investment in vision projects and programs. This is how other public health programs develop. Why should refractive care be any different?

Sorry for the length of this - following are two small sections of my thesis that dealt with what we are discussing.

With the world still battling malaria, TB, HIV/AIDS, malnutrition, and other diseases, why should scarce resources be allocated to vision care? One reason is that blindness is a key barrier to development(WHO, 2004). Blindness has extensive developmental, socio-economic, and quality of life implications(Pararajasegaram, 2001). Not only does blindness place an economic burden on the blind individual but it also places an economic burden on her family, her community, and the country as a whole(Tabbara, 2001). The loss of productivity of the blind individual often leads to the loss of productivity of a care-taker who must care for the blind individual rather than participate in the workforce(Tabbara, El-Sheikh, & Shawaf, 2005). A large proportion of visually impaired individuals are found in the economically productive age(Rahki Dandona & Dandona, 2001). In a study of staff at an institution in Lagos, Nigeria it was found that workers with ocular morbidity had a higher incidence of absenteeism(Ashaye & Asuzu, 2005).

The economic burden of blindness is estimated to be $4.4 billion in India(Thulasiraj et al., 2003). On a global scale, if nothing is done to stem the tide of increasing blindness and low vision, economic productivity losses will increase from $42 billion to $110 billion between 2000 and the year 2020(Frick & Foster, 2003).

There are approximately 1.4 million blind children in the world, two-thirds in the developing world(R Dandona & Dandona, 2003). Childhood blindness has drastic consequences on childhood development(Pararajasegaram, 2001) as it often occurs during the formative years. Early blindness can adversely affect psychomotor, social, and emotional development(Gilbert & Awan, 2003). Aside from affecting development, childhood blindness affects the educational ability of the child,(Tabbara, El-Sheikh, & Shawaf, 2005) and potentially her earning potential. Despite almost half of childhood blindness being avoidable with cost effective interventions(Gilbert & Awan, 2003), it is estimated that 500,000 children become newly blind each year. Up to 60-80% of newly blind children in developing countries die within one or two years of becoming blind(Gilbert & Awan, 2003; Lewallen & Courtright, 2001).

Many would argue that these volunteer based vision NGOs (VBVNGOs) are meeting their own objectives and that the strategies outlined in VISION 2020 are not appropriate for the kind of work VBVNGOs do. The larger prevention of visual impairment community has decided that VISION 2020 is the over arching document that should guide the world’s efforts in preventing and treating visual impairment. The larger multi-national organizations are using VISION 2020 as their guiding framework and encouraging nations to develop their own VISION 2020 national programs. In order for the volunteer based NGOs to be a part of the solution to global visual impairment, they must join the community of organizations and nations who accept the strategies of treating five priority diseases along with developing human resources and infrastructure as the best method for decreasing the burden of preventable blindness and low vision.

Ashaye, A. O., & Asuzu, M. C. (2005). Ocular Findings Seen Among the Staff of an Institution in Lagos, Nigeria. [I]West African Journal of Medicine, 24(2), 96-99.
Dandona, R., & Dandona, L. (2001). Refractive error blindness. Bulletin of the World Health Organization, 79(3), 237-243.
Dandona, R., & Dandona, L. (2003). Childhood Blindness in India: A Population Based Perspective. British Jouranl of Opthalmology, 87, 263-265.
Frick, K. D., & Foster, A. (2003). The Magnitude and Cost of Global Blindness: An Increasing Problem That Can Be Alleviated. American Journal of Ophthalmology, 135(4), 471-476.
Gilbert, C., & Awan, H. (2003). Blindness in Children. British Medical Journal, 327, 760-761.
Lewallen, S., & Courtright, P. (2001). Blindness in Africa: present situation and future needs. British Jouranl of Opthalmology, 85, 897-903.
Pararajasegaram, R. (2001). The Challenge of Escalating Avoidable Blindness: A call for action. The National Medical Journal of India, 14(6), 324-326.
Tabbara, K. F. (2001). Blindness in the Eastern Mediterranean Countries. British Jouranl of Opthalmology, 85, 771-775.
Tabbara, K. F., El-Sheikh, H. F., & Shawaf, S. S. (2005). Pattern of Blindness at a Referral Center in Saudi Arabia. Annals of Saudi Medicine, 25(1), 18-21.
Thulasiraj, R. D., Nirmalan, P. K., Ramakrishnan, R., Krishnadas, R., Manimekalai, T. K., Baburajan, N. P., et al. (2003). Blindness and Vision Impairment in a Rural South Indian Population: The Aravind Comprehensive Eye Survey. Ophthalmology, 110(1491-1498).
WHO. (2004, November 2004). Magnitude and causes of visual impairment: World Health Organization. Retrieved February 13, 2006, from http://www.who.int/mediacentre/factsheets/fs282/en/print.html

Cindy K

10-27-2006, 11:10 AM

In the ideal world, there would be no poverty nor 'develloping nations' nor disease nor bloodshed. However, the world in which we do live this is the day to day life in which millions live.

In the ideal world, we would only need to visit each area of these nations once; refract, examine, perform surgery, dispense, then teach these skills to locals, then leave. However, the world in which we do live does not render this possible nor practical. Therefore, there will likely always be the need for medical missions and donated glasses.

Some years back we had a fellow who worked for one of the medical missionary groups come to us asking that he be taught optical lab skills in order that he may return to his homeland with the necessary equipment and instruction to perform these functions. His initial enthusiasm proved inadequate as he was not especially talented in this field, though we did dontate to the cause one of our company's old edgers. As I recall from some of our lengthy discussions about the situation in his homeland, it was not due to lack of interest nor identity of the need that the residents there were unable to fend for themselves medically, but rather the costs involved in importing the necessary goods were so exhorbitant it was impossible to sustain the services after the medical missions left. If our old edger broke down, it was likely that the parts required would have been too costly to replace! Same goes for medical supplies and such.

Donate your glasses to whichever collection service you desire; there are many, including my fav, the Lions Club. Do you donate you your local food bank? Women's shelter? SallyAnn? These organisations should not be necessary any more than the need for the more fortunate nations to provide medical missions.

I don't forsee the end to the need for donated glasses. We simply don't live in an ideal world.

FVCCHRIS

10-27-2006, 11:54 AM

This has been a very interesting thread. I want to thank all that have contributed. I have learned alot. It really got me thinking.

Gosh...I Love Optiboard! (and thank Steve for weeding out the consumers;) )

It's what I like so much about this board. Go back and read the Original post and look at where we've gone with this. Sometimes I think there should be continuing ed. credits available to us for attending what to me has become a truly top notch educational experience for me on a daily basis. Someone should get Steve going on that!:D

xmattMPHx

10-27-2006, 12:02 PM

Thank you Cindy K for your addition to the conversation.

It is an overwhelming task isn't it? Developing infrastructure and human resources. It is simply easier for us to go and do! I agree. I've collected glasses, I've washed them, neutralized them, organized them, found prescriptions in developing countries and dispensed them. It feels good, but it isn't the solution.

The following is taken from The Elmination of Avoidable Disability due to Refractive Error published by the WHO.

"9. Affordable or fully subsidized spectacles should be provided to those in need, preferably at the site of the screening/refraction. The spectacles should be of acceptable optical and safety quality (conforming to ISO standards), be of good/acceptable appearance and be well fitted and comfortable to encourage use...

10. Low-cost spherical ready-made spectacles can be imported in some countries which may meet up to 70% of the community's need. However, there may be a role for low-cost spectacle workshops in the manufactring of prescription spectacles and the distribution of ready-made spectacles. Before establishing such a workshop, careful consideration should be give to the available "market", the cost-effectiveness of the workshop and the long-term financial sustainability of the programme.

11. Although the collection and recycling of used spectacles is a well-intentioned voluntary activity, experience has shown that the redistribution of recycled spectacles is not a cost-effective strategy for uncorrected refractive error, and the participants do not recommend it."

I write this to explain that using recycled spectacles is a noble idea but it is not accepted in the public health world. There are vast restrictions on the use of expired/donated medicines, medical equipment, etc. Soon, I believe the restrictions will move into the realm of glasses. We need to be ready for these restrictions with other plans/programs.

It is true that we don't live in an ideal world. We live in a world of poverty and despair. Our job as public health professionals/volunteers should be to ease that poverty and despair while treating the communites we serve in with respect and justice. Recycled spectacles no longer have a place in that treatment.

With respect,

Steve Machol

10-27-2006, 12:57 PM

Sometimes I think there should be continuing ed. credits available to us for attending what to me has become a truly top notch educational experience for me on a daily basis. Someone should get Steve going on that!:D
I host this site which is run by the esteemed Mr. Darryl Meister:

http://www.opticampus.com/

Jubilee

10-27-2006, 01:06 PM

This is a quick reply since I am just taking a short break at work..

I appreciate your desire to come up with better solutions. However, how does ready made glasses (I am taking this is similar in vein to the reader market) solve the delima any better than recyled eyewear? Does correcting someone with -5 spheres in a new frame any better than correcting that person with -3.00 -3.50 x 160 when their refraction is -3.00 -4.00 x 150? How does it set up a better infrastructure if you are still shipping the glasses into the country? What about the costs in just shipping the glasses into these territories?

While I agree that recycled glasses aren't the best solution for long term care, what other solutions are availble NOW?

The people in these countries can't put their lives on hold while we figure out a better solution. Are we really doing them a favor to put on hold all optical mission trips with the use of recycled materials if there are currently no other viable options on the table for them?

Once again I am not stating that I don't support the efforts of the World Health Organization, and I would love to be a part of the conference if money wasn't a concern. I am willing to do what I can on my end to help make a difference. I just think it is too premature to call for the end of these missions. Once a plan is in place.. then maybe we can evaluate what is most efficient.

Cassandra

xmattMPHx

10-27-2006, 02:35 PM

Cassandra,
Thanks for the response. Although "a quick reply" it is, again, full of insight and great questions.

It is estimated - through some studies - although work remains to be done that 80% of refractive error need in the developing world is for presbyopic correction. I did cut out some of the WHO suggestions that address some of your concerns - ready mades only for aniso less than 0.5 D and cyl under 0.75. The biggest need in the refractive error community is epidemiological research to determine what type of correction is needed - some countries where there is a high prevalence of astigmatism or aniso will not be able to use ready mades others may be able to.

I am not calling for the discontinuation of vision camps without replacement. I am calling for those involved to put thought into repacement projects/programs and to partner with other organizations who are currently working in a fashion that is acceptable under the VISION 2020 parameters.

One issue that I have with groups that go in and do vision camps with recycled specs. is that they are often lone wolf groups. They partner with no one other than community service groups/churches/etc. They are out of the public health loop. Work is being done that differs from the vision camp model but the vision camp people either ignore that work or are unaware of it.

See the International agencey for the Prevention of Blindness organizations for a taste of the types of projects/programs being conducted. (http://www.iapb.org/other_links.htm)

FVCCHRIS

10-27-2006, 03:03 PM

I'm sorta starting to come around on this issue a little, .....keep talking..Chris.

walleye

10-28-2006, 02:35 PM

xmattMPHx

10-28-2006, 02:56 PM

For all those participating in this thread- especially xmattMPHx- please go to the website for Lions Clubs International Foundation. It is located at
www.lcif.org (http://www.lcif.org) There one can see what is done to prevent blindness in a here and now world.

Walleye,

Thanks for the comment and the link. Please note I have nothing but respect for the lions and their tireless work in the area of preventable/treatable blindness. Nobody is denying that the Lions are working to prevent blindness. What remains to be seen is if their refractive work is in agreement with VISION 2020. Their collection and distribution of recycled spectacles indicates that it is not.

It you note on their website their SightFirst Grants do not address refractive error but are used to develop infrastructure and human resources for things like Oncho., trachoma and cataracts. (Which is great!) In my brief purusal of their website I see very little mention of refractive programs other than the collection of recycled specs. Can you point me to the sustainable programs they sponsor in developing countries in regards to refractive care?

Your comment is correct in that the website indicates work being done now to treat/prevent blindness. If you read the website you'll read a lot of what I've been saying all along - developing infrastructure, human resources, sustainability, partnerships, studies, etc. I am not bashing the Lions I am calling for an end to the use of recycled spectacles and the vision camp model of care trumpeted by GOS, VOSH, etc.

I'll look at their website more fully after work today.

Thanks,
Matt

walleye

10-28-2006, 03:48 PM

Matt,
Thanks for your continued input. It is true the Lions may not have refractive work in agreement with VISION 2020. I will dig deeper also to see if this is being done. Go to another website called www.voshpa.org (http://www.voshpa.org) and look what developed from the vision camp model. They now have 3 local eye clinics in Guatemala.

Walleye,

Thanks for the comment and the link. Please note I have nothing but respect for the lions and their tireless work in the area of preventable/treatable blindness. Nobody is denying that the Lions are working to prevent blindness. What remains to be seen is if their refractive work is in agreement with VISION 2020. Their collection and distribution of recycled spectacles indicates that it is not.

It you note on their website their SightFirst Grants do not address refractive error but are used to develop infrastructure and human resources for things like Oncho., trachoma and cataracts. (Which is great!) In my brief purusal of their website I see very little mention of refractive programs other than the collection of recycled specs. Can you point me to the sustainable programs they sponsor in developing countries in regards to refractive care?

Your comment is correct in that the website indicates work being done now to treat/prevent blindness. If you read the website you'll read a lot of what I've been saying all along - developing infrastructure, human resources, sustainability, partnerships, studies, etc. I am not bashing the Lions I am calling for an end to the use of recycled spectacles and the vision camp model of care trumpeted by GOS, VOSH, etc.

I'll look at their website more fully after work today.

Thanks,
Matt

Ory

10-29-2006, 09:06 AM

This thought came up while reading Dave Nelson's thread (http://www.optiboard.com/forums/showthread.php?t=20091) but I figured this is the better place to post.

India has been specifically named as a place that needs better infrastructure for optical services. I know for a fact that many of these internet retailers are selling specs made in India.

This begs the question, is it better to infuse North American money into the Indian economy or to use their existing spectacle producing facilities to enhance quality of life locally?

Jubilee

10-29-2006, 10:07 AM

When I was in Chile, we had moderate to high minus scripts with a lot of oblique astigmatism. Talking 2-4 diopter cylinder values. Ptygerium was also very prevalent...

In Mexico there was more of a regular mix of primarily minus scripts with lower cylinder values..

China had more extreme myopia..

Obviously the location has a lot to do with what types of scripts are more prevalent. I know in Chile we talked alot about the light reflecting off the desert sand and with the lack of sun protection, many of these people squinted for hours at a go possible causing some of the oblique cylinder.

I know some of the optiboarders are already trying to come up with cheap alternatives to edging equipment. The cost of the lenses still concerns me as being a hurdle to this.

Ory:
I fully believe that as more North American money gets infused to India, their standard of living is rising. With that they can invest in their own infrastructure. I totally agree that if there are optical labs existing in India, then we should train refractionists to operate there as well and use those facilities to aid India in their visual health.

I would think some American companies would be willing to invest in this project. Afterall, wouldn't we want those people working the call centers and assembling components be able to see what they are doing? Making them more productive....

Cassandra

xmattMPHx

10-31-2006, 02:53 PM

Go to another website called www.voshpa.org (http://www.voshpa.org) and look what developed from the vision camp model. They now have 3 local eye clinics in Guatemala.

I was very lucky to have been at the VOSH annual retreat in Sanford, Florida earlier this month. Many VOSH chapters are catching on to what this thread is about - ending the vision camp model and using their expertise to develop local resources. VOSH California is doing tremendous work in Nicaragua. Some VOSH chapters are still stuck in the 1960s though. I think that this will be the trend for VOSH. As they become more aware of VISION 2020 and public health they will shift gears and become trainers and supporters rather than clinicians.

When I was in Chile, we had moderate to high minus scripts with a lot of oblique astigmatism. Talking 2-4 diopter cylinder values. Ptygerium was also very prevalent...

In Mexico there was more of a regular mix of primarily minus scripts with lower cylinder values..

China had more extreme myopia.

This is where working with the governments and doing proper epidemiolgoical research come into play. What type of correction is needed? What VA is appropriate in the national context? Is 20/20 desired or is 20/60 (WHO cut off) more appropriate in the cultural/national context? On your trips you were not seing a standard population. You were seeing a self-selected population. Perhaps you saw the 2-3% of the population that is refractively the worst? Maybe everyone is like the people you saw. Who will know until the research is conducted. Their is some really good work going on in Nicaragua (Guatemala? I forget which - sorry) (thanks in part to VOSH) now that will serve as the epidemiology for the rest of Latin America. (Hopefully more nations will do population based studies soon - expensive and time consuming though!) The governments should be telling us where the need is and saying this is what we would like you to do. If not national governments (as indicated in VISION 2020) then at least local governments. I am the last one you would expect to extol the role of government like this but we need someone to know where all the groups are working within a country and what they are doing. We need someone to coordinate all the efforts to prevent redundancy.

India has been specifically named as a place that needs better infrastructure for optical services. I know for a fact that many of these internet retailers are selling specs made in India.

This begs the question, is it better to infuse North American money into the Indian economy or to use their existing spectacle producing facilities to enhance quality of life locally?

I am far from an economist so I can't comment on your questions directly but there is some great work going on in India now. The problem is the vast population (obviously). See http://www.aravind.org/

A lot of the refractive error research is coming from India as well.

Dandona, L., Dandona, R., & John, R. K. (2001). Estimation of Blindness in India from 2000 through 2020: Implications for the Blindness Control Policy. The National Medical Journal of India, 14(6), 327-334.
Dandona, L., Dandona, R., Naduvilath, T. J., McCarty, C. A., Nanda, A., Srinivas, M., et al. (1998). Is current eye-care-policy focus almost exlusively on cataract adequate to deal with blindness in India? The Lancet, 351, 1312-1316.
Dandona, L., Dandona, R., Srinivas, M., Giridhar, P., Vilas, K., Prasad, M. N., et al. (2001). Blindness in the Indian State of Andhra Pradesh. Investigative Ophthalmology and Visual Science, 42(5), 908-916.
Dandona, R., & Dandona, L. (2001). Refractive error blindness. Bulletin of the World Health Organization, 79(3), 237-243.
Dandona, R., & Dandona, L. (2001). Review of Findings of the Andhra Pradesh Eye Disease Study: Policy Implications for Eye-care Services. Indian Journal of Ophthalmology, 49(4), 215-234.
Dandona, R., & Dandona, L. (2003). Childhood Blindness in India: A Population Based Perspective. British Journal of Opthalmology, 87, 263-265.
Dandona, R., Dandona, L., Srinivas, M., Giridhar, P., Prasad, M. N., Vilas, K., et al. (2002). Moderate Visual Impairment in India: the Andhra Pradesh Eye Disease Study. British Journal of Opthalmology, 86, 373-377.

In addition, India does have optometry as a recognized profession. This will decrease the burden on the surgeons freeing them up to try to combat cataract blindness while optometrists/opticians deal with refractive error issues.

12-15-2006, 12:22 AM

It looks like I am a couple of months late adding comments here, but I just stumbled across this thread a few days ago.

After reading all of the messages here I can see that there are strong feelings associated with "helping" others.

Some comments:

There were some back and forth comments about what a typical "mission" might entail. I think that although perhaps some groups make efforts to contact relevant local officials, national government, etc. there are a great deal of missions that do fly under the radar. Such behavior will only hurt everybody's efforts sooner or later.

There were some comments about infrastucture not being needed because the Lions Club already has that in place - far from it. The largest areas of need (mostly this would be rural Africa) do not have a Lion's club presence.

There were comments about Lion's being part of Vision 2020, etc. This is true at the international level, but there are a lot of individual Lion's club chapters sponsoring trips that are not well coordinated at all at national or international level.

Here is what we are up against - current estimates are hundreds of millions of people lack eyeglasses to correct refractive errors. Presbyopes are NOT part of this estimate. If you were to include uncorrected presbyopes, the number of people who need but lack eyeglasses would exceed a billion.

This number is not a one off need. Making a generous assumption that the average pair of eyeglasses given lasts 3 years or 4 years before needing an update in power or needing replaced because of loss or damage, then we need to be providing somewhere between 250 million and 333 million additional eyeglasses PER YEAR.

At best, the efforts of VOSH, Lion's various church efforts, etc. probably contribute about a million eyeglasses a year to the needy (this is a generous estimate).

We therefore are reaching less than 1% of the need and all of our contributions combined are actually statistically insignificant.

Not only that - we are loosing ground given population growth + population aging, the percent of need we are covering will only get smaller in the future if we stick to current methods.

The "mission model" is very expensive. When you add the human resources, actual costs of airfare, hotels, food, local transportation and everything else that goes into a mission, the costs per recipient are often close to what an eye examination costs in the states.

It does not take professionally qualified people from foriegn countries to appropriately dispense simple eyeglasses. Presbyopia in particular, which by far is the largest need, can be diagnosed and dispensed for by local people trained in very short courses.

Charity (free stuff) although vital at selected times, is harmful in oveall development efforts. Charity leads to dependency. Whey even try to take care of a problem at a local level if a bunch of foriegners are going to come in and take care of it for you.

Charity also hinders development. In locations where small local optical shops are trying to make a business or local optometrists are trying to survive, the last thing you want to do is charity.

There has been almost zero efforts to date to evaluate the outcome of mission style eye care. Everybody comes home feeling very good about themselves with interesting photos, and a few interesting cases to discuss, but nobody can actually say how many of the people you have helped actually use the eyeglasses provided for any length of time. This is particularly vital when spherical only lenses are provided and even more vital when donated lenses are provided.

I say almost zero because there is a bit of information out there. There was a small evaluation of a VOSH trip to the South Pacific several years ago. The outcomes were not very good (few continued to use eyeglasses provided). Check PubMed for Fiji, VOSH evaluation or similar key words to find this study, sorry I don't have it in front of me right now.

Also a Helen Keller program in Mexico that provides eyeglasses to school children was recently evaluated - (see IOVS). Again, a very low percentage of students who recieved eyeglasses continued to use them.

The final answer has not yet been identified, but it will absolutely include training of local people to take care of the basic refraction needs. It is the only way we can begin to address the needs of hundreds of millions. Otherwise we have to find solutions that can be replicated and scaled up and are ultimately financially sustainable.

I could go on for quit a bit more, but perhaps this is enough for now.

For the record, I have been working in international eye care full time for over 20 years.

Peace.

Jubilee

12-15-2006, 07:46 AM

So as someone who has strong feelings in this area, what do you need from us now?

How does the average (or slightly above since we are talking about people here on optiboard ;) ) optical professional get on board to help these programs?

As I stated in my responses several weeks ago, I am not comfortable telling these people to wait 5 years while we figure out a better solution.

What can we do to speed up and contribute to the overall goal of Vision2020 without leaving these people currently high and dry?

Cassandra

Dave Nelson

12-15-2006, 04:58 PM

The most astonishing fact was revealed to me during a mission to Fiji. Many people did not want the glasses that were donated. Even inhabitants of third world countries have pride in their appearance, and handing out 58 mm -6.00s with green nosepads to someone who was poor, but clean and fairly well dressed made me wince. It took me a while to understand that people, while very appreciative of our efforts, were not dancing in the streets with joy for the kindness and benevolence of these westerners who bestowed the rather shabby well-used spectacles to all the downtrodden, and highly myopic, population. We made every effort to accomodate teenagers, who, like teens the world over, want to look attractive. Many of them were school-girls in immaculate school uniforms understandably reluctant to be seen wearing pair of old thick glasses that had obviously been worn by someone else for many years. I do recognise the need to continue these programs, and I disagree that using donated spectacles are hindering progress in other areas. At the very least, I can ill imagine sending away a -9.00 myope without spectacles because, I could tell him, I don't want to hinder you from getting new glasses someday. but, I also agree that the days of donated eyeglasses are going to become history, and the sooner the better. As pointed out, the cost of missions is very high, and adding a cost of say, ten dollars a pair for new spectacles would not increase the cost of the mission much, and in fact, some of the cost can be recovered by charging people 5 or 10 dollars for new spectacles, an alternative that would be readily accepted by many, or most people, even in developing countries. As I have posted in the past, a model of sustainability is needed, and this will involve setting up clinics that also function as schools. It would need to be integrated into existing health models and use existing facilities where possible. It is an enormous undertaking, and the scope of the problem is its own undoing. We want to "instant gratification" we get from handing out the specs, but we understandably, are less motivated to put financial and other resources into a project where the results are less tangible, and progress is slow. But do it we must, and as stated, there are a number of projects and studies underway which seek to find long term sustainability and solutions to the problem. XmatMPHx appears to have taken his/her interest in the problem to a higher level than most, and I hope this interest will spark all of us to contribute to this global problem. I also hope to see threads posted from this person, and others who are involved in third world vision care.

01-07-2007, 05:13 AM

A very significant portion of the planet's population was born high and dry and most of these populations will continue to be high and dry long after you and I are dead and gone. That doesn't mean that change isn't possible.

You, as an individual, can rush overseas and dish out eyeglasses to a few hundred or a few thousand people every year. This will have absoultely no statistically significant impact on the bottom line of the global need. Even if you and everybody and every organization doubled thier current output, it would still be insignificant.

A great deal of time and effort goes into "mission" style services but the few evaluation studies of these services to date does not look good. In the end, YOU are probably the biggest "beneficiary" of your trip.

In regards to those few thousand you do help each year - I am willing to wager a great deal of money that neither you nor your organization tracks and monitors the actual visual outcomes among your recipients (how well do they see with the eyeglasses you provide?) I am also willing to bet that you never track later what percentage of these people you gave glasses to actually continue to use them (say 6 months later or some other time frame).

Both the humanitarian relief field and the international development field have realized that the idea of flying people across oceans to do hands on tasks that can be done by local persons is
a) an incredible waste of resources
b) misses the boat in terms of building local capacity
c) ultimately not very effective at all

Matt had touched earlier on the need for research and epidemiological studies.

We already know, by virtue of data that there aren't enough people or resources to conduct enough mission to meet the global needs in an ongoing manner. To continue to go on mission where local capacity is not also developed should not only be discouraged, I believe to continue to do so is actually an unethical use of resources.

Local capacities HAVE to be developed and by this I mean village level basic health workers. We can't expect that hundreds of optometry schools will be built in needy countries around the world in the next few years, turning out enough clinicians to take care of the needs.

The statistics I have reviewed from VOSH and similar organization and our own data show that a vast majority of eyeglasses given on "mission" type trips are for reading glasses. Given that correction of presbyopia is going to be the largest need, simply providing local people with the skills to give reading glasses and setting them up will go far. One organization, SCOJO does just this. (they have a website). locals are set up to approprirately dispense simple readers and make a small amount of money in doing so. This fills a local need, creates a local job and stimulates the local economy.

In Pakistan, Sight Savers International does refraction training a several levels. The first level one person is given very basic refraction skills and they go out and provide spherical lenses. Among those who have done this, some come back for additional training to upgrade their skills to do more. For those with the aptitude and interest, after several cycles, skills are upgraded to the point that this person is working at the capacity of a trained optometrist.

The Africa branch of ICEE also trains trainers in basic refraction skills (see ICEE website) and IRC recently published a paper in Optometry and Vision Science (November issue) describing a program that uses local health workers to provide eyeglasses as needed, while one of the faculty at New England College of Optom. developed a curriculum to train locals to do refractions somewhere in Central America (see AAO website and look at the abstracts from 4-5 years ago). There are quite a few other examples out there also.

What needs to happen now is that we will have to conduct some operational research of all these various efforts to determine:
a) which of these models work
and
b) among the models that work, which models can be scaled up and reproduced across several environment
and
c) among these, which are economically sustainable or cost effective

If we can find a handful of models that fit these criteria, we can then scale up world wide.

My recommendation to organizations (such as VOSH) who feel that they don't know how to do anything other than a mission model, is to at least pick a truely needy area, work with the government at the national and local level and commit to this area, returning to the same place year by year. While doing this, do what you can to train local staff to do your work - get the local health officials to help identify good potential candidates.

Spend time and effort to monitor and evaluate your efforts, find out what works and what does not work. Are visual outcomes acceptable? Is utilization at 6 months acceptable? etc.

READ more about this and related topics not only in the eye, health and medical journals but also in editorials and commentaries - actually read the core Vision 2020 document. It isn't about "providing service" at all - it is about controlling five key eye conditions (including refractive error) via development of infrastructure and development of the local human resources to allow for sustainable eye care into the future.

The mission model is a relic and the sooner it is gone the better.

kaypaula

01-09-2007, 03:41 PM

Very interesting post. While it sounds good in theory, you have to be practical about this. A severely myopic patient (for instance) in a third world country, who cannot make a living because he/she cannot see, would benefit from a recycled pair of glasses-- would be like a MIRACLE to actually be able to see for the first time in their lives, what a life changing thing for them! That is practicality. Can you imagine telling this person that it would be better for them to wait, until their country is set up properly with good health care. Please.

Paula

Andrew Weiss

01-09-2007, 05:36 PM

1) There has to be a way of doing both -- taking care of the short-term need for immediate relief while at the same time educating and building the necessary infrastructure so that charity becomes obsolete. All too frequently those folks at the front of the line suffer most when the rules change (in this case, if we switched abruptly from donated eyewear to new, locally manufactured eyewear). I'd love to avoid that.

2) There have to be innovations going on in eyeglass fabrication for areas where surfacing/edging labs would be difficult or impossible to maintain. What ever happened to those glasses with the fluid-filled membranes that could be adjusted to create different powers, for example? Developing those kinds of solutions could really help in the long run.

3) Sometimes it's easier, and less painful, to focus on suffering abroad than at home. Focusing on suffering at home means acknowledging that we have work to do to clean up our own house.

Just some thoughts. I really appreciate this thread, I learned a lot from it. Thanks to everyone, especially Matt and Cassandra.

cash1

01-09-2007, 06:06 PM

lens crafters will sell them:finger:

01-09-2007, 07:22 PM

Some quick comments

for kaypaula,

1. This is practical. What is not practical is (again) to send people half way around the world to do fairly simple work.

2. Severe myopes in any country would appreciate being corrected - fully or partially. I have not discussed the merits of partial correction or full correction here at all - it is the methods in which services and eyeglasses are provided that I have discussed

3. (FYI) rates of myopia are fairly low in developing countries, particularly in the rural areas. Rates of high myopia are even lower in these areas - there aren't as many high myopes out there (in poor countries) as you think. In most of rural Africa, well under 5% of the population has any refractive error of any kind.

4. Tell people they have to wait? - please? This is funny. You make it sound as if you have a viable solution now and that I am asking you to withhold your solution from the masses. If you have the solution, tell us. Whatever it may be, the mission model is NOT it. The mission model is highly ineffective, extremely costly and potentially hinders local development of eye care. At this point all efforts should go into models and/or programs that are much more efficient and will be in a position to responsibly replicate or spread across populations faster.

for Andrew,

You are right, the long term goal is developing sustainable systems. Your term short term need for immediate relief is a bit of a misnomer in this case. You can't call this need short term when it has been there pretty much forever. There is no real chance for immediate relief when up to a billion people are in need.

You are also right there are a lot of innovations going on out there. Hand held autorefractors are an obvious innovation useful in some areas while instruments such as the Focometer are also playing a useful role out there. Very simple methods to conduct refractions "in the bush" have been described by Joseph Taylor in the Journal of Community Eye Health more than a decade ago. The adjustable film lenses you refer to have been in use and are undergoing large field trials in Ghana and elsewhere (Adaptspecs). CBM (the largest eye related non-profit organization in the world) has determined that if you are able to give 5,000 specs or more in an area, it makes economic sense to set up a modest edging facility. This is being done also.

Much time, energy and effort are going into these sorts of solutions and some of these will end up paying off.

In the mean time, these various efforts are all being tried out in the field now, where they are helping people now - they are not being tested on graduate students at some ivory tower academic institution.

I am not clear what you mean when you say people at the front line suffer when the rules change?

Peace,
jV

Jubilee

01-09-2007, 07:57 PM

The concern is that many of these places are used to getting a mission in their area on a fairly regular basis. I know when I was active with the Gift of Sight mission teams, there were countries we visited on a yearly, or every couple of years basis.

When these missions consisted of handing out 30-50 thousand pairs of glasses, it does make a difference into the community. It may be short term, and it may not be the best use of the funds.. it may put a damper on the rate of change in a given area to local based services. However.. the people who do receive these services in a short period of time are able to have a significant and immediate improvement in their lives.

We always left any undispensed glasses there, along with showing members of the local Lion's club how to do simple repairs etc...

I agree with the long term goals of the WHO Vision2020 plan. I want to help. However, I believe withdrawaling away from mission plans without being able to impliment a locally sustaining system in its place for several years will indeed be detrimental.

Imagine telling the Chilean Lion's club: "Well we want to help you. However the World Health Orgainization has deemed these missions to be detrimental for your health care system, and has asked us to cease all of these type trips. We are working on a replacement that will help you train people to do these things locally, along with getting low cost materials. Unfortunately we don't have a solution quite yet, but all of our money that we would normally spend in coming to your country will be put into the research and development of these programs. With any luck, we will have a solution for you in 5-10 years!"

You really think they will believe we are looking into their best interests w/o being condenscending?

Cassandra

Jubilee

01-09-2007, 08:04 PM

3) Sometimes it's easier, and less painful, to focus on suffering abroad than at home. Focusing on suffering at home means acknowledging that we have work to do to clean up our own house.

Just some thoughts. I really appreciate this thread, I learned a lot from it. Thanks to everyone, especially Matt and Cassandra.

Thanks, obviously this is a subject dear to me.

Maybe since we are having problems getting going on the "Optiboard World Vision Project" (don't think I have forgotten.. I am doing research still) we can focus our attention on the home front.

How many Doctors on board here are willing to do one free eye exam a week? Is every slot on your appointment book filled? If you are really that busy, can you do 2 a month then?

Opticians.. how many of you know who is at your local Lion's Club and Prevent Blindness locations? Are you aware of any programs that they have going?

Have any of you contacted that lab you have a great relationship with and asked them if they can help you provide glasses to someone on a limited income?

Are you willing to sell someone a pair of glasses at your cost to help them out?

What are you doing personally to solve the problem here?

Are people willing to make a commitment to do a certain amount of charity this year? I would love to start something here!

Cassandra

Jacqui

01-09-2007, 08:35 PM

Are people willing to make a commitment to do a certain amount of charity this year? I would love to start something here!

Cassandra

Keep it up, I'm still plotting :D :D

01-09-2007, 08:36 PM

It's a big world and VERY FEW places are use to getting a mission every year. I applaud your organization for having the forsight to return to the same place again and again. It is about the only way you can make a mission model worthwhile. You should be identifying and training local people to dispense glasses in your absence.

Your giving of a certain number of eyeglasses, although appreciated probably by some, can be detrimental and can hinder development of local eye care. Imagine you are a small local businessman who wants to open a very modest optical shop. You do a very modest amount of business but each year these very visible team of foreigners comes in and gives out eyeglasses for FREE. You don't think it hinders things?

If anybody tells you to "stop" doing this, it would eventually be the national government. They fully understand the development model and fully understand how these mission can and do hinder things.

That these people are having a short term impact as a result of the eyeglasses given is not necessarily the case. First off, you have to disregard most of the low powers you give out. Probably a fairly high proportion of the glasses you give are less than 1.0 Diopter. Anything less than a diopter does not represent a debilitating need and providing eyeglasses of say + or - 0.50 will do very little to improve something in ones life.

Second, and I don't know what your organization does - but if you are giving out used eyeglasses, you have no idea how well they are ultimately accepted or how long they may actually last before breaking. As noted before, the research on this is very slim and does not look favorable. Your comment that you have made a "significant and immediate" improvement in their lives is appreciated but is unsubstantiated. An improvement can be stated when you can show, WITH DATA, that there has been a measurable improvement in vision (what percent of your patents see 20/30 or better with the eyeglasses you give them) that is sustainable (what percentage of your eyeglass recipients actually still have and still use the eyeglasses you provide 6 months later? one year later?). Improvements on their life can be stated when you show WITH DATA that their economic standing is better, their grades are better or their quality of life (using a suitable questionnaire) is better.

The number of "smiles" you see don't count and are not necessarily correlated with any of the changes noted above.

Finally, there is not necessarily a justification for delaying development of ongoing sustainable services. When highly qualified people or professional go overseas to do something, they should be training and not providing direct services.

It would be great if your group started training up local people, develop a local capacity and then leave and go to another location and do the same thing again.

Peace,
jV

01-09-2007, 08:45 PM

Cassandra,
Forgot to add...
It should not take "several years" to get something going. You can start training now. You can send down fewer people and use the money that would have been spent on airfare, hotel and food, etc. for local eye care development.

Dave Nelson

01-09-2007, 10:24 PM

the optiboard world vision project is alive and well, although inactive during the holidays. I have been doing some research as well, and hope to see more on the thread soon.

Andrew Weiss

01-10-2007, 08:38 AM

I am not clear what you mean when you say people at the front line suffer when the rules change?

Peace,
jV

I apologize for being cryptic :o. What I mean is, when a social system changes the rules, frequently the first folks affected by the new rules take the heat of the fallout caused by the change. This is a non-optical (and perhaps somewhat loaded) example: when the US District Court ordered busing of schoolchildren in Boston in the 1970's, the first generation of kids who were bused, and their parents, had to live through a very difficult situation (buses were stoned, kids ostracized and heckled, parents hurled insults at each other, etc.). If we were to suddenly divert all monies to developing ways to create and maintain local vision care world-wide and stop all vision "missions" cold, the folks who have vision needs right now would most likely get less service as they waited for the new project to gear up. That's what I meant when I said I believe we really have to do both.

I also understand the reality that change tends not to happen when there isn't an immediate and powerful motivator, and that we can create one by stopping the vision care missions, in this instance. I believe Cassandra and Matt have explored the dynamics of this tension already.

Dave, thanks for letting us know that the Optiboard World Vision Project is still alive and well. And Cassandra, thanks for your post on what we can do locally. At the place I last worked, we made an effort to serve with low-cost or at-cost eyewear for those in need.

As always, I am awed by the caring, generosity, sincerity and dedication of our Optiboard community.

Is there perhaps a way of combining this thread with the Optiboard World Vision Project one? We're basically talking about the same thing. Steve?

EyeFitWell

01-10-2007, 12:41 PM

lens crafters will sell them:finger:
I'm guessing you're saying here the Lens Crafters is selling the gift of sight donations? I just wanted to post that LC gives tons of money, time, and resources to their Gift of Sight program which allows people both in the US and outside the US to recieve free eyeglasses. You have no reason to say this, nor anything to back it up with. Besides, if you saw a few of the frames donated at LC, you would realize that there is no way they could be passed off as new, even to a blind person!!
I disagree with many things about large chains, however I respect and admire the Gift of Sight Program. When I worked for LC, I was the GOS Captain, and I just couldn't let your comment slide without correcting such a preposterous assumption.

Luma

01-11-2007, 06:15 PM

I am a social geographer from Sweden.
Sweden is a large country with a small but industrious population.
In 1979 The org. for the Visually handicapped of Sweden started a school for opticians in Moshi on the slopes of Kilimanjaro in Tanzania with support from SIDA, the Swedish Development Aid.
Swedish opticians worked as teachers there until 1986.
After 1986 two of the first students who had been able to get scholarships in USA and Australia to become doctors of optometry, took over as teachers.
These two are still working at the school as teachers. The school has 10 students each year in a three year educational plan. Almost 250 opticians have been trained at the school at Kilimanjaro Christian Medical Centre.
Most of these opticians work at regional, district or mission hospitals all over Tanzania including Zanzibar.
My husbond, Bo Hesselmark worked at this school 1980-86.
Together the two of us have done projects to help his former students in Dar es Salaam, Mwanza and on both islands of Zanzibar.
Since 2000 we are concentrating on Zanzibar and as known from earlier in this Forum most people only need reading glasses as 95% of the population has no refractive error.
In February 2007 we are leaving for Zanzibar to spend 4 weeks there. We cooperate with the Zanzibar Ministry of Health and the opticians on Unguja and Pemba.
We plan to bring at least 1500 reading glasses. These will be dispensed in the rural areas after simplified eye tests, often performed under a tree.
As there is existing eye care in Tanzania patients requireing referrals will get one.
Anyone wanting to learn more about our projects may visit our homepage
http://hem.passagen.se/luma
some is in Swedish, but some also in English. There are a lot of pictures.
Our motto has always been: Let's do what we can and hope someone else will do the rest.
Karibuni 8-))

LadyDie

03-18-2007, 06:18 PM

Originally Posted by cash1 http://www.optiboard.com/forums/images/buttons-az/viewpost.gif (http://www.optiboard.com/forums/showthread.php?p=171528#post171528)
lens crafters will sell them:finger:
I'm guessing you're saying here the Lens Crafters is selling the gift of sight donations? I just wanted to post that LC gives tons of money, time, and resources to their Gift of Sight program which allows people both in the US and outside the US to recieve free eyeglasses. You have no reason to say this, nor anything to back it up with. Besides, if you saw a few of the frames donated at LC, you would realize that there is no way they could be passed off as new, even to a blind person!!
I disagree with many things about large chains, however I respect and admire the Gift of Sight Program. When I worked for LC, I was the GOS Captain, and I just couldn't let your comment slide without correcting such a preposterous assumption.

I think when cash 1 made that statement they were just going with their gut. However they weren't completly wrong. I am on the board of our local V.O.S.H. board (vosh.org). We can no longer get our used glasses from our previous source. But, LC will sell us the ones they don't want (super ugly, high cyl, no spheres) for $1.00 each. That isn't a lot but when you consider we are a small group and do several foriegn missions a year and take thousands of glasses on each one it really adds up.

k12311997

03-18-2007, 06:26 PM

03-18-2007, 09:22 PM

I have just returned from the First International Congress on Refractive Error in Durban, South Africa. Over 600 people were at this congress which was well attended by WHO, IAPB, the large non-profit groups that work in eye care, some governments and a lot of people working in the field in developing countries. The idea of dispensing used, donated eyeglasses came up in several presentations over the three day period and a couple of times during plenary sessions. The general consensus was that using donated eyeglasses does not contribute towards the development of sustainable eye care and in fact, may hinder the local economy. The use of donated eyeglasses will be increasingly discouraged.

Jacqui

03-18-2007, 10:26 PM

The general consensus was that using donated eyeglasses does not contribute towards the development of sustainable eye care and in fact, may hinder the local economy. The use of donated eyeglasses will be increasingly discouraged.

I agree with them, it is degrading

xmattMPHx

03-21-2007, 06:36 AM

It is very appropriate that this thread was resurrected. I was unable to add to the earlier resurrection as I was in the midst of an international move but I read it with great interest. As jV mentioned the World Congress on Refractive Error and Service Development just concluded in Durban. It was an interesting meeting. I had the opportunity to meet a number of people who are working on the ground in Africa. One mentioned that he painstakingly worked with key stakeholders to establish refractive clinics and opticals in Ghana only to be confronted by a vision camp coming in and handing out free spectacles. The population wondered why one group was charging and the other was giving services for free. The free care was inferior but the lure of a vision camp is large.

After receiving recycled spectacles the patients then presented to the opticals for repairs further impacting the development of the local infrastructure. The argument here is not entirely about the quality of recycled specs. but rather the creation of sustainable systems.

I hope that groups like GOS (who unfortunately were not represented at the WCRE) at least consider what type of care is available in the countries they visit to ensure that they are not negatively impacting the local practitioners.

If you have the desire visit http://icee.org/index.asp to see the "Durban Declaration" - what will surely become the guiding document for refractive care in developing countries.

35oldguy

03-21-2007, 04:04 PM

I have been following this thread. Everyone has some very good ideas and not everyone will agree on how to get the job done. It is a well known fact that there are people in need all over the globe whether it is in your home town or where I live. I live in Guatemala. I moved here to provide eyecare to the needy and many have been helped through lots of work projects we have done over the past ten years. We give them a free eye exam to determine if they need eyeglasses by the use of a autorefractor. If we find they have a refractive error we continue with the use of a phoropter or trial lens sets with trial frame. If they are really in need of a pair of eyeglasses we sent to make a pair of new eyeglasses at a local lab to fit their RX exactly. They are charged a low price that cover the cost of materials and other expenses.

I went on many optical missions over a period of 20 years. Yes some people will benefit from used eyeglasses. If the lenses do no correct their particular problem they throw away those lenses and buy new ones. At least they do not have to buy the frame. In some cases I have found people are very happy with used lenses. But I found that many people would stick them in their pocket and never wear them.

People like to see well no doubt. People like to look nice too. Many people we have seen buy eyeglasses with low RX's because they want to be in style. I have also seen many Mayan Indian girls 20 years old and younger that had very high nearsighteded RX but their parents would not buy them for them. They would instead buy them for their sons who really did not need them. Why? Your guess is good as mine!

I believe that whatever you do helps in some way. If you think you should give at home do so. If you would like to provide at least a opportunity for someone in a third world country help them. Why do so many people from Latin America illegally enter the USA? There is no opportunities in their own countries to find a job and earn a living. They earn money in the USA at jobs you would not ever think of doing. Unskilled labor. They then send the money home to help support their families so they at least will be able to survive! So send your used eyeglasses here. Donate your used equipment to a good cause that you have depreciated out.

If anyone has a used autorefractor in good condition I need one! The one I have used no longer works. We organize projects all year long. We would like to continue doing them.

As a person who has gone on optical missions and has worked with the Lion's Club and the Gift of Sight program for optical based missions.. let me tell you a few things about how this is done.

When deciding on a location for an international mission, the mission leaders, and the Lion's Club both from the US and the country of the possible site investigate local and state laws and are in contact with government officials. NONE of this work goes on under the radar. How can you with optical missions that help 30-50 THOUSAND people in a matter of 10 days?

When I was on my missions, we had the Civil Defense, the local Nursing School, Teachers, Missionaries, along with the Lion's Club volunteers helping to not only help people through the process but to ensure our safety as well.

Lions Club members are shown how to screen people to see if a "vision" problem existed. We had a surgeon with us who did cataract surgeries, and local health officials were shown how to do follow up care. We not only had thousands upon thousands of recycled eyeglasses, we also had readers and sunglasses to give away as well. I also was in charge of a project to make glasses for children if we didn't have the appropriate rx in a frame to fit.

Some of the missions in Mexico now have functional labs to edge finished lenses for the thousands of people who need only single vision correction.

When I was in Chile, the nearest "eye doctor" was over 250 miles away from the desert town I was in. People don't have the money to travel, or to pay for the eye care. The time and expense involved made it IMPOSSIBLE for most. Are you saying we should tell these people they don't deserve anything, or even better yet "You deserve better care than we can provide so we aren't going to do anything but lobby for a better healthcare and vision care system for you.."

They need the help NOW. Not 10 years from now.In order for those people to develop the skills necessary to examine and fabricate glasses, don't they need to be able to see?

How about countries where they only work in spherical equivalents? Aren't the people there missing part of the acuity they could have? But that is ok...

I agree that we need to help these people develop their own system of care. But while this is in development, they need the recycled donations to get them there.

A far as your 5 step approach:

1) Screening is done to see who would benefit
2)Refractions are done, along with eye health check
3) Glasses given from either donated or manufactured stock
4) Dispensed based upon the rx guide. While it may not be spot on, many are close and you can't say that correcting to -3.50 is worse than no correction for someone who is a -4.25 sph.
5) Local Lions are shown how to repair and unused donations are left with them for future replacement purposes.

The work for the US will be in a different post.

Cassandra