Optiboard World Vision Project

[Dave Nelson]

Less talk, more walk. The thread on keeping edging costs down in developing countries was pretty good. I learned a few things about the existance of low-cost edging equipment that I didn't know before, since there are people on the optiboard who know far more than I do about laboratory equipment, and the manufacture of spectacles.
Third world eyecare presents a complex set of problems, and a wide cross section of skills and talents are required to present real and lasting solutions. The optiboard is such a pool of talent. optometrists, opticians, lab people, educaters,and people who have vast knowledge of equipment, supplies, business, and socialological issues raised when attempting to bring change to various developing countries.
Why can't we pool our knowlege and resources to design a model, or template, that seeks to deliver refractive services in a sustainable, cost effective manner?
Such a project would involve evaluating educational programs, equipment needs, sourcing materials and supplies, and an analysis of the most cost effective means of delivery of service. Standards and parameters can be set, based on cost, accessability, viabilty, and sustainability.
This proposed template could be adopted, studied and/or reviewed by any one at any time. I propose limiting it to refractive error only, at least for the time being, with allowance to "mesh" with a more comprehensive model involving a higher level of care.
The "mission statement," if you will:
"To develop an efficient, effective and sustainable model for the delivery of service to alleviate refractive error as a cause of the diminishment of the quality of life."
I'm not trying to save the world here, but such a template could be a valuable resource for those seeking to put such a plan into place.
It is also important to remember such plans are theoretical: getting them to work in the real world is another story.
Shall we try this? Anyone interested? help me out here.

[Jubilee]

I was thinking about this some last night...

I wondered if one of the equipment manaufacturer's might offer to buy a practice's/lab old equipment in exchange for buying some of their's. Then gather the old equipment up and refurbish it to use for a redementary vision training/lab model...

Good will could translate into good sales for the manaufacturer, and eqiupment qould become available to send to these developing countries.

My concerns with such a program is shipping the equipment to the various locations, set up/training, and maintenance. Especially with those that heavily use computerized electronics.

In my mind, the Weco 440 really would be a great machine prototype for this kind of work. Very straightfoward mechanical based that is easy to troubleshoot.

Now would our goal be to provide spherical equivalents to make things less complex initially? What about presbyopes? It was stated in the other thread that ready made readers would serve well. However for a presbyope that has a distance rx as well, would we then provide two pair of glasses or utilize press on adds or some such to keep it to one pair?

Cassandra

[Dave Nelson]

You have some really good ideas. Thats what I mean, the optiboard has a diverse cross section of people and ideas to make this work. A model, or template is essentially a plan, rather than an actual project. if you were asked to set up a sustainable vision project in a developing county, You would spend weeks, or months trying to figure which equipment, which suppliers, what training you could access, cost effectivness, and other considerations. If you were able to access an existing plan developed by such a diverse group of vision professioals, such as optiboarders, you may save weeks of planning, and possibly costly mistakes that can sink such an enterprise overnight.
Essentially, my idea is to set parameters which can work. Your questions about sherical equivilents and bifocals for example. Do we do bifocals? Well, I don't know. Will they push the cost per pair to high to make the project viable? What is the cost per pair we think will will make it viable? I have $10 per pair in my mind as a cost which I think is a realistic goal, but, again, I need some input.
Can we do bifocals and keep the $10 per pair criteria? or do we change the criteria to 12 a pair? Or do we skip bifocals because presbyopia is less of a problem? Personally, I hope to include bifocals, even progressives, in the plan, as well as cylinder lenses. I'm interested in the weco 440, as well. Is it available new? Is it being refurbished, or dicontinued? is it patternless? can it be retrofitted for patternless? How many cycles bofore it needs sevicing? Oh, and did I mention that, the first person to respond to my post is automatically made the co-director of this project?:D
Thanks Cassandra. anyone else?

[HarryChiling]

no longer playing in this sand box

[Dave Nelson]

Some good thoughts. My thinking about patternless, was more for flexibility. What about spherical equivilent in bifocal? That way, one could use stock lenses, in say, +150 and +250 adds. Or, could krytok be used since this would half the inventory needed since you don't need lefts and rights? this would leave astigmatic presbyopes a bit in the lurch. Did I mention the second person to respond to this thread is automatically a co-director of this project?

[HarryChiling]

no longer playing in this sand box

[Dave Nelson]

Actually, I have checked the WHO site, in which they talk about uncorrected refractive error coming to the forefront as a significant problem in many countries. It diminishes the quality of life, and as WHO points out, has a significant economic impact on many communities as well. We also have people on this board, such as Cassandra, myself, and many others who have worked on projects in developing countries, who are able to contribute some first hand knowledge and experience. I was impressed by a project I have mentioned before which sought to bring the cost of cataract surgery down to within an identified amount, making it more accessable and affordable. every 50 cents they were able to shave off the cost of the procedure was a gain in terms of reaching their goal, and I think we have the brains and motivation on the optiboard to put a plan, or template together as well directed to refractive error. Someone tell us more about the Weco 440. Is it still in production? Is it available refurbished? Are parts available?

[HarryChiling]

no longer playing in this sand box

[Jubilee]

The 440 hasn't been in production for years, but I know of several that are still in use, both the orginal 440 and the 2440.

The edger Harry linked to, has promise.

We can either use frames that are massed produced via injection molding (the GOS Chabella frames are a good example) that are low cost plastic to fit the bill..

or..

We can utilize the thousands of discountinued frames that companies are left with each year. Many frame companies currently donate discontinued models and even some new ones to various vision charities. I am not sure if sufficient quantities exist to support the international efforts or not, but maybe we can use a combination of methods to supply the developing labs.

What kind of equipment do we envision somoene having for refraction purposes? How long do we think a group needs to go in and train a couple of people on refraction and the actual production of spectacles? Do we ask for volunteers or do we have a way to recruit the people we feel will be best suited? Do we plan on these people being "full time employees?" or people who will volunteer on a regular basis?

Cassandra

[Jacqui]

Dave, Do you have the web address of the WHO site you mention here??

Actually, I have checked the WHO site, in which they talk about uncorrected refractive error coming to the forefront as a significant problem in many countries. It diminishes the quality of life, and as WHO points out, has a significant economic impact on many communities as well. We also have people on this board, such as Cassandra, myself, and many others who have worked on projects in developing countries, who are able to contribute some first hand knowledge and experience. I was impressed by a project I have mentioned before which sought to bring the cost of cataract surgery down to within an identified amount, making it more accessable and affordable. every 50 cents they were able to shave off the cost of the procedure was a gain in terms of reaching their goal, and I think we have the brains and motivation on the optiboard to put a plan, or template together as well directed to refractive error. Someone tell us more about the Weco 440. Is it still in production? Is it available refurbished? Are parts available?

[a1vo]

ALL W.H.O. pages related to "uncorrected refractive error"

http://search.who.int/search?ie=utf8...&Search=Search

[Dave Nelson]

Whoa, Cassandra, you're going to fast for me.:D
I did look at the edger, but have some concerns about the proven long term reliabilty of the unit, as well as the use of electronic, rather than mechanical systems. The 440 has been mentioned due to its simplicity, and proven track record of long-term reliabilty. We need some criteria, we think an edger should meet. Cost, reliability, accessability, access to parts, weight, flexibility, ect. Should we look at dry edgers, so the cost of replacing/refurbishing the diamond wheel is eliminated? We aren't limited to one edger, either. What about that low cost machine out of Texas Jackie mentioned on another thread? You must calculate the cost of the unit, and divide by the number of cycles the unit is expected to complete reliably, and add the resultant figure to the cost per unit of producing spectacles.
Frames. There does appear to be a fair number of suppliers for low cost frames, but, again, they would need to be reliable, and attractive, and the sources need to be fairly consistant and reliable. Injection molding looks good as a means of producing low cost frames, but we also need some metal ones. I suggest we only consider plastic, non-ar coated lenses as well.
Education/training. Distance education with some on-site training? We need to train people to the level that they are then able to train others. Not an easy task. I suspect a bright individual could be trained in the basics of refracting, finishing, and dispensing in about a year or so, and could seek higher levels of training after.
Refracting. Trial clip/phoropter/retinoscopy? Must be inexpensive, reliable, simple, and must not be to labour intensive. Lets just say for the moment we assume our model uses a phoropter. (Harry's link also has one.) How much time shall we consider to be appropriate for a refraction?

[Dave Nelson]

ALL W.H.O. pages related to "uncorrected refractive error"

http://search.who.int/search?ie=utf8...&Search=Search

Thanks for the link.

"Also, adequate infrastructure has to be developed in underserved areas of the world to facilitate the logistics of providing affordable, reasonable quality spectacles to individuals who suffer from refractive error blindness."
Rakhi Dandona, Lalit Dandona,
Prasad Eye Institute

[Dave Nelson]

Go ahead and say something, Jeff, you arn't usually quiet...:bbg:

[Jacqui]

I'm watching this thread with great interest as I am working with a group that is trying to set up a long term program in a developing country

[Johns]

[quote=Dave Nelson;169078]... they would need to be reliable, and attractive... quote]

Why would they need to be attractive ?

[Dave Nelson]

Read my last post on "where to donate frames." Why shouldn't the frames look attractive? Don't you wear nice frames?

[Jubilee]

I believe the implication is that if they aren't attractive (or at least if they are butt ugly) then people may not wear them.

It is true that some of the teens/etc would get upset if the only glasses we had for their script was a 62 eye double bar aviator...It was rough explaining to them that looks weren't are focus, it was vision. In fact I even told a couple of them that if they weren't happy with them or were going to wear them, then please let us have them back so we could give them to someone who would appreciate them.

I don't think attractive has to be designer like...

Perhaps something similar to what is offered by Capri optics... inexpensive but fairly attractive frames..just hopefully something that the finish doesn't wear off in less than a year.

Cassandra

[Johns]

If you are trying to "help" as many people as possible, how can you get involved in "fashion"? If 20,000 frames are donated, but they are destined for a geographical area that the style or color of frame is deemed not "attractive" for the skin color or facial bone structure of the people of the area, shouldn't they be used anyway?

In the situation of starving nations, is the mission statement to "deliver foods that are not only nutritious and life sustaining, but also delicious?"

I'm not trying to hi-jack the thread, I think the intentions of all posters are honorable. It just seems to me that any frames that are donated, would be frames that didn't sell because they weren't "attractive" enough in the first place.

[Dave Nelson]

Sorry, perhaps I havn't been clear enough. We are not looking for donated frames, equipment, or anything else. We are looking to source frames, equiment and supplies that can be purchased. Charity is great, but long term, sustainable solutions must be economically viable, so long term reliance on outside charity is reduced and, hopefully, eliminated. Accessability and affordability are the key elements in health care for any region, and economic viability is the engine that insures accessability. A charitable organization that seeks to address the problems of uncorrected refractive error, (UCRE, from now on,) will look for both short term, (medical missions with donated eyeglasses) and long term solutions. My effort is to use the collective skills and talents of optiboard to set up a "blueprint" for a reliable means of delivering new eyeglasses to areas with the greatest need, with the least start-up cost, most efficient means, and lowest cost per unit, while sustaining economic viability. Setting up such a system, only to have it collapse when the funding runs out does little towards long term goals. As pointed out as well, such a plan could, concievably be adopted by a charity who may prefer distributing new glasses instead of, or in addition to, used ones. Given that we must find a reliable source of low-cost frames to make this work, we may as well find some attractive ones, as ugly ones. Many of the worlds poor are willing and able to work, and do work, and nearly all of them have dignity and pride. Johns, no-one thinks you are hijacking this thread. Your comments are most welcome. Did I mention you are now a co-director of this little project?:bbg:

[Johns]

Did I mention you are now a co-director of this little project?:bbg:

So long as it doesn't require me to wear a hat that makes me look like a bus driver...;)

[Dave Nelson]

anyone know how many cycles one could expect to get from a reconditioned Weco 440, or any other similar edger, before the stone needed reconditioning?
How many cutting cycles does a dry edger bit get before replacing?

[Jacqui]

anyone know how many cycles one could expect to get from a reconditioned Weco 440, or any other similar edger, before the stone needed reconditioning?
How many cutting cycles does a dry edger bit get before replacing?

I can't really give you any numbers as such, but a dry cut edger blade needs to be replaced more than a wet cut wheel. Don't think only Weco 440, the AIT Mark V and Grande Mark are also workhorses.

[Fezz]

Aren't there enough in need in our own countries?

[Dave Nelson]

anyone using, or has used a horizon 2 dry edger?