missionary vision care refractive error assessment missionary vision care - medical missions...

$: Missionary Vision Care Refractive Error Assessment Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010$
Missionary Vision Care

Refractive Error Assessment

Missionary Vision Care - Medical Missions Interface Conference, June 12, 2010


Refractive Error AssessmentObjective Methods – limited communication• Retinoscopy• Auto-refractor Subjective Methods – extensive communication• Trail lens set• Foropter (Phoropter)• Focometer • Near-point card for presbyopia



Refractive Error AssessmentObjective Methods• Retinoscopy equipment and process

• http://eyeontechs.com/new/?p=308 (retinoscopy simulator)


http://eyeontechs.com/new/?p=308


Refractive Error AssessmentObjective Methods• Retinoscopy assessment– Acquired skill – takes practice!– Limited by cataracts and other conditions– Sphere and astigmatic capable– Complex cases may stump you– May want a subjective confirmation– Little patient cooperation/communication needed



Refractive Error AssessmentObjective Methods• Auto-refractor equipment and process



Refractive Error AssessmentObjective Methods• Auto-refractor equipment and process

• http://kendall-optometry-ministry.com/kendall-optometry/Missionary Vision Care - Medical Missions

Interface Conference, June 12, 2010

http://kendall-optometry-ministry.com/kendall-optometry/

Missionary Vision CareRefractive Error AssessmentObjective Methods• Auto refractor assessment– Mixed reviews from the field– Requires a large inventory, re-cycled glasses– Requires support staff– Low cost if equipment loaned– Low skill requirement but high information yield– “point

and shoot” high-tech solution.– Requires little patient cooperation/communication



Refractive Error AssessmentSubjective Methods – all require a much higher

degree of patient cooperation/interaction• Trail lens set• Foropter (Phoropter)• Focometer



Refractive Error AssessmentSubjective Methods• Trail lens set - equipment and process



Refractive Error AssessmentSubjective Methods• Trail lens set assessment– Trail and error bracketing process (0.25-0.5 dia)– Sphere and Astigmatic capable– Slower than other methods– Low-tech: no electronics– Requires full patient cooperation/communication



Refractive Error AssessmentSubjective Methods• Foropter (also spelled Phoropter)



Refractive Error AssessmentSubjective Methods• Foropter Method #2



Refractive Error AssessmentSubjective Methods• Foropter methods assessment– Trail and error bracketing process (0.5 diopter)– Sphere and Astigmatic capable– Quicker than trial lenses– Low-tech: no electronics– Requires full patient cooperation/communication



Refractive Error AssessmentSubjective Methods• Focometer - equipment and process



Refractive Error AssessmentSubjective Methods• Focometer methods assessment– Continuous RE increments (0.25 diaopter)– Sphere and Astigmatic capable– Quicker than trial len but slower than foropter– Low-tech: no electronics– Requires full patient cooperation/communication



Presbyopia Assessment (technically not RE)Subjective Methods• Near-point card• Age-guided trial and error method• Mono or biometric approach



RE Assessment Considerations– Duration of trip– Comfort level with the method– Degree of personal interaction desired– Cost of equipment and supplies– Glasses available to dispense– Support staff available– Experience: start simple and move up



Vision Clinic End Results• Hugs and smiles!



Practical Considerations for Primary Vision Care



Practical considerations for Primary Vision Care• Biometrics vs. monocular exam• Improvement vs. Optimization• Glasses Dispensing• Training and Supply Options



Practical considerations for Primary Vision Care• Biometrics vs. monocular exam – two schools of thought

• Which one is correct?• Can you do harm?


Eyes are often the same Eyes may be very different

I want to see more patients to help more people

I want to do the best I can on every patient

The time invested only yields incremental improvements

I’m happy to invest time to provide optimal correction

I only have single vision, fixed frame glasses.

I have the ability to build the needed glasses.


Practical considerations for Primary Vision Care• Biometric blending– Subjective best vision with both eyes

• Disregards astigmatism• Disregards anisometropia (different refracting powers)• Best chance of causing imbalance

– Subjective or Objective assessment with tables• Start with more positive, blend toward more negative• Disregards astigmatism• Avoids imbalance



Practical considerations for Primary Vision Care


Missionary Vision CarePractical considerations for Primary Vision Care• Improve vs Optimize – two schools of thought

• Which one is correct?• Can you do harm?• Are you missing opportunities to witness?


Any improvement is a blessing

The Lord’s service requires my very best effort.

I want to see more patients to help more people

I want to do the best I can on every patient

The time invested only yields incremental improvements

I’m happy to invest time to provide optimal correction

I have an abundance of glasses to give away.

I have the ability to build the needed glasses.


Practical considerations for Primary Vision CareJesus’ example? He certainly ministered to large groups, but His

relationship-building touches were 1:1– Matt 8: 14-16 = Healing Peter’s mother-in-law, then minister to ALL

brought – John 3 = Nicodemus – born again; John 4 - Samaritan woman – living

water– Luke 8:43 = Jairus’ daughter, but stopped in the crush, to find the

woman. Her faith had healed her.– Mark 10:46 = Jericho, Blind Bartimaeus - one out of a multitude;

spiritual sight– Luke 19 = Bethany on His way to the cross – Zacchaeus, stopped to be

his guest

Lesson: Jesus wasn’t in a hurry & He didn’t try to heal everyone.Missionary Vision Care - Medical Missions

Interface Conference, June 12, 2010


Practical considerations for Primary Vision Care• Dispensing Glasses – Objectives– Best available fit : lenses and frames– Function before fashion (mirror?)– PD (pupillary distance) and optical center• Induce prism/distortion• The higher the strength the more important this is

– System of organizing inventory to expedite, simplify and avoid errors.



Practical considerations for Primary Vision Care• Dispensing Glasses – Option 1– Re-cycled: Lion’s Club with Salvation Army• Assorted lenses and frames of all kinds• Sorting, organizing and matching fit a challenge• Least expensive supply, but large inventory required

and greatest amount of preparation.• Link with an inventory management system (Holland)• Potential for optimal fit – sphere, cylinder and add

power (bifocals)



Practical considerations for Primary Vision Care• Dispensing Glasses – Option 2– Fixed lens, single-vision plus and minus• Generally of lower quality (imports)• May have the ability to swap out lenses• Biometric blending approach – error potential• Generally 1.0 diopter increments



Practical considerations for Primary Vision Care• Dispensing Glasses – Option 3– Custom, single-vision plus and minus• Generally of higher quality (imports)• Option of pre-fitted or build your own• Mono-optical approach – reduced error potential• +10 to -10 range, 0.25 to 0.5 diopter increments• Frame and lens style options• Left/right or interchangeable lenses



Practical considerations for Primary Vision Care• Dispensing Glasses – Option 4– Custom, single-vision +/- with cylinder• Generally of higher quality (imports)• Custom build frames and lenses• Mono-optical approach – reduced error potential• +4 to -4 range, 0.25 to 0.5 diopter increments• Frame and lens style options• Fully interchangeable lenses (reduced inventory)



Practical considerations for Primary Vision Care• Dispensing Glasses



Practical considerations for Primary Vision Care• Training Options (handout)– Eye Doc in a Box (Dr. David Curtis)

• Exceptional in basics, optics, foropter emphasis

– InFOCUS/Visual Compassion (Dr. Joey Dollak)• Exceptional in retinoscopy, biometric blending

– Kendall Optometry Minisitry (Holland Kendall)• Exceptional in auto-refractor, integration software to make

use of recycled glasses



Practical considerations for Primary Vision Care• Material suppliers (handout)– Peachtree Optical (Mr. Jay Biggs)

• Custom missionary field kits, interchangeable +4.0 to -4.0 lenses for multiple frame sizes and styles

– Good-Lite Company (Mr. Joe Villari)• Vast supply of charts, equipment and supplies for missionary

vision care.

– InFOCUS/Visual Compassion (Mrs. Diane Baker)• Retinoscopes, Focometers , lens and frame selections



Tips for planning and conducting vision clinics



Tips for planning and conducting vision clinics – Connections on the ground – a must!– Organize/ Communicate, Organize/ Communicate, repeat– KISS approach – stay in your comfort zone– Arrive 2 days ahead of team for set-up– Limit the number of patient records allowed/day– Leave your watch at home– Involve others – you can’t do it all yourself– It will not go the way you plan – that’s OK!– Leave room for God– Pray!


missionary vision care refractive error assessment missionary vision care - medical missions...

Documents

error bracketing process

astigmatic capableslower

high information yield

large inventory

hightech solution