Vision outcomes with ready-made spectacles on the thai-burma border

Uncorrected refractive error, combined with inadequate presbyopic correction, is the leading cause of vision loss in the world. Gold standard refractive services are unavailable in many rural areas of developing countries, where, ready-made spectacles (RMS) are often used in place of full corrections. This observational study describes vision outcomes obtained with RMS by local health workers doing subjective spherical refractions in remote locations.

We retrospectively reviewed records of 9 eye clinics serving refugee/displaced populations on the Thai-Burma border to extract vision acuity (VA) data and other study variables. Trained local health workers dispense RMS in 0.50 D steps from +1.00 to +4.00 and –1.00 to –2.50.

Among 954 distance vision RMS recipients, 30.4% had VA 6/6 compared to 3.1% without RMS; 83.6% had VA 6/12 or better compared to 16.3% without RMS; and 96.3% had VA of 6/18 or better compared to 44.9% without RMS. After RMS correction, only 3.7% could not see 6/18 (WHO defined normal vision).

Among 2820 reading RMS recipients,18.4% had NearVA 20/20 compared to 0.5% without RMS; 87.9% had NearVA 20/30 or better compared to 1.9% without RMS; 98% had NearVA of 20/50 or better compared to 8.3% without RMS. After RMS correction, only 2% were unable to see newsprint (20/50).

As RMS provide a workable solution from a public health perspective, we recommend standardizing vision outcomes reporting to allow for monitoring the effectiveness of RMS as a whole and in different contexts. Monitored outcomes for individual refractionists provide valuable quality control information, thus improving programs.