Ready-made Spectacles Research Articles

Assessment of optical quality of ready-made reading spectacles for presbyopic correction.

Many presbyopic patients in both developed and developing countries use ready-made reading spectacles for their near vision correction even though the quality of these spectacles cannot always be assured. This study assessed the optical quality of ready-made reading spectacles for presbyopic correction in comparison with relevant international standards. A total of 105 ready-made reading spectacles with powers ranging from +1.50 to +3.50 dioptres (D) in +0.50 D steps were randomly procured from open markets in Ghana and assessed for their optical quality, including induced prisms and safety markings. These assessments were done in line with the International Organization for Standardization (ISO 16034:2002 [BS EN 14139:2010]) as well as the standards used in low-resource countries. All lenses (100%) had significant induced horizontal prism that exceeded the tolerance levels stipulated by the ISO standards, while 30% had vertical prism greater than the specified tolerances. The highest prevalence of induced vertical prism was seen in the +2.50 and +3.50 D lenses (48% and 43%, respectively). When compared with less conservative standards, as suggested for use in low-resource countries, the prevalence of induced horizontal and vertical prism reduced to 88% and 14%, respectively. While only 15% of spectacles had a labelled centration distance, none had any safety markings per the ISO standards. The high prevalence of ready-made reading spectacles in Ghana that fail to meet optical quality standards indicates the need for more robust, rigorous and standardised protocols for assessing their optical quality before they are sold on the market. This will alleviate unwanted side effects including asthenopia associated with their use. There is also the need to intensify public health awareness on the use of ready-made reading spectacles, especially by patients with significant refractive errors and ocular pathologies.

Modelling ready-made spectacle coverage for children and adults using a large global database

Background/aimsTo model the suitability of conventional ready-made spectacles (RMS) and interchangeable-lens ready-made spectacles (IRMS) with reference to prescribing guidelines among children and adults using a large, global database and to...

A Survey on the Status of Ready-made Reading Spectacles for the Senior Aged 65 and Over in Daegu Region

A Survey on the Status of Ready-made Reading Spectacles for the Senior Aged 65 and Over in Daegu Region

Eligibility for the use of ready-made spectacles among children in a school-based programme in Ghana.

Ready-made spectacles are low-cost spectacles for correcting refractive errors in children who would otherwise have their refractive errors uncorrected due to lack of availability and affordability of conventional, expensive custom-made spectacles. Thus, this study seeks to estimate the proportion of children with uncorrected refractive errors eligible for ready-made spectacles in a school-based programme. A school-based descriptive cross-sectional study was employed to screen children aged 12-15 years in eighteen public junior high schools within the Bongo district of Ghana. Children who failed the 6/9 acuity test were refracted and given spectacles. Ready-made spectacle was prescribed when visual acuity improved by ≥2 lines in at least one eye with full correction (astigmatism of ≤0.75D); spherical equivalent corrected visual acuity to ≤1 line worse than best corrected visual acuity with full correction in the better eye; and there was ≤1.00D difference between the two eyes. A total of 1,705 school children were examined. Of this number, 30 (1.8%; 95% CI: 1.2-2.5%) met the criteria for refractive correction but none had any. Twenty-six (86.7%; 95% CI: 69.7-95.3%) were found to be eligible for ready-made spectacles (power range: -1.50D to +1.00D, mean spherical equivalent ± SD = -0.27D ± 0.79D) while 4 (13.3%; 95% CI: 4.7-30.3%) were not, hence, given custom-made spectacles. A binary logistic regression analysis revealed that the odds of being eligible for one type of spectacles was similar between males and females (OR: 1.1; 95% CI: 0.1-12.7; p = 0.93). A large proportion of students who met the criteria for spectacle correction could be corrected with ready-made spectacles. There is, therefore, the need for these spectacles to be considered an appropriate alternative for refractive error correction during school eye health programmes.

Optical Quality of Ready-Made Reading Spectacles and Symmetry during Manufacturing Process are Good Enough?

Purpose : This study aimed to assess whether the ready-made reading spectacles (RMS) in Korea comply with the required optical standard. In addition, symmetricity of RMS was also investigated. Methods : A total of 100 of RMS of power +1.00, +2.00, +3.00, and +4.00 D currently available in optical practice were collected. Optical quality of the RMS including refractive power, optical center distance (OCD) between right lens (RL) and left lens (LL), optical centre height (Oh) were measured. Optical quality tolerances was compared with the ISO standard (ISO 8980-1 and ISO 16034:2002) and the RAL-RG-915. Induced horizontal and vertical prism were calculated from discrepancy between OCD and average pupillary distance (PD) of male and female using the prentice rule. In addition, asymmetric RMS due to manufacturing error was measured by difference of monocular OCD and Oh. Results : Twenty-three percent of the 100 RMS did not meet the ISO 8980-1 in spectacle power. Average OCD of the RMS was 62.06±1.41 mm and induced horizontal prism due to discrepancy between OCD and PD were 0.53±0.54 △ BI (range of 0.18~1.06 △) for male and 0.98±0.68 △ BI (range of 0.37~1.78 △) for female. For monocular OCD from the centre of frame, 85% of RMS had more than 1 mm monocular OCD difference between RL and LL. Optical centre height difference between RL and LL was 1.26±0.83 mm and the range of induced vertical prism was 0.12~0.45 △. Conclusion : Large amount of RMS in the study did not meet the optical quality. As RMS cannot consider the wearer’s facial shape, there was a mismatch of OCD and PD which induced significant amount of horizontal prism. Therefore, wearing RMS with improper optical quality may not provide comfort vision rather than causing additional visual burden and intervention from professional to confirm the quality of RMS is strongly recommend.

The Compliance of Ready-Made Spectacle-Wear and Custom-Spectacle-Wear in Refractive Errors Screening

Background: Uncorrected refractive errors that could seriously affect children’s future. The compliance of spectacle-wear has been a problem in refractive errors management in developing countries in terms of the cost, availability and service range of both medical professionals and optical service. Aim: To study the compliance inferiority of ready-made spectacle-wear compared to custom spectacle-wear in refractive errors screening program.Method: Non-inferiority trial research, cluster-randomized trial was conducted to children aged 11-15 years old. Participants with corrected refractive errors (presenting visual acuity <6/12, spherical equivalent -6.00 until +6.00 Diopter (D), astigmatism ?1.00 D, anisometropic ?1.00 D) without other ocular abnormalities were given ready-made spectacles (RMS) and custom spectacles (CS). The observation was carried out in the first (1st) and third (3rd) month; subsequently, non-inferiority test was conducted with 20% margin. Result: Of 1009 school children, 365 were detected with uncorrected refractive errors. Among this number, 220 participants that met the inclusion criteria were prescribed RMS (n = 110) and CS (n = 110). The most common type of refractive errors found was myopia with mild degree of refractive errors. Compliance rate on the first (1st) month for RMS-wear was 63.6% and for CS-wear was 75.5% with d = -11.9% (95% CI -17.95% until -5.85%). Compliance rate on the third month (3rd) for RMS- wear was 65.5% and for CS-wear was 72.7% with d = -7.2% (CI 95% -12.03% until -2.37%). Conclusion: Based on the compliance observation performed in the first (1st) and third (3rd) month, there was no inferiority found among RMS-wear compared to CS-wear. This result could be used as the foundation of RMS use as an alternative for refractive errors management in refractive errors screening program to solve problems in the area of cost, availability and service range of both medical and optical service.

Comparison of Improvement of Quality of Life After Using Ready- Made Spectacles and Custom-Made Spectacles in Junior High School Students in Bandung District

Introduction: Uncorrected refractive error remains a leading cause of blindness and visual impairment among different population groups worldwide. In school children, it has a considerable impact on quality of life including social development, school performance and academic achievement that can affect their future. Management of refractive errors in developing countries is not adequate related to the cost, availability and distance of health and optical services. Hence, early detection and intervention with ready-made spectacles at the time of school children vision screening programs is expected to help solving these problems. Objective: To evaluate outcome measure of wearing ready-made spectacles (RMS) and custom-made spectacles (CS) on children’s quality of life.Method: A non-inferiority trial with a margin of 25%, cluster-randomized trial. Children aged 11-15 years in Bandung Regency, that meet the inclusion criteria were randomized to receive RMS and CS. Main study outcome was global score on the National Eye Institute Refractive Error Quality of Life- 42 after one month of wearing study glasses, comparing both group. Result: A total of 220 eligible subject were allocated to RMS (n = 110) and CS groups (n = 110) respectively. Baseline and end line score data were available for 220 (100%) of subjects. Improvement of quality of life in RMS group was 19.48±9.33 and CS was 24.14±9.68 with D = -18.11(CI 95% - 19.36 to -16.64). Conclusion: Improvement of quality of life in RMS group is non-inferior compare with CS group

Cost-minimisation Analysis from a Non-inferiority Trial of Ready-Made versus Custom-Made Spectacles for School Children in India

ABSTRACT Purpose: Uncorrected refractive error is the leading cause of visual impairment in children. Many countries, including India, implement school eye health programmes involving vision screening and provision of free spectacles. This is costly for governments/organisations involved. This analysis estimates potential cost-savings if ready-made spectacles, in addition to traditional custom-made spectacles, are available for dispensing in school eye health programmes. Methods: An economic evaluation was conducted alongside a randomised controlled trial comparing spectacle wear of ready-made spectacles versus custom-made spectacles for children aged 11–15 years in schools in India. A cost-minimisation approach was used to calculate cost-savings of a ‘ready-made spectacles available’ programme compared with a ‘custom-made spectacles only’ school programme. The analysis was from a service provider perspective. Main outcomes: cost-saving per child needing spectacles and cost-saving per 1000 children screened. Results: The prevalence of uncorrected refractive error was 2.23%, and 86% of children were eligible for ready-made spectacles. The cost per child needing spectacles in a custom-made spectacles only programme was USD$26.91, and in a ready-made spectacles available programme was $11.15, producing a 58.6% cost-saving per child needing spectacles of $15.76. Considering the total cost of the eye health programme, this equated to a 15.1% cost-saving per 1000 children screened of $361. Results were robust to multivariate sensitivity analyses. Conclusion: Our study is the first to demonstrate the significant cost-saving potential of ready-made spectacles in school eye health programmes for uncorrected refractive error compared with custom-made spectacles alone. This has substantial economic benefits for national/international programmes.

A Randomized Noninferiority Trial of Wearing Adjustable Glasses versus Standard and Ready-made Spectacles among Chinese Schoolchildren: Wearability and Evaluation of Adjustable Refraction III

To compare wear of standard, adjustable, and ready-made glasses among children. Randomized, controlled, open-label, noninferiority trial. Students aged 11 to 16 years with presenting visual acuity (VA) ≤6/12 in both eyes, correctable to ≥6/7.5, subjective spherical equivalent refractive error (SER) ≤-1.0 diopters (D), astigmatism and anisometropia both <2.00 D, and no other ocular abnormalities. Participants were randomly allocated (1:1:1) to standard glasses, ready-made glasses, or adjustable glasses based on self-refraction. We recorded glasses wear on twice-weekly covert evaluation by head teachers (primary outcome), self-reported and investigator-observed wear, best-corrected visual acuity (BCVA) (not prespecified), children's satisfaction, and value attributed to glasses. Proportion of glasses wear on twice-weekly covert evaluation by head teachers over 2 months. Among 379 eligible participants, 127 were allocated to standard glasses (mean age, 13.7 years; standard deviation [SD], 1.0 years; 54.3% were male), 125 to ready-made (mean age, 13.6; SD, 0.83; 45.6%), and 127 to adjustable (mean age, 13.4 years; SD, 0.85; 54.3%). Mean wear proportion of adjustable glasses was significantly lower than for standard glasses (45% vs. 58%; P= 0.01), although the adjusted difference (90% confidence interval [CI], -19.0% to -3.0%) did not meet the prespecified inferiority threshold of 20%. Self-reported (90.2% vs. 84.8%, P= 0.64) and investigator-observed (44.1% vs. 33.9%, P= 0.89) wear did not differ between standard and adjustable glasses, nor did satisfaction with (P= 0.97) or value attributed to study glasses (P= 0.55) or increase in quality of life (5.53 [SD, 4.47] vs. 5.68 [SD, 4.34] on a 100-point scale, P > 0.30). Best-corrected visual acuity with adjustable glasses was better (P < 0.001) than with standard glasses. Change in power of study lenses at the end of the study (adjustable: 0.65 D, 95% CI, 0.52-0.79; standard, 0.01 D; 95% CI, -0.006 to 0.03, P < 0.001) was greater for adjustable glasses, although interobserver variation in power measurements may explain this. Lens scratches and frame damage were more common with adjustable glasses, whereas lens breakage was less common than for standard glasses. Proportion of wear was lower with adjustable glasses, although VA was better and measures of satisfaction and quality of life were not inferior to standard glasses.

Predictors of Spectacle Wear and Reasons for Nonwear in Students Randomized to Ready-made or Custom-made Spectacles

Visual impairment from uncorrected refractive errors affects 12.8 million children globally. Spectacle correction is simple and cost-effective; however, low adherence to spectacle wear, which can occur in all income settings, limits visual potential. To investigate predictors of spectacle wear and reasons for nonwear in students randomized to ready-made or custom-made spectacles. In planned secondary objectives of a noninferiority randomized clinical trial, students aged 11 to 15 years who fulfilled eligibility criteria, which included improvement in vision with correction by at least 2 lines in the better eye, were recruited from government schools in Bangalore, India. Recruitment took place between January 12 and July 15, 2015, and analysis for the primary outcome occurred in August 2016. Data analysis for the secondary outcome was conducted in August 2018. Spectacle wear was assessed by masked observers at unannounced visits to schools 3 to 4 months after spectacles were distributed. Students not wearing their spectacles were asked an open-ended question to elicit reasons for nonwear. Predictors of spectacle wear and reasons for nonwear. Of 460 students recruited and randomized (52.2% male; 46 students aged 11 to 12 years and 13 to 15 years in each trial arm), 78.7% (362 of 460) were traced at follow-up, and 25.4% (92 of 362) were not wearing their spectacles (no difference between trial arms). Poorer presenting visual acuity (VA) and improvement in VA with correction predicted spectacle wear. Students initially seen with an uncorrected VA less than 6/18 in the better eye were almost 3 times more likely to be wearing their spectacles than those with less than 6/9 to 6/12 (adjusted odds ratio, 2.84; 95% CI, 1.52-5.27). Improvement of VA with correction of 3 to 6 lines or more than 6 lines had adjusted odds ratios of 2.31 (95% CI, 1.19-4.50) and 2.57 (95% CI, 1.32-5.01), respectively, compared with an improvement of less than 3 lines. The main reason students gave for nonwear was teasing or bullying by peers (48.9% [45 of 92]). Girls reported parental disapproval as a reason more frequently than boys (difference, 7.2%). Three-quarters of students receiving spectacles were wearing them at follow-up, which supports the use of the prescribing guidelines applied in this trial. Predictors of spectacle wear, poorer presenting VA, and greater improvement in VA with correction are similar to other studies. Interventions to reduce teasing and bullying are required, and health education of parents is particularly needed for girls in this setting. isrctn.org Identifier: ISRCTN14715120.

Meeting the need for corrective spectacles in visually impaired Chinese school children: the potential of ready-made spectacles

PurposeTo assess the potential of ready-made (spherical) spectacles (RMS) in meeting the need for refractive correction in visually impaired children in China.MethodsEligible children aged 5–17 years were identified from the...

Evaluating Self-Refraction and Ready-Made Spectacles for Treatment of Uncorrected Refractive Error

ABSTRACTPurpose: Uncorrected refractive error is the leading cause of visual impairment worldwide and has significant quality of life and economic implications. Treatment with subjective refraction and custom-made spectacles requires expensive equipment and highly trained personnel. We examine several alternatives.Methods: Patients were taught to self-refract using two devices: AdSpecs and the I-test Vision Screener. Ready-made spectacles were fit to the self-refraction and visual acuity (VA) was measured. Donated-spectacles were fit to subjective refraction and VA was measured. Self-refraction and donated spectacles spherical equivalent (SE) and VA were compared to subjective refraction SE and VA.Results: About 57 patients (102 eyes) were enrolled in the study. Patients accurately determined refractive power with self-refraction by both AdSpecs and the I-test (compared to subjective refraction SE, r2 = 0.97 and r2 = 0.94, respectively). SE of donated spectacles fit well with self-refraction SE (r2 = 0.91). There was no significant difference between best-corrected VA by subjective refraction and VA treated by ready-made spectacles fit to self-refraction by either device (analysis of variance (ANOVA), p non-significant). Patients fit with donated spectacles had significantly worse VA than best-corrected VA by subjective refraction (ANOVA, p < 0.01), although 80% improved to >20/40.Conclusion: Patients accurately self-refract using both devices and ready-made spectacles fit to self-refraction have excellent visual outcomes. Donated spectacles have worse visual outcomes but might be useful in a subset of patients. Ready-made spectacles fit to self-refraction may provide a treatment alternative to uncorrected refractive error.

Vision screening for correctable visual acuity deficits in school-age children and adolescents.

Vision screening for correctable visual acuity deficits in school-age children and adolescents.

Ready-made and custom-made eyeglasses in India: a cost-effectiveness analysis of a randomised controlled trial

ObjectiveReady-made spectacles have been suggested as a less resource-intensive treatment for the millions of people living with uncorrected refractive error (URE) in low-income environments. In spite of this interest, there...

Spectacle Wear Among Children in a School-Based Program for Ready-Made vs Custom-Made Spectacles in India

Uncorrected refractive errors are the most common cause of visual impairment in children despite correction being highly cost-effective. To determine whether less expensive ready-made spectacles produce rates of spectacle wear at 3 to 4 months comparable to those of more expensive custom-made spectacles among eligible school-aged children. This noninferiority, double-masked, randomized clinical trial recruited children aged 11 to 15 years from January 12 through July 31, 2015, from government schools in urban and periurban areas surrounding Bangalore, India. Follow-up occurred from August 1 through September 31, 2015. Participants met the following eligibility criteria for ready-made spectacles: failed vision screening at the 6/9 level in each eye; refraction was indicated; acuity improved with correction by 2 or more lines in the better-seeing eye; the corrected acuity with the spherical equivalent was not more than 1 line less than with full correction; anisometropia measured less than 1.0 diopter; and an appropriate frame was available. Eligible children were randomized to ready-made or custom-made spectacles. Proportion of children wearing their spectacles at unannounced visits 3 to 4 months after the intervention. Of 23 345 children aged 11 to 15 years who underwent screening, 694 had visual acuity of less than 6/9 in both eyes, and 535 underwent assessment for eligibility. A total of 460 children (227 female [49.3%] and 233 male [50.7%]; mean [SD] age, 13.4 [1.3] years) were eligible for ready-made spectacles (2.0% undergoing screening and 86.0% undergoing assessment) and were randomized to ready-made (n = 232) or custom-made (n = 228) spectacles. Follow-up rates at 3 to 4 months were similar (184 [79.3%] in the ready-made group and 178 [78.1%] in the custom-made group). Rates of spectacle wear in the 2 arms were similar among 139 of 184 children (75.5%) in the ready-made arm and 131 of 178 children (73.6%) in the custom-made arm (risk difference, 1.8%; 95% CI, -7.1% to 10.8%). Most children were eligible for ready-made spectacles, and the proportion wearing ready-made spectacles was not inferior to the proportion wearing custom-made spectacles at 3 to 4 months. These findings suggest that ready-made spectacles could substantially reduce costs for school-based eye health programs in India without compromising spectacle wear, at least in the short term. isrctn.com Identifier: ISRCTN14715120.

Self-refraction, ready-made glasses and quality of life among rural myopic Chinese children: a non-inferiority randomized trial.

To study, for the first time, the effect of wearing ready-made glasses and glasses with power determined by self-refraction on children's quality of life. This is a randomized, double-masked non-inferiority trial. Children in grades 7 and 8 (age 12-15years) in nine Chinese secondary schools, with presenting visual acuity (VA) ≤6/12 improved with refraction to ≥6/7.5 bilaterally, refractive error ≤-1.0 D and <2.0 D of anisometropia and astigmatism bilaterally, were randomized to receive ready-made spectacles (RM) or identical-appearing spectacles with power determined by: subjective cycloplegic retinoscopy by a university optometrist (U), a rural refractionist (R) or non-cycloplegic self-refraction (SR). Main study outcome was global score on the National Eye Institute Refractive Error Quality of Life-42 (NEI-RQL-42) after 2months of wearing study glasses, comparing other groups with the U group, adjusting for baseline score. Only one child (0.18%) was excluded for anisometropia or astigmatism. A total of 426 eligible subjects (mean age 14.2years, 84.5% without glasses at baseline) were allocated to U [103 (24.2%)], RM [113 (26.5%)], R [108 (25.4%)] and SR [102 (23.9%)] groups, respectively. Baseline and endline score data were available for 398 (93.4%) of subjects. In multiple regression models adjusting for baseline score, older age (p=0.003) and baseline spectacle wear (p=0.016), but not study group assignment, were significantly associated with lower final score. Quality of life wearing ready-mades or glasses based on self-refraction did not differ from that with cycloplegic refraction by an experienced optometrist in this non-inferiority trial.

Spectacle wearing in children randomised to ready-made or custom spectacles, and potential cost savings to programmes: study protocol for a randomised controlled trial.

BackgroundUncorrected refractive errors are the commonest cause of visual impairment in children, with myopia being the most frequent type. Myopia usually starts around 9 years of age and progresses throughout adolescence. Hyperopia usually affects younger children, and astigmatism affects all age groups. Many children have a combination of myopia and astigmatism. To correct refractive errors, the type and degree of refractive error are measured and appropriate corrective lenses prescribed and dispensed in the spectacle frame of choice. Custom spectacles (that is, with the correction specifically required for that individual) are required if astigmatism is present, and/or the refractive error differs between eyes. Spectacles without astigmatic correction and where the refractive error is the same in both eyes are straightforward to dispense. These are known as ’ready-made’ spectacles. High-quality spectacles of this type can be produced in high volume at an extremely low cost. Although spectacle correction improves visual function, a high proportion of children do not wear their spectacles for a variety of reasons. The aim of this study is to compare spectacle wear at 3–4 months amongst school children aged 11 to 15 years who have significant, simple uncorrected refractive error randomised to ready-made or custom spectacles of equivalent quality, and to evaluate cost savings to programmes. The study will take place in urban and semi-urban government schools in Bangalore, India. The hypothesis is that similar proportions of children randomised to ready-made or custom spectacles will be wearing their spectacles at 3–4 months.Methods/designThe trial is a randomised, non-inferiority, double masked clinical trial of children with simple uncorrected refractive errors. After screening, children will be randomised to ready-made or custom spectacles. Children will choose their preferred frame design. After 3–4 months the children will be followed up to assess spectacle wear.DiscussionReady-made spectacles have benefits for providers as well as parents and children, as a wide range of prescriptions and frame types can be taken to schools and dispensed immediately. In contrast, custom spectacles have to be individually made up in optical laboratories, and taken back to the school and given to the correct child.Trial registrationISRCTN14715120 (Controlled-Trials.com)Date registered: 04 February 2015

Self-adjustable glasses in the developing world

Uncorrected refractive errors are the single largest cause of visual impairment globally. Refractive errors are an avoidable cause of visual impairment that are easily correctable. Provision of spectacles is a cost-effective measure. Unfortunately, this simple solution becomes a public health challenge in low- and middle-income countries because of the paucity of human resources for refraction and optical services, lack of access to refraction services in rural areas, and the cost of spectacles. Low-cost approaches to provide affordable glasses in developing countries are critical. A number of approaches has been tried to surmount the challenge, including ready-made spectacles, the use of focometers and self-adjustable glasses, among other modalities. Recently, self-adjustable spectacles have been validated in studies in both children and adults in developed and developing countries. A high degree of agreement between self-adjustable spectacles and cycloplegic subjective refraction has been reported. Self-refraction has also been found to be less prone to accommodative inaccuracy compared with non-cycloplegic autorefraction. The benefits of self-adjusted spectacles include: the potential for correction of both distance and near vision, applicability for all ages, the empowerment of lay workers, the increased participation of clients, augmented awareness of the mechanism of refraction, reduced costs of optical and refraction units in low-resource settings, and a relative reduction in costs for refraction services. Concerns requiring attention include a need for the improved cosmetic appearance of the currently available self-adjustable spectacles, an increased range of correction (currently −6 to +6 diopters), compliance with international standards, quality and affordability, and the likely impact on health systems. Self-adjustable spectacles show poor agreement with conventional refraction methods for high myopia and are unable to correct astigmatism. A limitation of the fluid-filled adjustable spectacles (AdSpecs, Adaptive Eyecare Ltd, Oxford, UK) is that once the spectacles are self-adjusted and the power fixed, they become unalterable, just like conventional spectacles. Therefore, they will need to be changed as refractive power changes over time. Current costs of adjustable spectacles are high in developing countries and therefore not affordable to a large segment of the population. Self-adjustable spectacles have potential for “upscaling” if some of the concerns raised are addressed satisfactorily.

Presbyopia: Prevalence, distribution and determinants in Owerri, Nigeria

Background: Presbyopia causes blurring and impairment of vision at near. It is the most common physiologic change in the adult eye with advancing age. Good near vision is a necessity for domestic activities, office work and near vision tasks other than reading and writing, especially among adults in a resource-limited economy. The study determined the prevalence, distribution and determinants of presbyopia; presbyopic spectacle coverage; and provided data for ready-made near vision spectacles in Imo State, Nigeria. Materials and Methods: A total of three thousand, four hundred and fifty-one adults consisting of 2606 persons as study group and 845 persons as controls were randomly selected for the study. Structured questionnaire was administered to the subjects. Their visual acuity at far and near including tonometry, ophthalmoscopy, perimetry, retinoscopy and subjective refraction were done. Subjects who could not read N6 and emmetropes, who are 40 years and above were considered as presbyopic. Results: The prevalence of presbyopia was 70.9% and 75.0% of study and control groups respectively. Females aged 40-49 were in the majority (57.1% and 51.9% of females in the study and control groups respectively). Subjects requiring additions at near of ˃+1.50DS to 2.00DS were in the majority (39.0% and 46.4% of study and control groups respectively). Amongst the presbyopes 61.3% and 78.7% of study and control groups respectively did not have presbyopic correction. The subjects were also ignorant of corneal inlay technology in treatment of presbyopia. A higher prevalence exists among rural dwellers and the contributory factors were environmental influences, poor nutrition and irrational use of chloroquine for treatment of malaria. Conclusion: Over seventy-percent of presbyopia was found in this study. The determinants were age, gender, nutrition and drug use. Majority of the presbyopes were domicile in the rural area and did not have corrective spectacles. We recommend visual health education, regular vision screening and intervention to achieve the targets of vision 2020 in low-and-medium-income countries.

Use of Ready-Made Spectacles to Meet Visual Needs in a Low-Resource Adult Population

In affluent societies, distance and near vision problems are typically corrected with custom-made eyeglasses. Many persons in less affluent areas do not have the resources for such. The purpose of this study was to assess the use of less expensive ready-made (RM) bifocals and readers to correct distance and near refractive error and presbyopia in an outreach clinic in Nicaragua. This is a retrospective review of records of all patients older than 34 years who presented for an eye examination in an outreach clinic in Granada, Nicaragua, in 2010. A visual satisfaction questionnaire had been administered to patients before they were examined and after RM plus sphere bifocals or plus sphere reading spectacles were dispensed. The main outcome measures included pre- and post-distance and near visual acuities, vision satisfaction and difficulty ratings, and perceived cost and willingness to pay for replacement rating. Ready-made plus sphere spectacles (bifocals or single-vision readers) were dispensed to 95.4% of those examined. The remaining 4.6% required custom prescriptions because of astigmatism, myopia, or anisometropia. The RM bifocals were very well accepted, with high visual satisfaction ratings with the bifocals improving from a presenting value of 11 to 89.4% at distance and from 6.6 to 89.4% at near. Percentage of patients achieving visual acuity of 20/40 or better improved from 60 to 84.5% at distance and from 44 to 97% at near. Percentage achieving functionally good near vision (20/40 or better) improved from 38 to 97% with RM readers. Patients reporting highest satisfaction with near vision improved from 6.3 to 86.6%. Patients indicated that, on average, they would be willing to pay US$18.39 to replace the bifocals and US$16.67 to replace the readers. Ready-made bifocals and RM single-vision readers may be an acceptable and affordable alternative for many patients with hyperopia and/or presbyopia where access to custom-made eyeglasses is difficult.