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Prakash Paudel, Sonja Cronjé, Patricia M. O'Connor, Brien A. Holden; Rural Eye Care in the Developing World: The Role and Performance of Vision Technicians. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5540.
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To evaluate the clinical performance of one-year trained Vision Technicians (VTs) in the context of rural eye care in the developing world.
The examination results and management plan for 279 patients examined by 24 VTs in 24 vision centres (VCs) in rural villages of Andhra Pradesh, India were compared with those of a ‘Gold Standard Optometrist’ (GSO). The evaluation of the VT’s performance in patient management included eye examination, refraction, dispensing of glasses, recognising disease and making referrals to the ophthalmologist at secondary care centres. The eye examination included retinoscopy, slit lamp examination, applanation tonometry and undilated direct ophthalmoscopy. All clinical findings, diagnosis and management plan were recorded and agreements were analysed using SPSS v 17.0 software.
Overall agreement in disease diagnosis and management were 69.2% and 78% respectively. Highest sensitivity in disease diagnosis was observed for cataract (72.1%) and refractive error (83.3%). Moderate agreement was measured (k=0.41 to 0.60) for conditions of cornea and conjunctiva and good agreement (k=0.61 to 0.80) for lens conditions. Fair agreement (k=0.21 to 0.40) was observed in detecting abnormalities of eyelid and retina. VTs exhibited low or poor sensitivity in diagnosing sight threatening and rapidly emerging problems like glaucoma (36.4%), diabetic retinopathy (DR) (0%) and maculopathy (0%). Very good agreement was evident in patient management (k=0.83) as VTs did refer patients with fundus problems if vision did not improve with glasses.
VTs in rural eye care in India efficiently detect and manage the two most common causes of vision impairment: cataract and refractive error. Their capabilities in detecting glaucoma, diabetic retinopathy and maculopathy need improvement.
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