Research Agenda for Global Blindness Prevention:

Clinical Conditions: 7. Refractive Error

Research opportunities

• Short- to Medium-Term
  
  
• Medium- to Long-Term

Refractive error is the most common ocular abnormality, a situation exacerbated in many poor countries by lack of access to refractive services and low-cost spectacles.

In some countries, this relates to artificial political and legal constraints (only ophthalmologists can prescribe glasses, effectively disenfranchising the vast majority of the rural poor); and in other countries, to cost.

These limitations are eminently responsive to careful cataloguing and operations research, though in the final analysis (as for most conditions), the limiting factor for effective solutions will prove to be "political will."

In India, for example, it is that untreated or under-treated refractive error is responsible for 40 million individuals having visual impairment of 20/60 or less, and 3 million with vision less than 20/200.

The two major refractive disorders impacting on employment and quality of life are myopia and presbyopia (aside from surgical aphakia).

Short- to Medium-Term:

• Identify social and cultural constraints to utilizing refractive services and spectacles
  
  
• Develop protocols for the education, training, and certification of low-cost spectacle providers
  
  
• Experiment with alternative organizational systems and infrastructural support for the sustainable provision of appropriate low-cost spectacles (e.g., micro-credit enterprises, formal refraction vs. patient self-selection from among spectacles of varying correction, individually ground lenses vs. snap-in spherical equivalents)
  
  
• Enroll high risk populations into epidemiologic studies and randomized clinical trials seeking environmental/behavioral etiologic factors and effective strategies for reducing the incidence/progression of refractive error
  
  
• Analyze the cost-benefit and cost-effectiveness of alternative interventions (including spectacles), considering their economic impact on education (and subsequent earning power)
  
  
• Investigate the value of social marketing of refraction/spectacles

Medium- to Long-Term:

• Identify the origins of myopia
  
  
• Investigate alternative interventions for reducing the incidence/progression of refractive error
  
  
• Apply evolving technologies to the treatment of refractive error in poor populations.

Next: Closing Considerations

Also see: Table of Contents of the Research Agenda for Global Blindness Prevention