Correction of refractive error in the Victorian population: the feasibility of “oV the shelf” spectacles

Aims—To assess the feasibility of providing a stock of ready made spectacles for correction of refractive error in the general population. Methods—Data were collected in the Visual Impairment Project, a population based survey of Victorian residents aged 40 years or older in randomly selected urban and rural sample areas. This included a refractive eye examination and the proportion of subjects with hypermetropia, emmetropia (defined as −1.0 to +1.0D spherical equivalent), and myopia documented in the 40–60 year age group. Results—2595 (54.8%) participants were aged between 40 and 60 years. Those with a best corrected visual acuity of less than 6/12, astigmatism of more than 1.25D, and anisometropia of more than 0.5D were excluded. 516 participants had refractive error which was deemed suitable for correction by “oV the shelf” spectacles. This represents 19.9% of all participants between 40 and 60 years of age. Provision of spectacles in 0.5D increments would provide suitable stock spectacles for 85.5% of a −3.0 to +3.0D range or 89.2% of a −3.50 to +3.50D range. Conclusions—Ready made “oV the shelf” spectacles could significantly alleviate visual morbidity due to refractive error in up to 20% of an urban population in Australia. This approach may also be useful in developing countries with poor access to optometric services. (Br J Ophthalmol 2001;85:1283–1286) A significant proportion of the general population is visually impaired solely because of undercorrected refractive error, this is especially true for mild degrees of visual impairment. The Baltimore Eye Survey revealed that up to 75% of white US citizens with a potential visual acuity of 6/12 could improve their acuity simply with updated spectacle lenses. In the Visual Impairment Project (VIP) in Victoria, Australia, we found that 60% of participants with refractive error in their sample were not wearing distance correction. The Blue Mountains Eye Study found that refraction improved acuity in 45% of participants. Refractive error is one of the five priority areas for “Vision 2020,” the global initiative for the elimination of preventable blindness by the year 2020. It represents a common condition that can be cheaply remedied (by spectacles) with a resultant significant functional and lifestyle improvement. It has also been demonstrated that uncorrected refractive error is associated with higher mortality and morbidity from hip fractures and falls. However, there still exists a lack of knowledge on the global prevalence of refractive errors; recent studies have attempted to address this gap in our knowledge. Wong et al found that 74.2% of Singaporean Chinese between the age of 40 and 79 years had myopia or hyperopia ranging from −5.0D to 5.0D (excluding emmetropes). It is estimated that more than 7% of Chilean children could benefit from the provision of proper spectacles and that refractive error was the cause in 56% of those children with reduced vision. Zhao et al studying a rural population in China found that myopia (<−0.5D) increased from an insignificant prevalence at age 5 years to 37% for males and 55% for girls aged 15 years. Similar figures of prevalence have been noted in the “developed” world: the Visual Impairment Project found a prevalence of myopia of 24% in those aged 40–49 years in Victoria, and the Blue Mountains Eye Study found a prevalence of myopia and hyperopia of 72% for an Australian population aged between 49 and 97 years. The global population will increase from 5.8 billion in 1996 to 7.9 billion in 2020, with an increase in the population aged over 45 years from one billion to two billion over the same period. Most of this increase will take place in the developing world and will mean an increasing demand for refractive correction. In many countries, poor supply of refraction services, supply of spectacles, and economic factors may limit access of the general population to refractive correction. The cost of individually made up spectacles would be prohibitive for large scale supply in many developing areas. The provision of ready made spectacles provided in bulk at low cost across a range of refractive corrections could potentially Br J Ophthalmol 2001;85:1283–1286 1283 Centre for Eye Research Australia, Melbourne, Australia