A New Method of Vision Care Delivery: A Pilot Study

• Published in: Health services reports Vol. 88; no. 5; pp. 405 - 415
• Main Authors: Aran Safir, Casimir Kulikowski, Crocetti, Annemarie F., Maria I-Hwa Kuo, Deuschle, Kurt
• Format: Journal Article
• Language: English
• Published: United States Health Services and Mental Health Administration 01.05.1973
• Subjects: Child; Child health services; Children; Community Health Workers - utilization; Cylinders; Delivery of Health Care; Eyeglasses; Eyes; Female; Humans; Male; Mydriatics - administration & dosage; New York City; Ophthalmology; Ophthalmoscopy; Pilot Projects; Referral and Consultation; Refractive errors; Refractive Errors - diagnosis; Refractive Errors - therapy; Retinoscopy; School Health Services; Sex Factors; Standard deviation; Strabismus - diagnosis; Vision Tests - instrumentation; Visual Acuity; New York City
• ISSN: 0090-2918; 2327-6347
• DOI: 10.2307/4594810

Paramedical technicians using a recently developed automatic refracting instrument measured the refractive errors of 143 fourth-grade children. According to a written protocol they classified the children as either needing or not needing eyeglasses, based on the measurements made by the automatic instrument. Those needing eyeglasses were given test glasses "dispensed" by the technicians from ophthalmic trial lenses. Visual acuities were measured with and without trial eyeglasses. The technicians' prescriptions were compared to those determined by ophthalmologists using traditional methods of refracting. The ophthalmologists prescribed glasses for 26 children, 25 of whom had also been identified by the technicians as needing glasses, based on machine refractions. Thus there was one underreferral. If visual acuity without glasses is considered, and glasses are not given to any child having 20/30 or better in one or both eyes, there were no over-referrals. Sixty-five percent of the prescriptions for spheres generated by the instrument agreed within half a diopter with those generated by the practitioners using retinoscopy under similar conditions. Astigmatisms compared the same way agreed in 74 percent of cases. The protocol was repeated for about 25 percent of the cases. The precision of the automatic instrument was greater than that of the practitioners when measured under similar conditions. An unexpected high prevalence of myopia was found among the Puerto Rican children. It is feasible to have properly trained and equipped paramedical technicians perform school vision screening, make appropriate referrals, and dispense satisfactory eyeglasses.