Simulation in Ophthalmic Training.

Vision impairment and blindness arise both as a cause, and a consequence, of poverty. Achievement of the United Nations Sustainable Development Goals in providing universal access and equity in eye care, both within and between among countries, remains challenging. A severe shortage of eye care providers is creating unnecessary blindness and vision impairment in developing communities worldwide. Education and training develops and strengthens the capacity of emerging nations to contribute to global eye health and the World Health Organization Development Goals in an effective and sustainable way. Although relative to other medical professions, adoption of simulation in ophthalmic training has been relatively slow, simulation potentially offers reduced training costs, increased accessibility, objective measurement of training outcomes, and improvements in patient safety during and after clinician training, all of which can help address the global burden of vision impairment and blindness. Simulation training offers advantages over apprenticeship models, the traditional mode of transferring knowledge and skills in medicine and health, which suffers from imperfect transference due to inherent biases, heuristic and idiosyncratic expectations of experts, and subjective measures of outcomes. Simulation does not completely do away with these confounders because it is made to fit into established curricula, making it difficult to measure effectiveness of the simulation in isolation. The power of simulation training for resource-limited regions and countries is immense in offering cost-effective training in-country; however, it is important that any such tools are developed within the context of the limitations in situ.

The influence of a novel simulated learning environment upon student clinical subjective refraction performance: A pilot study.

BACKGROUND: Optometry students are taught the process of subjective refraction through lectures and laboratory-based practicals before progressing to supervised clinical practice. Simulated leaning environments (SLEs) form part of an emerging technology used in a range of health disciplines; however, there is limited evidence regarding the effectiveness of clinical simulators as educational tools. METHODS: Forty optometry students (20 fourth year and 20 fifth year) were assessed twice by a qualified optometrist (two examinations separated by four to eight weeks), while completing a monocular non-cycloplegic subjective refraction on the same patient with an unknown refractive error, simulated using contact lenses. Half of the students were granted access to an online simulated learning environment, The Brien Holden Vision Institute (BHVI) Virtual Refractor, and the remaining students formed a control group. The primary outcome measures at each visit were; accuracy of the clinical refraction compared to a qualified optometrist and relative to the Optometry Council of Australia and New Zealand (OCANZ) subjective refraction examination criteria. Secondary measures of interest included descriptors of student SLE engagement, student self-reported confidence levels and correlations between performance in the simulated and real-world clinical environment. RESULTS: Eighty per cent of students in the intervention group interacted with the simulated learning environment (for an average of 100 minutes); however, there was no correlation between measures of student engagement with the BHVI Virtual Refractor and speed or accuracy of clinical subjective refractions. Fifth year students were typically more confident and refracted more accurately and more quickly than fourth year students. A year group by experimental group interaction (p = 0.03) was observed for accuracy of the spherical component of refraction and post hoc analysis revealed that less experienced students exhibited greater gains in clinical accuracy following exposure to the SLE intervention. CONCLUSIONS: Short-term exposure to a SLE can positively influence clinical subjective refraction outcomes for less experienced optometry students and may be of benefit in increasing the skills of novice refractionists to levels appropriate for commencing supervised clinical interactions.

The role of optometrists in India: an integral part of an eye health team.

India has a proud tradition of blindness prevention, being the first country in the world to implement a blindness control programme which focused on a model to address blinding eye disease. However, with 133 million people blind or vision impaired due to the lack of an eye examination and provision of an appropriate pair of spectacles, it is imperative to establish a cadre of eye care professionals to work in conjunction with ophthalmologists to deliver comprehensive eye care. The integration of highly educated four year trained optometrists into primary health services is a practical means of correcting refractive error and detecting ocular disease, enabling co-managed care between ophthalmologists and optometrists. At present, the training of optometrists varies from two year trained ophthalmic assistants/optometrists or refractionists to four year degree trained optometrists. The profession of optometry in India is not regulated, integrated into the health care system or recognised by the majority of people in India as provider of comprehensive eye care services. In the last two years, the profession of optometry in India is beginning to take the necessary steps to gain recognition and regulation to become an independent primary health care profession. The formation of the Indian Optometry Federation as the single peak body of optometry in India and the soon to be established Optometry Council of India are key organisations working towards the development and regulation of optometry.

The impact of continuing professional development on ophthalmic dispensing of progressive addition lenses in the Asia-Pacific region.

BACKGROUND: Discrepancies exist in optometric education, practice and regulation across the Asia-Pacific region and the competence of optometric practitioners in adopting new lens technologies may vary widely. Over the past 10 years, a continuing professional development program, Varilux Academy Asia-Pacific (VAAP), was implemented and conducted in countries across the Asia-Pacific region to improve practitioners' understanding of optometric fitting principles, with special emphasis on progressive addition lenses (PAL). The aim was to demonstrate the effectiveness of VAAP and to compare the competence of practitioners across the Asia-Pacific region in new lens fitting technologies. METHODS: From 2002 to 2008, all VAAP participants from 12 countries across Asia-Pacific were invited to complete a pre- and a post-program competency test and a post-program survey. RESULTS: A total of 5658 practitioners were trained, and 69.9 per cent (n = 3,957) of participants completed the pre- and post-program competency test; 80.9 per cent (n = 4,580) of participants completed the post-program survey. There was a significant improvement in competency after VAAP (mean change = 19.4 per cent ± 3.3, p < 0.01). Before VAAP was conducted the mean competency score was significantly lower in developing countries compared with developed countries (mean score of developed countries = 50.6 ± 10.3, mean score of developing countries = 45.0 ± 7.8, p < 0.05). After VAAP, these differences were not significant. Confidence in fitting PAL improved by 27.1 per cent. Most participants (91.6 per cent) intended to fit more PAL and 96.8 per cent of participants rated the program as excellent or good. CONCLUSION: Our findings highlight the need for further continuing education of practitioners across the Asia-Pacific region. The results of the training course indicate that, across Asia-Pacific, continuing education courses in ophthalmic optics and dispensing encompassing modern lens design and best practice fitting principles are warranted.

Is optimal vision required for the successful execution of an interceptive task?

The importance of optimal visual function in demanding interceptive tasks is far from established. The aim of the study was to determine whether induced myopic blur and hence sub-optimal visual function would give rise to a detrimental effect on performance in the execution of an interceptive task. The batting performance of grade level cricket players was assessed facing a bowling machine whilst wearing contact lenses of four different refractive conditions (plano (nil), +1.00, +2.00 and +3.00D over-refraction), inducing increasing amounts of myopic blur. Performance for each condition was assessed based both on the shot quality against each delivery judged by a qualified cricket coach blind to each condition, along with an evaluation of the quality of ball-bat contact for each delivery. No significant change was found in batting performance with the introduction of +1.00 and +2.00D of induced myopic blur. A +3.00D over-correction was required before any significant decrease in batting performance was detected, demonstrating that batters needed to be essentially legally blind (as simulated through the use of the +3.00D over-refraction) before there was any significant measurable decrement in batting performance. We concluded that optimal visual correction is not necessarily required for optimal performance in a demanding interceptive task, and that the human perceptual-motor system is capable of compensating for marked alterations in input.