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Basic equipment list for screening and detailed examination

Equipment list should obviously be based on the selected protocol. This example list indicates what is usually required for multi-stage screenings as described earlier.

Initial screening Detailed examination Dispensing
Vision screener for three meters (6/9 optotype); appropriate for children ex E, Lea, Snellen)

Three meter rope Near VA chart (& +2.00 if used)

Record forms

Torch

Visual acuity charts :

  • Distance
  • Near
  • Lea

Occluder

Auto-refractor (if locally affordable)*

Retinoscopes, trial frames for adults and children and trial lenses

Cross cylinders and flipper lenses

Short-acting topical cycloplegic agents such as cyclopentolate hydrochloride – 1.0% if done on site **

Ophthalmoscope Fixation target (Portable tonometer)

Custom-made spectacles and conventional or clip in and out ready-made spectacles ***

Low vision devices

*Auto-refractors and photoscreening can be used as guidance for subjective refraction but not as a replacement of retinoscopy and are essential for screenings in limited resource settings (Harvey, others). IAPB’s technology guide can help evaluate available tools.
**Cycloplegia : use of drops requires approbation from head teachers and parents
***Recycled or self-adjustable spectacles should not be used as mentioned previously

New technologies

In the past few years, many technologies were developed in order to increase efficiency and efficacy of SEHPs.

While data shows that most of recent innovations cannot replace traditional tests such as retinoscopy, cycloplegia or subjective refraction, these tools can certainly be helpful as screening devices to complement programmes when cost and infrastructures allow it 5,45,46.

However, the software and hardware needs to be monitored and the device calibrated periodically. Here is a non-exhaustive list of recent tools used in screening settings, which is likely going to evolve with emerging technologies. Devices that have been compared to comprehensive eye exams are preferred over those without valid studies supporting the outcomes.

IAPB’s Eye Health Technology Guide can help programme-makers decide on which technology to invest on based on evidence and availability.

Category Technology Utility Advantages Limits
Programme management software Peek Vision Software to implement, optimise and evaluate eye health services in schools: app-based charts for screenings, SMS referral reminders, Monitoring – Better attendance at hospital follow-ups 47 – No significant improvement in spectacle wear with the health education intervention due to poor fidelity 48
Rapid assessment of local needs 49 Effective planning Data collection
Refraction* EyeNetra Smart-phone powered autorefraction Handheld phoropter Digital Lensometer Scientific publications – Overcorrection of myopia 50
Spot Vision Screener Handheld, binocular photoscreeners for detection of amblyopic risk factors: Designed for younger children; can screen for refraction and other binocular vision abnormalities (strabismus) Acceptable screening tool to guide subjective correction but not a replacement for retinoscopy 51 – moderate-to-poor low sensitivity for hyperopia, anisometropia and astigmatism 52,53
Plusoptix Vision Screener (based on transillumination test) – Minimal time for screening a child and cost-effective compared to Mohindra retinoscopy 54
– Most useful device for estimating refractive error in young children with low to moderate levels of hyperopia 46
– Variable validity 54
Adaptica 2Win/2WinS – Valid at detecting amblyopia risk factors, refractive error and strabismus higher than 10PD 55,56
– Cost-effective compared to Mohindra retinoscopy 54
– Poor validity for vertical deviations 57
Plenoptika QuickSee

Aurolab e-see wavefront autorefractor

Handheld monocular autorefractor – High level of agreement with subjective refraction 58-60
– Most accurate and patient-preferred compared to other portable autorefractors according to a systematic review 61
Retinomax K+ – Industry standard
– Child mode: good cooperation with children over 5yo 45
Fundus examination ArcLight Multi-purpose diagnostic tool for direct ophthalmoscopy and anterior segment loupe – low cost
– solar powered
– easier to use than standard direct ophthalmoscope 62,63
– can be effectively used to perform the Bruckner reflex test and identify eye disease and common amblyogenic risk factors with higher sensitivity than torchlight 64,65
D-Eye Smartphone ophthalmoscopes uses the camera and the light source from the Smartphone, illuminating the interior of the eye for examination
– fast, easy to use for non-ophthalmologists 66-68
– variability in quality of images 69
– limited options compared to direct ophthalmoscopy (no filters, no fixation target) 70

*adapted from 71