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Blog: Thinking Beyond A Pair of Glasses

Thinking beyond a pair of glasses. From left to right: Himal Kandel, Professor Konrad Pesudovs and Dr Jyoti Khadka

This post urging “thinking beyond a pair of glasses” is a must read, especially if you procure spectacles. Mr Himal Kandel from Flinders University in South Australia summarises a range of issues gleaned from a number of studies by his group. He casts a different light on correcting refractive error, highlighting the patient’s perspective.

Photo (from L-R) Himal Kandel, Prof Konrad Pesudovs and Dr Jyoti Khadka.

Thinking beyond a pair of glasses: understanding the impact of refractive error

Refractive error is recognised as the single largest cause of avoidable visual impairment, even larger when we include presbyopia. Yet, it appears to be the simplest of all causes of avoidable visual impairment to correct – requiring only a pair of glasses. Globally, governments, NGOs and various other stakeholders are all attempting to address this public health problem.

Why then are millions of people still living with blindness and visual impairment due to uncorrected refractive error?

While studies in a few countries have quantified the decreased quality of life (QoL) of people with uncorrected refractive error, there is little qualitative information to help us understand the whys and hows of the impact of refractive error and its correction on QoL. We conducted interviews in a higher income (Australia) and lower income (Nepal) setting. Interestingly, in both locations, we found that correcting the refractive error, instead of solving all the QoL issues of uncorrected refractive error, often added other issues. For example, many participants, particularly young females were very concerned about their appearance with glasses.

“I don’t at all like my looks with these thick glasses. Therefore I hate wearing them especially when going to parties or social occasions. I feel I look older than my age, and very different from others. In addition, glasses hide my eyes and make-ups, and they don’t go well with my dresses.”

–18-year-old female participant.

A number of participants from Nepal, particularly female, said it might be difficult to get married because of their glasses, which made it apparent that they have serious eye problems.

“Twice, my marriage was almost fixed [in Nepal, arranged marriages are common]. But when the boys came to see me, they got worried about my eyes seeing my thick glasses. They think that I might be blind in the future, or if they get married with me, our children may also inherit my eye problems. I am educated and I earn good money. But the boy parties are not interested in me thinking I might lose my vision in the future and my husband might have trouble having to look after me.”

–25-year-old female participant

Many participants also reported that the glasses they received in free eye-camps were not attractive or comfortable, and some people had thus ceased to wear these.

“I got glasses from an eye camp. The glasses were too big in size and looked ugly. I was not comfortable with them. I even got terrible headaches when wearing them. So, I stopped using them.”

–37-year-old male participant

This confirms that even free or low cost glasses need to be comfortable and attractive, if people are to continue wearing these. Another reason for ceasing glasses wear was reported by participants in Nepal who experienced extreme difficulty with glasses slipping off their faces during activities such as cutting grass, ploughing fields etc. Many said they stopped using glasses because of this.

“While carrying loads in a doko (bamboo-basket full of grasses or firewood, carried with a strap ‘namlo’ over forehead) and the glasses slip down the nose, it is difficult pushing them up every time. Sweating makes the problem worse, especially during the hot weather. Doing things like digging, when we have to bend down, is also extremely difficult wearing glasses as the glasses keep slipping down the nose.”

–54-year-old male participant

Differences in clinician and patient perspectives in refractive outcomes - patient's aims are beyond perfect visual acuity
Differences in clinician and patient perspectives in refractive outcomes – patient’s aims are beyond perfect visual acuity

Therefore a sufficiently wide range of frames, suited to the general population in the region is necessary to enable glasses to be well fitted. Attention should also be given to custom fitting frames securely to the person’s face. For people engaged in physical activities, Lanyard loops or straps may be provided to keep the glasses in place. Based on the findings of these two studies, we recommend that glasses should not only be affordable, but attractive and fashionable, light, sturdy, comfortable and safe. We also hope these findings will make clinicians aware that a sole aim of providing everybody with the best visual acuity, while obviously important, is not sufficient. The aim of people who access refractive error services is often beyond achieving best visual acuity, as depicted in the figure below. The team providing refractive services should tailor their services and products to the socio-economic, cultural and individual characteristics of those consulting them. There is no simple ‘one size fits all’ when it comes to refractive correction.

Flinders Logo

Would you like to contribute to the ongoing understanding of refractive error? Do you or anyone else you know have uncorrected or corrected refractive error (wearing glasses, contact lens or those who have undergone refractive surgery) but otherwise healthy eyes? Mr Himal Kandel, Dr Jyoti Khadka and Professor Konrad Pesudovs at Optometry, Flinders University are working on the project “Development of technologically advanced patient reported outcome instrument for refractive error”. Items (questions) derived from these qualitative studies (along with few from existing questionnaires) have been used to develop two pilot questionnaires. Currently they are recruiting adults with for validating the questionnaire. For more information, collaboration or participation in the survey, please contact Himal. ([email protected]). The survey for the developed countries is available at: https://www.surveymonkey.com/r/REBankAus

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