FVI EXAMINATION QUESTIONS
Written exam questions
(1) Approximately how many people worldwide are blind or visually-impaired (i.e. suffer from low vision)?
(a) 5 million
(b) 10 million
(c) 50 million
(d) 150 million or more
Answer: Worldwide, it is estimated that at least 38 million people are blind and that an additional 110 mission have severely impaired vision. In all, about 150 million people are severely visually disabled – Source: Vision 2020 The Right to Sight http://www.v2020.org/main_page.asp; DiStefano, A, Optometry, vol.72(10): 619-621, October, 2001; see also reference list from FVI handout
(2) The prevalence of visually disabling refractive error worldwide is difficult to estimate; however, it is thought that severe refractive errors account for approximately how many blind people worldwide?
(a) Approximately 1 million.
(b) Approximately 3 million.
(c) Approximately 5 million.
(d) Approximately 50 million.
Answer: Severe refractive errors have been estimated to account for approximately 5 million functionally blind people, according to the Vision 2020 website (http://www.v2020.org/Eye_disease/refractive_error.asp); see also the WHO document “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79)
(3) The number of blind is increasing at a rate such that:
(a) There will be a 2 times increase by the year 2020.
(b) There will be a 10% increase by the year 2020.
(c) There will be a 20% increase by the year 2020.
(d) There will be a 50% increase by the year 2020.
Answer: The estimate is that there will be a doubling of world blindness by the year 2020 unless aggressive intervention is undertaken. Source: Thylefors, B. (see reference list to accompany FVI handout); also, http://www.v2020.org/right_to_sight/index.asp
(4) Where do most blind people live?
(d) Latin America
Answer: India – it is estimated that 9 million blind people live in India, 7 million live in Africa and 6 million people live in China, although it is feared that these figures are in fact much higher; see FVI references; also, Thylefors, B et al., Global Data on Blindness, Bulletin of the WHO, 1995, vol 73(1): 115-121
(5) Which of the following is correct regarding geography and the major causes for blindness and visual impairment?
(a) For industrializedcountries in North America, Europe, and Australasia blindnessis mainly due to disorders of the posterior segment of the eye(for example, macular degeneration and diabetic retinopathy); however, in Africa, Asia, and parts of South America it is disorders of theanterior segment of the eye (cataract, corneal scarring fromvarious causes) that predominate.
(b) For industrializedcountries of North America, Europe, and Australasia blindnessis mainly due to disorders of the anterior portions of the eye(for example, cataract, corneal scarring); whereas, in Africa, Asia, and parts of South America it is disorders of theposterior segment of the eye (e.g. macular degeneration, diabetic retinopathy) that predominate.
(c) There is no geographic difference in the major causes of blindness worldwide.
(d) The major geographic differences are latitude dependent only, and independent of industrialization.
Answer: A – Source: Foster A., Patterns of blindness. In: Tasman W, Jaeger E, eds. Duane’s clinical ophthalmology Vol 5. Philadelphia: Lippincott, 1991:1-7; see also: Potter AR, Preventing Blindness Worldwide. BMJ, September 17, 1994, 309:682-683 (this reference may be found on the internet, as well)
(5) It has been stated that up to what percentage of blindness found in developing countries is, in principle, avoidable or curable?
(d) 60% or more
Answer: Depending on which source is quoted, the figures vary, but most assume at least 66% or greater; Thylefors has stated that “more than 2/3rds of all blindness is avoidable (either preventable or curable)” (Thylefors, B, Editorial – A global initiative for the Elimination of avoidable blindness, American Journal of Ophthalmology, vol. 125(1):90-93, January, 1998); Dr. Gro Harlem Brundtland, Director-General of the WHO has stated: “Up to 80% of global blindness is avoidable: it either results from the conditions that could have been prevented, or can be successfully treated with the sight restored.”
(6) VISION 2020 has chosen 5 major ophthalmic conditions or categories as priorities “because they are the most significant contributors to the economic, social, and public health burdens of countries throughout the world, and because they offer cost-effective interventions for prevention and treatment”. Please list them.
Answer: Cataract; refractive error/low vision; trachoma; onchocerciasis; xerophthalmia/childhood blindness – Source: DiStefano, A., VISION 2020: The Right to Sight, JAOA, volume 72(10):619-621, October,2001; however, see also Vision 2020 website (http://www.v2020.org/Eye_disease/index2.asp) and Thylefors, B, Editorial – A global initiative for the Elimination of avoidable blindness, American Journal of Ophthalmology, vol. 125(1):90-93, January, 1998
(7) Please list 5 specific challenges (not diseases) which need to be addressed and overcome in developing a successful strategy for the prevention of world blindness:
Answer: Geographic maldistribution of resources (e.g. manpower and technical equipment) vs. disease distribution; sheer lack of manpower and technical resources; need for financial resources; understanding of epidemiology and etiology; cultural issues; inadequate infrastructure (e.g. clinics, hospitals, sanitation systems, etc.); inadequate public health programs/education; aging of the world population – Source: see FVI reference list articles; also, the WHO document “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79)
(8) Please describe 5 methods for determining refractive error to dispense glasses:
Answer: retinoscopy; autorefractor; focometer; subjective refraction; photoscreeners; wavefront technology could also be included as an answer – Source: the WHO document “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79)
(9) Please list 5 other international NGOs involved in the delivery of eye care worldwide.
Answer: multiple NGOs can be found on the web, of which any could be possible answers; some of the more well-known would be those which are included as members of the WHOs VISION 2020 Task Force: International Agency for the Prevention of Blindness; Agenzia Internazionale per la Prevenzione della Cecita; Christoffel-Blindenmission (Christian Blind Msn Inter.); Helen Keller Worldwide; ORBIS International; Sight Savers International; Al Noor Foundation; International Federation of Ophthalmological Societies; Lions Club International Federation; Organisation pour la Prevention de la Cicite; Operation Eyesight Universal; The Carter Center; The Fred Hollows Foundation; International Centre for Eyecare Education. Others might include S.E.E., Unite for Sight, etc., etc.
(10) What is a “Focometer”?
Answer: this device, which was invented by Drs. Ian Berger and Larry Spitzberg, was presented at the VOSH/International annual meeting in New Orleans by Dr. Berger. It is also described in the WHO document “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79), which can be found online; also, by visiting the Focometer website at: http://www.infocusonline.org/focometerinfo.html
(11) Please describe the “Richmond Eyeglass Inventory Matching System (REIMS)” in use by VOSH chapters and developed by legendary VOSHer.
Answer: this, too, has been discussed at VOSH/International meetings and will be familiar to attendees. However, it may also be found on the web at: http://www.friendsofasaprosar.org/manual.html
(12) Please describe the idea of “barefoot optometry”, a phrase coined by Dr. Eric Weissberg of the New England College of Optometry.
Answer: See Dr. Zeltzer’s lecture “VOSH/International: Update and Models of Humanitarian Eye Care Delivery” presented at Oxford University, August 7-9, 2004
(13) Please describe the World Health Organization’s global initiative VISION 2020 – The Right to Sight.
Answer: see the website: http://www.v2020.org/main_page.asp as well as articles listed in the FVI references.
(14) What is a significant cause of childhood blindness throughout the world?
Answer: Vitamin A deficiency; however, other causes include childhood diseases, such as measles, and ROP. See: http://www.v2020.org/Eye_disease/childhood_blindness.asp, as well as FVI references
(15) Approximately what is the ratio of the world’s blind who hail from developing countries vs. those who live in industrialized nations:
Answer: Approximately 90% of all blind people live in developing countries. See Thylefors, B, Editorial – A global initiative for the Elimination of avoidable blindness, American Journal of Ophthalmology, vol. 125(1):90-93, January, 1998, as well as FVI references.
(16) Onchocerciasis, or river-blindness, is endemic in 30 countries, and is found mostly in:
(a) Latin America
Answer: about 90% of the disease occurs in Africa, but can also be found in six countries in Latin America and in Yemen in the Arabian Peninsula – Source: the VISION 2020 website, which is located at http://www.v2020.org/Eye_disease/onchocerciasis.asp
(17) Which of the following is NOT TRUE, according to the World Health Organization (WHO) report on the “Elimination of Avoidable Visual Disability Due to Refractive Errors”:
(a) A lack of refractive care and spectacle availability has important negative consequences in terms of lost educational and employment opportunities.
(b) The refractive error situation varies greatly throughout the world; however, it is clear that countries in the Third World require improvement, while those in the developed world do not.
(c) Cultural barriers exist, even to the simple use of spectacles.
(d) The need for near spectacles (e.g. reading glasses) for close work after the age of 45 is almost universal, although this need may develop earlier in countries nearer the equator.
(e) There is a wide variation in magnitude of refractive error across age, gender, and even ethnicity.
Answer: (b); it is NOT TRUE that “those in the developed world do not” require improvement; in fact, there remain significant barriers to availability of refractive care and spectacles even in affluent, developed countries such as the U.S. See the WHO document “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79); also see the Helen Keller Worldwide Childsight Program website at: http://www.childsight.org/, as well as many other easily found sources regarding the status of healthcare to the poor and underserved in this country
(18) Which of the following is NOT TRUE, according to the World Health Organization (WHO) report on the “Elimination of Avoidable Visual Disability Due to Refractive Errors”:
(a) The level of visual impairment considered significant for children is binocular vision of worse than 20/40.
(b) It is recommended that children should NOT even be screened for refractive error if no appropriate resources for follow-up refraction and delivery of spectacles exist.
(c) The use of an auto-refractor (e.g. Retinomax, Sure Sight, etc.) for rapid, accurate refraction is considered an appropriate basis on which to prescribe glasses for children.
(d) Subjective refraction alone is NOT recommended as an appropriate basis on which to prescribe glasses for children.
(e) Visual acuity, measured binocularly and in each eye separately, is the most appropriate screening test to identify children with visual impairment due to uncorrected refractive error.
Answer: (c); the use of “objective refraction by itself not considered an appropriate basis on which to prescribe spectacles (to children) as a routine” – Source: the WHO document “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79)
(19) Which of the following is NOT TRUE, according to the World Health Organization (WHO) report on the “Elimination of Avoidable Visual Disability Due to Refractive Errors”:
(a) It is not enough to provide refractive services to those in need; there needs to be a mechanism in place to monitor whether patients are using their glasses after they are dispensed.
(b) In some countries, there may be a lack of public awareness regarding the importance of eye care and the availability of vision correction.
(c) Refraction examination of children should ONLY be carried out by eye care personnel skilled in objective and subjective refraction, eye movement assessment, and ocular disease evaluation.
(d) WHO encourages the practice of using trained health care workers to distribute cheap, ready-made spherical near vision glasses to those over 45 who present with near vision problems and distance vision of at least 20/60 in each eye.
(e) Experience has demonstrated that collection, recycling, and redistribution of used spectacles is a well-intentioned, cost-effective strategy for correcting uncorrected refractive error, and it is endorsed by the WHO
Answer: (e); the WHO does NOT endorse the use of recycled glasses as a cost-effective strategy for correcting uncorrected refractive error, despite the well-intentioned efforts of individuals and NGOs, such as VOSH. See WHO report “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79)
(20) Which of the following is NOT true:
(a) Retinoscopy is a rapid, objective, cheap, mobile method of determining refractive error, but requires a skilled operator, as well as a power source.
(b) Portable autorefractors provide a rapid, objective, but expensive method of determining refractive error; they are relatively mobile, but require a power source.
(c) Focometers are relatively inexpensive, mobile devices which can be used by an unskilled, but trained assistant to obtain an objective measure of refractive error, and do not require a power source.
(d) Phoropters are relatively expensive devices which can be used by trained operators to obtain a subjective measure of refractive error, and do not require a power source.
(e) Photoscreeners are relatively mobile, easy to use, camera-based instruments that give an “indication” of the refractive state of the eye, as opposed to accurately measuring refractive error.
Answer: (c); the Focometer, while a relatively inexpensive and mobile device which does not require a power source, is NOT an OBJECTIVE method for the determination of refractive error, but rather a subjective technique. See the WHO document “Elimination of avoidable visual disability due to refractive errors” (WHO/PBL/00.79), which can be found online; also, the Focometer website at: http://www.infocusonline.org/focometerinfo.html
Open-ended, “philosophical” questions for oral discussion
(1) “Cultural sensitivity” may play an important role in the delivery of health care to unfamiliar people, whether in communities domestic or foreign. How do you perceive socio-cultural factors to be important in the delivery of health care?
(2) Can you describe for us an example or instance in which cultural issues played an important role in one of your missions?
(3) Cultural sensitivity requires a cohesive set of values, attitudes, beliefs, behaviors, and policies so that providers and teams can function ethically and effectively within a cross-cultural setting. Would you please describe for us what actions you might take, both as an individual and as a team leader, to ensure that issues of cultural competency are addressed during a mission?
(4) One philosophy in medical mission work is to screen only for what you can potentially help, and not for conditions for which you can offer no treatment or hope. What are your thoughts regarding the scope of VOSH missions, what should be tested for, screened for, and treated by a team?
(5) In what ways do you feel VOSH / International can improve to better achieve its stated mission?
(6) Why do you want to be a Fellow of VI? What do you perceive the role of a Fellow to be?
(7) You have no doubt heard the quote: “Give a man a fish and he will eat for a day; teach a man to fish and he will eat for a lifetime”. How do you see this quote as applying to VOSH chapters and the missions that we do each year?
(8) Do you feel that we need to change the way in which we deliver care? If so, in what ways do you think we might alter our approach to the underserved so that we may have a greater, longer-lasting impact toward eliminating global blindness?
(9) Please imagine yourself on an international mission. Your worksite is visited by a team of reporters (us) from your host country. We ask you to tell us about your organization, its “mission”, and “agenda” (e.g. why are you here, why are you “really” here, what are your motivations) – how do you reply? We would like also to know about the origin and history of VOSH – what information do you have to offer us?
(10) What is your thought on the establishment of permanent clinic sites vs. the present approach of providing “hit and run” missions? What do you see as the advantages and disadvantages of each?
(11) The WHO notes that more research needs to be done to successfully achieve the goals set forth for VISION 2020. What do you see as some ways in which VOSH may contribute to research, particularly with respect to elimination of avoidable visual disability due to refractive error?
(12) Do you feel public health education should be an important component to what we do on a VOSH mission? Have any of the missions which you have been involved with incorporated any public health education efforts? How might you do so in the future?
(13) Please describe from beginning to end the steps involved in planning and carrying out a VOSH mission.
(14) Some of the most disheartening situations that many of us face during our mission work are when we’re confronted by patients for whom we cannot offer any help. For example, the glaucoma patients whom we know will go blind for lack of necessary treatment; the cataract surgery patients for whom no care is available, or affordable; even those “simple” refractive patients with difficult eyeglass prescriptions for whom we have no glasses to offer. How do you handle these situations in which you find yourself without any help to offer? What do you say to your patient? How do you “prepare” your “teammates” to deal with these situations? What type of preparations do you make when planning your missions in order to minimize these situations?
(15) Please discuss what these words mean to you: “humanitarianism”; “charity”; and, “paternalism”. How do you see these concepts in relation to the mission of VOSH and the work we do?
(16) The WHO report on the “Elimination of Avoidable Visual Disability Due to Refractive Errors” notes that “recycled spectacles are not helpful in developing a sustainable process, as they perpetuate dependency of the community on outside resources”; rather, “the establishment of sustainable systems for the delivery of spectacles is an important part of the integrated refractive eye care system.” How do you respond to this in light of what most VOSH chapters and LIONS organizations presently do?
(17) The WHO report on the “Elimination of Avoidable Visual Disability Due to Refractive Errors” also notes that “short-term visits of NGO clinics to countries and areas in need should be complemented by training of local personnel to ensure sustainability.” Do you agree? Has this been a part of missions on which you have gone? Why, or why not?
(18) Some VOSH chapters utilized progressive addition lenses on their missions, while others do not. What has been done on your missions? How do you feel about the use of progressive addition lenses when dispensing recycled glasses?
(19) In order to survive and grow as an organization, VOSH / International (as well as its individual chapters) needs to increase its visibility. What suggestions might you have to increase public and corporate awareness of our mission, as well as improving our recognition amongst major international organizations such as the WHO, the WCO, and major NGOs?
(20) In order to survive and grow as an organization, and to continue to pursue its stated altruistic mission, VOSH / International (as well as its individual chapters) may wish to look for external sources of funding. Do you feel, philosophically, that VOSH should undertake such a venture; or, do you worry that our organization’s mission and/or ideals may become compromised? What suggestions, techniques, target audiences might you offer to implement a viable fund-raising effort?
Respectfully submitted, Stuart Frank, Seattle, WA, Frank.firstname.lastname@example.org, (206) 527-6588