Help to Bring the Issue of Global Blindness to the Forefront 

Please provide us with data from your clinic trip

As one of the largest organizations that provides direct delivery service of eye care in the developing world, VOSH Chapters have the potential to make a significant contribution to alleviating the global burden of blindness and visual impairment by simply recording our data.


As direct delivery providers, we have the benefit of seeing many people from different communities around the world and we can easily incorporate surveys as part of our mission that can help with epidemiological studies in identifying the visual needs of a specific community.

One of the priorities of VISION/2020 is identifying communities with visual disability due to URE.  VOSH projects can be an invaluable source of information for determining the prevalence of eye diseases and blindness from URE and an excellent way to rapidly assess the state of eye care in an underserved area.  These projects can identify which communities are most in need and which communities are more likely to  pay for eyeglasses and eye care.  Different levels of poverty and accessibility require different types of approach to best alleviate the burden of uncorrected refractive error.

Our data can be an invaluable tool for advocacy groups like Brien Holden Vision Institute, Vision Impact Institute, Eyelliance, and other partner organizations with whom VOSH is working to bring the issue of global blindness to the forefront, so that it can be  recognized as a public health concern to the same degree as malaria and river blindness is today.

Universal Optometric Mission Intake & Exam Form: Streamlines Missions/Clinics and Eases Essential Data Collection ‚Äč

V/I has developed a universal form to be used by all chapters during their clinics as an invaluable way to capture optometric mission data to enhance the global fight against uncorrected refractive error & preventable ocular disease.

This data will be shared with you and will be used by V/I and national organizations, such as IAPB, WCO and others, to improve humanitarian eye care delivery. You can use this data to anticipate the type of eye care issues will be treating, and apply for your own funding as well.  Please start using this on your next mission trip.

Why use this form:

  • The goal of a universal exam form is to create a consistent process that can support multiple global mission goals

  • Collecting exam data that can be analyzed and shared across the Optometric & Opticianry communities

  • The specific format allows for the scanning and data conversion of large amounts of information collected during the screening, exam and visual acuity or refractive error solution process

  • The forms are mailed to a central processing facility where they are scanned, analyzed by conversion software and turned into exam and encounter data

  • When completed the mission leader is emailed a report detailing the results of their mission trip

We know there will be questions! So please ask us: or

Download these forms & make your clinic experience even more meaningful for future patients:

Universal Exam Form: Intake Form
Universal Exam Form: Master Data Sheet
Universal Exam Form Instructions in Power Point

If you are not yet using the forms above, please send us your clinic data this way.  These are interactive forms. You can submit the information directly to VOSH. 

Initial Information and Day 1:

Day 2

Day 3:

Day 4:

Day 5:

If your clinic is more than 5 days, use this form:


Print the following form, bring it to your clinic and after the clinic, send to Marina Roma March, OD at