This article was originally published in a sponsored newsletter.

Like most other developing countries, Jamaica lacks adequate comprehensive eye care, which means specialties such as myopia control are deficient in reaching school-aged children who have myopia. Health policies and eye care have been discussed in the literature in Jamaica during the past two decades.¹ The American Optometric Association has seen robust growth in the number of professionals during this time; in 2020, the U.S. had about 110 ODs per million people in the country² and Canada boasts about 130 ODs per million.³ These proportions are in contrast to Jamaica with only about six ODs per million.⁴

Since 1981, Canadian Vision Care (CVC) has been working with Lions Clubs across Jamaica with public and private health providers to develop a unique sustainable eyecare system. What began as a training project for optometry students from the University of Waterloo in the 1970s has evolved into a program that provides routine eye care by Canadian optometrists, as well as eye surgery and training for Jamaican surgeons by American and Canadian ophthalmologists.⁵

Earlier in May, our CVC team provided routine eye care and cataract surgeries to an underserved population in Jamaica. Approximately 350 routine eye exams were performed, including 80 school-aged children who presented with uncorrected myopia. One of the most important first steps in myopia management is accurate optical neutralization. We know that blur in the eye due to both uncorrected or over-corrected refractive error may accelerate myopic progression.⁶

Prescribing medications long-term (i.e., possibility for atropine) would be best in the care of local eyecare providers; however, most are not familiar with the treatment strategies. Pharmacies in Jamaica do have the ability to compound atropine. Like all countries, regulation of compounded ophthalmic drops may vary and commercially available atropine would be best for the most optimal use when available.

An internet search of practices in Jamaica revealed only one office that mentioned myopia management therapies (atropine, spectacles, or contact lenses). Providers, patients, and caregivers with whom we interacted had not heard of myopia control. However, during our time at the CVC clinic, several local MDs visited me to discuss myopia management. These experiences demonstrated that local eyecare providers are capable, but there is a gap in knowledge compared to more developed countries where there are many more opportunities for advanced training and ongoing education.

Based on my recent experiences, a summary of take-home messages regarding myopia management and subspecialties in less developed countries are as follows:

1. There is a continued need for global awareness about options to prevent myopic progression.
2. There is an urgent need for specialty eye care, specifically for dry eye and myopia management.
3. There is a need for continued development of sustainable clinics, which can be accomplished by training local eyecare providers.
4. Economics play a significant role in access to care and materials in all countries. Future efforts for international mission trips could seek to establish access to myopia control spectacles or other therapies.
5. Specialty contact lenses, such as those for infant aphakia, irregular corneas, and myopia management, are largely underutilized in developing countries due to practicality and access to care.
6. Local eyecare providers in Jamaica were highly interested in learning about myopia management and specialty contact lenses. I would guess this interest would also be the case in many other Caribbean countries and around the world.

References

1. Buchanan N, Horwitz S. Health policy and eye care services in Jamaica. Optom Vis Sci. 2000 Jan;77:51-57.

2. Heath DA, Spangler JS, Wingert TA, et al. 2017 national optometry workforce survey. Optom Vis Sci. 2021 May 1;98:500-511.

3. Alaa A, Hallingham S, Buys Y. Workforce supply of eye care providers in Canada: Optometrists, ophthalmologists, and subspecialty ophthalmologists. Can J Ophthalmol. 2015 Dec;50:422-428.

4. Ricketts C. Raising awareness about the optometric profession in Jamaica. NECO Magazine. 2020 Dec 8. Available at neco.edu/news/raising-awareness-about-the-optometric-profession-in-jamaica. Accessed May 14, 2023.

5. Leinweber G. The Why of Community Vision Clinics in Mobay Jamaica. 2016 CVC Mission Statement.

6. Chung K, Mohidin N, O’Leary DJ. Undercorrection of myopia enhances rather than inhibits myopia progression. Vision Res. 2002 Oct;42:2555-2559.