title: Use of ready-made spectacles to meet visual needs in a low-resource adult population.
abstract: OBJECTIVE
  In affluent societies, distance and near vision problems are typically corrected with custom-made eyeglasses. Many persons in less affluent areas do not have the resources for such. The purpose of this study was to assess the use of less expensive ready-made (RM) bifocals and readers to correct distance and near refractive error and presbyopia in an outreach clinic in Nicaragua.
  
  
  METHODS
  This is a retrospective review of records of all patients older than 34 years who presented for an eye examination in an outreach clinic in Granada, Nicaragua, in 2010. A visual satisfaction questionnaire had been administered to patients before they were examined and after RM plus sphere bifocals or plus sphere reading spectacles were dispensed. The main outcome measures included pre- and post-distance and near visual acuities, vision satisfaction and difficulty ratings, and perceived cost and willingness to pay for replacement rating.
  
  
  RESULTS
  Ready-made plus sphere spectacles (bifocals or single-vision readers) were dispensed to 95.4% of those examined. The remaining 4.6% required custom prescriptions because of astigmatism, myopia, or anisometropia. The RM bifocals were very well accepted, with high visual satisfaction ratings with the bifocals improving from a presenting value of 11 to 89.4% at distance and from 6.6 to 89.4% at near. Percentage of patients achieving visual acuity of 20/40 or better improved from 60 to 84.5% at distance and from 44 to 97% at near. Percentage achieving functionally good near vision (20/40 or better) improved from 38 to 97% with RM readers. Patients reporting highest satisfaction with near vision improved from 6.3 to 86.6%. Patients indicated that, on average, they would be willing to pay US$18.39 to replace the bifocals and US$16.67 to replace the readers.
  
  
  CONCLUSIONS
  Ready-made bifocals and RM single-vision readers may be an acceptable and affordable alternative for many patients with hyperopia and/or presbyopia where access to custom-made eyeglasses is difficult.
authors.affiliation: NOVA Southeastern College of Optometry, Fort Lauderdale, Florida, USA. larryhookway@gmail.com
authors.forename: Larry Allen
authors.initials: LA
authors.lastname: Hookway
authors.forename: Patti
authors.initials: P
authors.lastname: Fuhr
authors.forename: Marcela
authors.initials: M
authors.lastname: Frazier
mesh_terms: D000328:Adult; D005139:Eyeglasses / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009527:Nicaragua / Q000453:epidemiology; D017060:Patient Satisfaction; D011203:Poverty; D015995:Prevalence; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014792:Visual Acuity