Le Quang Tram Tinh first became involved in school eye health in 2007. At the time, while cataract surgery followed standard clinical processes, refraction services for children relied heavily on the experience of individual eye doctors or refractionists. This inconsistency meant that visual outcomes varied between settings.
Tinh checked in regularly with students after they received spectacles, monitoring and following up as a central part of his daily work. He frequently met with students to ask how their new spectacles were working for them and whether their visual acuity had improved. However, it was difficult to assess the quality of refractive error interventions without clear guidelines. Experts from the Viet Nam National Eye Hospital were regularly invited to conduct spot checks. The results often concerned Tinh, as quality fluctuated from year to year and between settings. He was left with a question:
Children within the hospital partner project had access to structured support. If even they were experiencing inconsistent outcomes, what did that imply for the far larger number of children with no support at all?
Determined to find an answer, Tinh and his team raised these concerns about children’s spectacles with the Ministry of Health. That dialogue contributed to a strategic project launched in 2016 and led to the first quality of refractive error care pilot study in Viet Nam in 2018.
The study sent trained people to visit eye care services posing as ordinary patients, without staff knowing they were being assessed, and record what happened during their visits. The findings were unexpected for stakeholders: the overall quality of dispensed spectacles was often low, and that most services were provided by private optical shops without formally trained optometrists or refractionists..jpg?sfvrsn=cc7f80cd_2 "Tinh_ Transforming Eye Care (2)")
Tinh describes the study findings as a catalyst for a 15-year national roadmap to improve the quality of refraction and optical services nationwide. He sees five priorities ahead:
- Standardizing national guidelines: the Ministry of Health will develop a national protocol for refraction and optical services. Once nationally endorsed, it will apply to more than 12 000 optical shops across Viet Nam.
- Expanding the professional workforce: Viet Nam has a population of 100 million and an estimated need for 10 000 optometrists. However, only about 600 optometrists have graduated from the country’s two existing university degree programmes. To help address this gap, work is under way to establish a third bachelor’s degree in optometry.
- Strengthening school health policy: with 20 million students and rising rates of childhood refractive error, the Ministry of Education and Training is working to have refractive error recognised as a priority in the recently endorsed National School Health Plan for 2026–2035.
- Connecting the health and education sectors: allowing technical expertise from eye care professionals to inform school-based programmes.
- Securing professional recognition: Formal recognition of optometrists as eye care providers specializing in refractive error within the national health system. Work continues to expand this so that optometrist can perform comprehensive eye examinations.
Looking back, Tinh sees that what began with local spot checks has led to wider action to improve the quality of refraction and optical services in Viet Nam. This study methodology provided a systematic way to measure the quality of refractive error care and dispensed spectacles.
For Tinh, generating evidence on the quality of refractive error care is how gaps get identified and services get better, so that every child in need receives quality eye care.
This story was developed by The Fred Hollows Foundation, a member of the Global SPECS Network, in collaboration with the WHO Vision and Eye Care Programme.
Photo credits: The Fred Hollows Foundation.