NASEM declares eye health a public health imperative

In order to avoid a public health crisis and keep up with increasing vision loss among the aging baby-boomer generation, correctable vision impairments must be eliminated by 2030, according to a report issued by the National Academies of Sciences, Engineering, and Medicine (NASEM).

“Vision loss and visual impairment is a major public health problem,” said Rohit Varma, MD, MPH, report committee member, and chairman, Department of Ophthalmology, University of Southern California, Los Angeles. “In setting this high bar, the committee wanted to stimulate innovative ways on how to use the available resources more wisely.”

Among other recommendations, the “Making Eye Health a Population Imperative: Vision for Tomorrow” report recommends that the Secretary of the U.S. Department of Health and Human Services issue a call-to-action nationwide to increase public awareness of the impending crisis should vision and eye health not be taken more seriously on a local, state, and federal level.

The report is a result of a 1.5-year consensus study with committee members representing ophthalmology, optometry, and public health sectors.

The authors acknowledge the public view of eye care is something that may often be taken for granted.

"Avoidable vision impairment occurs too frequently in the United States and is the logical result of a series of outdated assumptions, missed opportunities, and manifold shortfalls in public health policy and health care delivery," they said. "As a chronic condition, vision impairment remains notably absent from many public health agendas and community programs. Rather, vision is often regarded as a given-until it is not."

Although precise data are not available for the number of people with undiagnosed or uncorrected vision impairment, one model estimates more than 142 million Americans over the age of 40 have vision problems and 8 to 16 million Americans are believed to have uncorrected refractive errors.

“We have an absolute lack of a comprehensible, sustainable, implemented, and funded surveillance system for vision loss and eye disease in the United States,” Dr. Varma said.

The committee predicts that the absence of nationwide efforts to improve eye care could result in a doubling of uncorrectable vision impairments by 2050. This increase of vision impairments could also negatively amplify the effects of other non-eye-related chronic illnesses. It also negatively effects quality of life, independence, and psychological well-being.

What the report calls for

The report calls for a population-health approach to increase the awareness of eye and vision health beyond the clinical setting. The committee also emphasized the multifactorial components of the problem, including access to safe work and play environments, access to clinical care, and health literacy. Preventing underlying chronic diseases, such as diabetes, can also reduce the prevalence of vision impairments, they said.

Steven M. Teutsch, MD, MPH, chairman of the committee, reported on the three goals of public health being assessment, policy development, and assurance (putting plans into action), as well as the determinants of public health, including a variety of factors such as individual behavior, healthcare access, and care quality.

Dr. Teutsch is also an adjunct professor at the Fielding School of Public Health, UCLA, University of Southern California, Los Angeles.

While the committee members embodied a wide range of fields in medicine and public health, they all were grounded on core principles involving integration of evidence- and population-centered solutions that are standardized, collaborative, culturally competent, and tailored to specific communities.

The full report included nine recommendations which aim to:

·      Facilitate public awareness through timely access to accurate and locally relevant information

·      Generate evidence to guide policy decisions and evidence-based actions

·      Expand access to appropriate clinical care

·      Enhance public health capacities to support vision-related activities

·      Promote community actions that encourage eye- and vision-healthy environments

AAO praises report

While this is the first major report citing eye health as a public imperative, the U.S. Centers for Disease Control and Prevention (CDC) previously launched a smaller Vision Health Initiative with similar goals as the NASEM report, according to Dr. Teutsch.

“I do see this as a landmark report, but the real question is then: How do we get the country to take the appropriate actions?” he asked. “Academies can do a fair bit in terms of presenting the information, but we are very dependent upon other other stakeholders, advocacy groups, and professional organizations to work with the decision-makers around the country to actually bring some of the recommendations to fruition.”                                                                                  

While Dr. Varma believes the report should have been released many years ago, he also urges that it is not too late.

“This comes at a very timely moment where we are just on the verge of getting hit by the entire baby-boomer generation, which is a huge increase of individuals in their 50s and 60s, when eye disease begins to become more and more prevalent,” he said. “So I think the time is right to begin to have a greater focus-no pun intended-on this condition.”

AAO praises report

The American Academy of Ophthalmology (AAO) pledged its support of recommendations in the committee’s recommendations, which is the first report of its magnitude to press the need for nationwide action on awareness and access for eye care.

The report references multiple resources from the AAO in support of its recommendations, including the national database of patient outcomes, clinical practice guidelines, and public health efforts.

"This report is a landmark moment in public health in America as it moves eye health to a prominent position on the national agenda," said David W. Parke II, MD, chief executive officer, AAO. "The action plan outlined by NASEM draws upon and echoes much of the evidence-based work we are already leading on behalf of the nation's community of eye physicians and surgeons to protect the sight and empower the lives of our patients. We look forward to continuing to play a leading role and collaborating with all stakeholders in making these recommendations a reality."

Commitee

Committee:

·      Steven M. Teuch (Chair), UCLA, University of Southern California, Public Health Institute

·      Sandra S. Block, Illinois College of Optometry

·      Anne L. Coleman, University of California, Los Angeles

·      Kevin Frick, Johns Hopkins University

·      Karen Glanz, University of Pennsylvania

·      Lori Grover, Salus University

·      Eve Higginbotham, University of Pennsylvania

·      Peter D. Jacobson, University of Michigan

·      Edwin Marshall, Indiana University

·      Christopher Maylahn, New York State Department of Health

·      Joyal Mulheron, Sagacity Group, LLC

·      Sharon Terry, Genetic Alliance

·      Cheryl Ulmer, Institute of Medicine (Retired)

·      Rohit Varma, University of Southern California

·      Heather E. Whitson, Duke University Medical Center

Study Staff

·      Margaret A. McCoy, Study Director

·      R. Brian Woodbury, Research Associate

·      Annalyn Welp, Research Assistant

·      Bettina Ritter, Research Assistant (through November 2015)

·      Marjorie Pichon, Senior Program Assistant

·      Rose Marie Martinez, Director, Board on Population Health and Public Health Practice

Sponsors

Study Sponsors

The 10 sponsors of the report were: American Academy of Ophthalmology, American Academy of Optometry, American Optometric Association, The Association for Research in Vision and Ophthalmology, Centers for Disease Control and Prevention, The National Alliance for Eye and Vision Research, National Center for Children’s Vision and Eye Health, National Institutes of Health, Prevent Blindness, and Research to Prevent Blindness.

In addition, the Focus Initiative, hosted by Prevent Blindness, is a virtual forum on vision and public health for professions. Ophthalmologists can connect with resources at http://www.preventblindness.org/focus-initiative-webinars  and www.preventblindness.org/linkedin.

A briefing of the report can be seen here.