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Several recent United States-based eye and vision research projects, including the Los Angeles Latino Eye Study and the Philadelphia Glaucoma Detection and Treatment Project, have highlighted significant disparities in the quality and equity of eye care throughout the country, including barriers within the health care and public health systems; inadequate prevention and screening strategies; and insufficient concerns with patient quality of life.
About the National Academies of Sciences, Engineering, and Medicine
The National Academies of Sciences, Engineering, and Medicine (NASEM) are private, nonprofit institutions that provide expert advice on significant challenges facing the nation and the world. Their work helps to shape policies, inform public opinion, and advance the pursuit of science, engineering, and medicine.
The foundation for NASEM was established in 1863, when President Abraham Lincoln signed a congressional charter that formed the National Academy of Sciences to meet the government’s need for an independent adviser on scientific matters. As science began to play an increasingly important role in national priorities and public life, the National Academy of Sciences expanded to include the National Research Council in 1916, the National Academy of Engineering in 1964, and the National Academy of Medicine in 1970.
Some Background for the NASEM Report
Excerpted from the NASEM website (with emphasis added):
“Despite the importance of eyesight, millions of people grapple with undiagnosed or untreated vision impairments—ranging from mild conditions to total blindness—and eye and vision health remain relatively absent from national health priority lists. Vision loss in adults is associated with increased risk of falls and injuries, social isolation, depression, and other psychological issues and can amplify the adverse effects of other chronic illnesses, increasing the risk for mortality. Similarly, undiagnosed or uncorrected refractive errors and other visual disorders in children can lead to developmental, academic, and social challenges, and in some cases permanent vision loss, which has lifelong implications.
In 2014, the Health and Medicine Division of The National Academies of Sciences, Engineering, and Medicine convened a multidisciplinary committee to “examine the core principles and public health strategies to reduce visual impairment and promote eye health in the United States,” including short- and long-term strategies to prioritize eye and vision health through collaborative actions across a variety of topics, settings, community stakeholders, and levels of government.
This report [published on September 15, 2016] proposes a population health action framework to guide action and coordination among various—and sometimes competing—stakeholders in pursuit of improved eye and vision health and health equity in the United States.
This report also introduces a population-health approach that promotes eye and vision health far beyond the clinical setting, with an emphasis on minimizing preventable and uncorrected impairment. It is also a model for action that highlights different levels of prevention activities across a range of stakeholders and provides specific examples of how population health strategies can be translated into areas for action at federal, state, and local levels.”
Eyesight affects how human beings perceive and interpret the world and is used for everyday communication, social activities, educational and professional pursuits, the care of others, and the maintenance of personal health, independence, and mobility.
As increased risk for poor eye health is associated with certain social, economic, cultural, health, and environmental conditions, these factors contribute to inequities that already affect populations with lower socioeconomic status and poor health. Moreover, the economic and social costs of vision impairment to patients, the healthcare system, and society are considerable. Yet vision impairment remains notably absent from many population health agendas and community programs.
Uncorrectable vision impairment affects an estimated 6.42 million people in the United States. Uncorrected vision impairment affects millions more people in the United States, with estimates for uncorrected refractive error alone ranging from 8.2 million to 15.9 million.
A number of factors contribute to the absence of focused and sustained programmatic investment that would translate into widespread action, including a lack of focus on prevention and underlying social and environmental determinants, inadequate information about the state of eye health, the segregation of eye care from the rest of medicine, minimal cross-discipline training, scant public health resources, and a lack of coordination within or across federal entities and among partner organizations.
Many public and private health insurance coverage policies, including Medicare, exclude eye examinations for asymptomatic or low-risk patients, corrective lenses, and visual assistive devices. Thus, in many cases, people must purchase additional vision insurance or shoulder costs out of pocket, exacerbating overall health inequities among populations least able to afford care. Moreover, effective interventions exist to improve or maintain the functioning of people with vision impairment, but information about, and access to, these services is often limited.
“The Secretary of the U.S. Department of Health and Human Services should issue a call to action to motivate nationwide action toward achieving a reduction in the burden of vision impairment across the lifespan of people in the United States. Specifically, this call to action should establish goals to (a) eliminate correctable and avoidable vision impairment by 2030; (b) delay the onset and progression of unavoidable chronic eye diseases and conditions; (c) minimize the impact of chronic vision impairment; and (d) achieve eye and vision health equity by improving care in underserved populations.”
“The Secretary of the U.S. Department of Health and Human Services, in collaboration with other federal agencies and departments, nonprofit and for-profit organizations, professional organizations, employers, state and local public health agencies, and the media, should launch a coordinated public awareness campaign to promote policies and practices that encourage eye and vision health across the lifespan, reduce vision impairment, and promote health equity.”
“The Centers for Disease Control and Prevention (CDC) should develop a coordinated surveillance system for eye and vision health in the United States. To advise and assist with the design of the system, the CDC should convene a task force comprising government, nonprofit and for-profit organizations, professional organizations, academic researchers, and the health care and public health sectors.”
“The U.S. Department of Health and Human Services should create an interagency workgroup, including a wide range of public, private, and community stakeholders, to develop a common research agenda and coordinated eye and vision health research and demonstration grant programs that target the leading causes, consequences, and unmet needs of vision impairment.”
“The U.S. Department of Health and Human Services should convene one or more panels—comprising members of professional organizations, researchers, public health practitioners, patients, and other stakeholders—to develop a single set of evidence-based clinical and rehabilitation practice guidelines and measures that can be used by eye care professionals, other care providers, and public health professionals to prevent, screen for, detect, monitor, diagnose, and treat eye and vision problems.”
“…professional education programs should proactively recruit and educate a diverse workforce and incorporate prevention and detection of visual impairments, population health, and team care coordination as part of core competencies in applicable medical and professional education and training curricula.”
“State and local public health departments should partner with health care systems to align public health and clinical practice objectives, programs, and strategies about eye and vision health…”
…”the Centers for Disease Control and Prevention should prioritize and expand its vision grant program, in partnership with state-based chronic disease programs and other clinical and non-clinical stakeholders, to (a) design, implement, and evaluate programs for the primary prevention of conditions leading to visual impairment; (b) develop and evaluate policies and systems that facilitate access to, and utilization of, patient-centered vision care and rehabilitation services, including integration and coordination among care providers; and (c) develop and evaluate initiatives to improve environments and socioeconomic conditions that underpin good eye and vision health and reduce eye injuries in communities.”
“Communities should work with state and local health departments to translate a broad national agenda to promote eye and vision health into well-defined actions. These actions should encourage policies and conditions that improve eye and vision health and foster environments to minimize the impact of vision impairment, considering the community’s needs, resources, and cultural identity.”
