Making Eye Health a Population Health Imperative Vision for Tomorrow (2016) / Chapter Skim
Currently Skimming:
3 The Impact of Vision Loss
3 The Impact of Vision Loss
Pages 135-162
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 135... ...
The economic impact of vision loss is also substantial. One national study commissioned by Prevent Blindness found that direct medical expenses, other direct expenses, loss of productivity, and other indirect costs for visual disorders across all age groups were approximately $139 billion in 2013 dollars (Wittenborn and Rein, 2013)
|
From page 136... ...
found that the QOL begins to slowly decline with the onset of vision loss, and then decreases more precipitously as measures of visual field defects increase. A systematic literature review of studies that reported QOL in patients with central vision loss or peripheral vision loss, and found that both types of vision loss were associated with similar degrees of detriment to QOL, although "different
|
From page 137... ...
The EQ-5D has five dimensions -- mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. 2 The authors defined "mild visual impairment" as visual acuity between 20/32 and 20/63; "moderate visual impairment" as visual acuity between 20/80 and 20/60; and "severe visual impairment" as visual acuity worse than or equal to 20/200.
|
From page 138... ...
. One cross-sectional study found that individuals with visual impairment, defined as a best-corrected binocular presenting visual acuity of 20/30 or worse, had greater disability across functional measures, such as task performance, walking speeds, and driving when compared to people with normal vision and even uncorrected refractive error3 (Zebardast et al., 2015)
|
From page 139... ...
Mobility is therefore greatly affected by vision loss, whether resulting from changes in visual acuity, visual fields, depth perception, or contrast sensitivity (Bibby et al., 2007; Lord and Dayhew, 2001; Marron and Bailey, 1982)
|
From page 140... ...
However, it is the committee's assessment that there remains a role for vision rehabilitation in mitigating fall risk associated with vision loss. Fractures Vision impairment has been shown to be associated with an increased risk of fractures in multiple studies.
|
From page 141... ...
. Various other aspects of visual impairment besides poor visual acuity have been shown to be associated with an increased fracture risk.
|
From page 142... ...
Of these, the link between vision loss and fall-related injuries has been most clearly documented. In a population-based cohort of Latinos in California, a greater risk of injurious falls was reported in those with both central vision impairment (OR = 2.76; 95% CI = 1.10, 7.02)
|
From page 143... ...
. Distress related to vision loss is more strongly correlated with depression than other key risk factors such as negative life events or poor health status (Rees et al., 2010)
|
From page 144... ...
. It is difficult to ascertain the influence of the vision loss on cognitive or academic function in diagnoses that are already associated with cognitive impairment.
|
From page 145... ...
Additional research is needed to determine whether vision loss is an independent risk factor for hearing loss and, if so, what factors underlie this relationship. Mortality Several studies report associations between vision impairment and an increased risk for all-cause and injury-related mortality, as compared to controls with normal vision (Christ et al., 2014; Lam et al., 2008; Lee et al., 2002, 2003; Zheng et al., 2014)
|
From page 146... ...
. Irreversible vision impairment resulting from eye disease should be considered a chronic condition; it can amplify the adverse effects of other illnesses and injuries, and people with vision loss commonly live with multiple chronic conditions.
|
From page 147... ...
Vision Loss Amplifies the Effects of Other Conditions A study of individuals ages 65 and older found that patients with a visual impairment and any of several other illnesses or conditions were many times more likely to have difficulty performing basic physical and social tasks than individuals in the same age range without visual impairment and without the particular illness or condition (Crews et al., 2006)
|
From page 148... ...
so that individuals who develop vision loss associated with chronic conditions, such as diabetes or glaucoma, are at a disadvantage in managing those chronic conditions. For example, vision loss makes it difficult to properly administer medications such as insulin or eye drops.
|
From page 149... ...
. This analysis estimated the direct and indirect costs attributable to vision loss and eye disease to be $138.9 billion in the United States in 2013 dollars and found that costs for individual states ranged from $250 million in Wyoming to more than $15.6 billion in California 5 A friend or relative with whom the participant had at least weekly contact.
|
From page 150... ...
. The total direct and indirect costs for eye disorders and vision loss per payer were $47.4 billion for government entities, $22.1 billion for private insurers, and $71.7 billion for patients (Wittenborn and Rein, 2013)
|
From page 151... ...
Age Group 0–17 18–39 40–64 65+ All Ages Direct costs Diagnosed disorders $2,844 $5,067 $14,218 $26,640 $48,769 Medical vision aids $1,480 $3,335 $6,222 $2,199 $13,236 Undiagnosed vision loss $48 $474 $1,702 $798 $3,022 Aids/devices $38 $77 $81 $553 $749 Educational/school screening $651 $119 -- -- $769 Assistance programs $25 $13 $23 $145 $207 Total direct costs $5,086 $9,086 $22,246 $30,335 $66,752 Indirect costs Productivity loss -- $12,978 $10,828 $24,622 $48,427 Informal care $601 -- $187 $1,264 $2,052 Nursing home -- -- -- $20,248 $20,248 Entitlement programsa $0.50 $165 $279 $1,782 $2,226 Tax deductionsa -- $6 $11 $10 $28 Transfer deadweight loss $47 $98 $538 $808 $1,490 Total indirect costs $648 $13,075 $11,553 $46,941 $72,217 Total economic burden $5,734 $22,161 $33,799 $77,276 $138,970 Loss of well-being measures Disability adjusted life years lost 6.92 26.35 33.38 216.48 283.13 a Transfer payment costs are not included in total. SOURCE: Wittenborn and Rein, 2013.
|
From page 152... ...
. Individuals paid for slightly more than half -- $71.7 billion -- of the total cost of eye disorders and vision loss, "largely due to productivity and informal care losses" (Wittenborn and Rein, 2013, p.
|
From page 153... ...
demonstrated among Medicare beneficiaries with glaucoma that patients with any vision loss had 46.7 percent higher costs compared with patients without vision loss; the higher costs were the result of the increased risk for nursing home admission, depression, falls, accidents, and injury. These outcomes account for some of the most substantial health expenditures.
|
From page 154... ...
Moreover, other conditions may affect the management of eye disease, including vision rehabilitation to improve the functionality and quality of life for those with vision impairments. No studies are available on the total costs attributable to the promotion of eye and vision health and the economic impact of vision loss in the United States.
|
From page 155... ...
2008. Impact of vision loss on costs and outcomes in Medicare beneficiaries with glaucoma.
|
From page 156... ...
2009. The quality of life impact of peripheral versus central vision loss with a focus on glaucoma versus age-related macular degeneration.
|
From page 157... ...
1998. Visual impairment and falls in older adults: The Blue Mountains Eye Study.
|
From page 158... ...
2007. Impact of visual impairment on quality of life: A comparison with quality of life in the general population and with other chronic conditions.
|
From page 159... ...
2010. Central and peripheral visual impairment and the risk of falls and falls with injury.
|
From page 160... ...
2006. Impact of visual impairment on measures of cognitive function for children with congenital toxoplasmosis: Implications for compen satory intervention strategies.
|
From page 161... ...
2013. Cost of vision problems: The economic burden of vision loss and eye disorders in the United States.
|
From page 162... ...
2015. Comparing the impact of refractive and nonrefractive vision loss on functioning and disability.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.