Making Eye Health a Population Health Imperative Vision for Tomorrow (2016) / Chapter Skim
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. Yet, as a chronic condition, vision impairment remains notably absent from many public health agendas and community programs.
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affects millions more people in the United States, with estimates for uncorrected refractive error alone ranging from 8.2 million (Varma et al., 2016) to 11.0 million (CDC, 1 The committee adopted these definitions of vision loss and vision impairment to help facilitate discussion of eye and vision health in the context of population health.
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. Identifying populations at high risk for certain types of vision loss can help target limited resources, tailor effective interventions, and promote policies that better achieve eye and vision health and improve population health equity.
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Early diagnosis and appropriate access to high-quality treatment could improve the trajectory of modifiable, correctable, and uncorrectable vision impairment by either slowing the progression of specific diseases or conditions, correcting the vision impairment itself, or improving the functionality, independence, and quality of life of populations with uncorrectable vision impairment. For example, estimates suggest that vision impairment caused by uncorrected refractive error and cataracts -- both largely treatable -- accounts for a substantial portion of undiagnosed vision impairment every year in the United States (CDC, 2015c; Wittenborn and Rein, 2016)
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To further inform its deliberations, the committee also commissioned a paper on the costs and preventable burden of vision impairment for select eye conditions. A POPULATION HEALTH APPROACH TO IMPROVE EYE AND VISION HEALTH A population health approach involves multiple actors who work separately and cooperatively to "[focus]
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6 FIGURE S-1 Examples of factors that could be part of a population health approach to eye and vision health. SOURCE: Adapted from IOM, 2003a, p.
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TRANSLATING A CONCEPTUAL FRAMEWORK INTO ACTION: RECOMMENDATIONS The long-term goal of a population health approach for eye and vision health should be to transform vision impairment from a common to a rare condition, reducing associated health inequities. Given the genetic and biological components of many eye diseases and conditions, the occurrence of eye injuries, and the aging process itself, populations will never be without vision impairment.
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Many of the following nine recommendations are broadly framed but are critical to establish conditions that will support a sustainable population health initiative that will effectuate a long-term reduction in vision impairment and its ramifications. These recommendations provide the foundational support for other, more specific actions by stakeholder groups, as described throughout this report.
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Preventive Services Task Force, and the World Health Organization have identified vision impairment in various populations as national or global public health problems (HHS, 2015; NEI/NIH, 2004; WHO, 2015)
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Specifically, this call to action should establish goals to: • Eliminate correctable and avoidable vision impairment by 2030, • Delay the onset and progression of unavoidable chronic eye dis eases and conditions, • Minimize the impact of chronic vision impairment, and • Achieve eye and vision health equity by improving care in under served populations. Enhancing public knowledge about a health threat is a fundamental first step in informing discussions that promote behavior change across multiple determinants of health and aligning health policies with general public health interests.
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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. This campaign should target various stakeholders, including the general population, care providers and caretakers, public health practitioners, policy makers, employers, and community and patient liaisons and representatives.
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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 design of this system should include, but not be limited to: • Developing and standardizing definitions for population-based studies, particularly definitions of clinical vision loss and functional vision impairment; • Identifying and validating surveillance and quality-of-care measures to characterize vision-related outcomes, resources, and capacities within different communities and populations; • Integrating eye-health outcomes, objective clinical measures, and risk/protective factors into existing clinical-health and population health data collection forms and systems (e.g., chronic disease questionnaires, community health assessments, electronic health records, national and state health surveys, Medicare's health risk assessment, and databases)
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This research agenda should include, but not be limited to: • Population-based epidemiologic and clinical research on the major causes and risks and protective factors for vision impairment, with a special emphasis on longitudinal studies of the major causes of vision impairment; • Health services research, focused on patient-centered care pro cesses, comparative-effectiveness and economic evaluation of clini cal interventions, and innovative models of care delivery to improve access to appropriate diagnostics, follow-up treatment, and reha bilitation services, particularly among high-risk populations; • Population health services research to reduce eye and vision health disparities, focusing on effective interventions that promote eye healthy environments and conditions, especially for underserved populations; and • Research and development on emerging preventive, diagnostic, therapeutic, and treatment strategies and technologies, including efforts to improve the design and sensitivity of different screening protocols. Expand Access to Appropriate Clinical Care Timely, appropriate, and equitable access to and delivery of effective care in all settings is an important component of a population health approach to improve eye and vision health.
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, new skills will be needed to ensure that health care professionals understand the types of patient experiences and data that are relevant to population health activities, including the moral imperative to reduce inequities in both health and health care. Moreover, public health practitioners should be familiar with eye and vision health, its risk factors, and the relationship between vision loss and other chronic health conditions.
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Improving eye and vision health requires that comparable services, information, and healthy environments are accessible to all populations. Public health departments serve as key community conveners to coordinate responses that address multiple de terminants of health and chronic conditions, such as vision impairment.
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. In the absence of federal directives and programs to advance eye and vision health, state and local public health departments are hard pressed to incorporate reduction of vision impairment as a categorical programmatic focus.
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It is important that community stakeholders (businesses, advocacy organizations, neighborhood groups, local health and public health departments, religious organizations, professional organizations, school boards and faculty, parent support groups, health care providers, eye care providers, etc.) be actively consulted and engaged in options to translate and implement national goals into workable community action plans to reduce the burden of vision loss and the functioning of populations with vision impairment across different community settings.
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2009. Why is vision loss a public health problem?
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2016. Falls among per sons aged > 65 years with and without severe vision impairment -- United States, 2014.
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2003. Vision loss: A public health prob lem?
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Paper prepared for the Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health. http://www.nationalacademies.org/hmd/~/media/ Files/Report%20Files/2016/UndiagnosedEyeDisordersCommissionedPaper.pdf (accessed September 15, 2016)
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