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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
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MAKING EYE HEALTH
A POPULATION
HEALTH IMPERATIVE

VISION FOR TOMORROW

Steven M. Teutsch, Margaret A. McCoy, R. Brian Woodbury,
and Annalyn Welp, Editors

Committee on Public Health Approaches to Reduce Vision Impairment
and Promote Eye Health

Board on Population Health and Public Health Practice

Health and Medicine Division

A Report of

images

THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by American Academy of Ophthalmology; American Academy of Optometry; American Optometric Association; Association for Research in Vision and Ophthalmology; National Alliance for Eye and Vision Research; National Center for Children’s Vision and Eye Health; Prevent Blindness; Research to Prevent Blindness; Contract No. 200-2011-38807, TO#32 with the U.S. Department of Health and Human Services [Centers for Disease Control and Prevention]; and Contract No. HHSN2632012000741, TO#61 with the U.S. Department of Health and Human Services [National Institutes of Health]. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-43998-5
International Standard Book Number-10: 0-309-43998-1
Digital Object Identifier: 10.17226/23471
Library of Congress Control Number: 2016956972

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

Image

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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Learn more about the National Academies of Sciences, Engineering, and Medicine at www.national-academies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

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Reports document the evidence-based consensus of an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and committee deliberations. Reports are peer reviewed and are approved by the National Academies of Sciences, Engineering, and Medicine.

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

COMMITTEE ON PUBLIC HEALTH APPROACHES TO REDUCE VISION IMPAIRMENT AND PROMOTE EYE HEALTH

STEVEN M. TEUTSCH (Chair), Adjunct Professor, University of California, Los Angeles, Fielding School of Public Health; Senior Fellow, Public Health Institute; Senior Fellow, Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California

SANDRA S. BLOCK, Professor, Illinois College of Optometry, Medical Director, School-based Vision Clinics, Global Clinical Advisor Special Olympics Lions Clubs International Opening Eyes

ANNE L. COLEMAN, Professor of Ophthalmology and Epidemiology, Stein Eye Institute, David Geffen School of Medicine, University of California, Los Angeles

KEVIN FRICK, Professor and Vice Dean for Education, Carey Business School, Johns Hopkins University

KAREN GLANZ, George A. Weiss University Professor, Director, University of Pennsylvania Prevention Research Center

LORI GROVER, Senior Vice President for Health Policy, King-Devick Technologies, Inc.

EVE HIGGINBOTHAM, Vice Dean, Perelman School of Medicine, University of Pennsylvania

PETER D. JACOBSON, Professor of Health Law and Policy, School of Public Health, University of Michigan

EDWIN C. MARSHALL, Professor Emeritus of Optometry and Public Health, Indiana University

CHRISTOPHER MAYLAHN, Program Research Specialist, Office of Public Health Practice, New York State Department of Health

JOYAL MULHERON, Managing Director, Sagacity Group, LLC

SHARON TERRY, President and CEO, Genetic Alliance

CHERYL ULMER, Retired, Institute of Medicine

ROHIT VARMA, Grace and Emery Beardsley Professor and Chair, University of Southern California (USC) Department of Ophthalmology; Director, USC Eye Institute; Associate Dean for Strategic Planning and Network Development, Keck School of Medicine of USC

HEATHER E. WHITSON, Associate Professor of Medicine (Geriatrics) and Ophthalmology, Duke University Medical Center and Durham Veterans Affairs Medical Center

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

Study Staff

MARGARET A. McCOY, Study Director

ASHNA KIBRIA, Associate Program Officer (until August 2015)

R. BRIAN WOODBURY, Research Associate

ANNALYN WELP, Research Assistant

BETTINA RITTER, Research Assistant (until November 2015)

MARJORIE PICHON, Senior Program Assistant

ROSE MARIE MARTINEZ, Senior Director, Board on Population Health and Public Health Practice

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

SUSAN A. COTTER, Southern California College of Optometry

JORGE CUADROS, University of California, Berkeley

DAVID S. FRIEDMAN, Johns Hopkins University

MARSHA GOLD, Mathematica Policy Research, Inc.

EMMETT B. KEELER, Pardee RAND Graduate School

RICARDO MARTINEZ, Adeptus Health Inc.

GLEN MAYS, University of Kentucky

DAVID O. MELTZER, The University of Chicago

ALAN R. MORSE, Lighthouse Guild International

CYNTHIA OWSLEY, University of Alabama at Birmingham

ROBERT M. PESTRONK, Ruth Mott Foundation

LOUISE POTVIN, Université de Montréal

SUSAN A. PRIMO, Emory University School of Medicine

DEJURAN RICHARDSON, Lake Forest College

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

BETSY SLEATH, University of North Carolina Eshelman School of Pharmacy

FRANK A. SLOAN, Duke University

ALFRED SOMMER, Johns Hopkins University

JOHN C. TOWNSEND, Veterans Health Administration

M. ROY WILSON, Wayne State University

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by BOBBIE BERKOWITZ, Columbia University School of Nursing and Columbia University Medical Center, and BRADFORD H. GRAY, Urban Institute. They were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×
Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

Acronyms and Abbreviations

AAMC Association of American Medical Colleges
AAN American Academy of Neurology
AAO American Academy of Ophthalmology
AAP American Academy of Pediatrics
AAPOS American Association for Pediatric Ophthalmology and Strabismus
ACA Patient Protection and Affordable Care Act of 2010
ACF Administration for Children and Families
ACO accountable care organization
ACVREP Academy for Certification of Vision Rehabilitation and Education Professionals
ADA Americans with Disabilities Act of 1990
ADL activity of daily living
AER Association for Education and Rehabilitation of the Blind and Visually Impaired
AFB American Foundation for the Blind
AHRQ Agency for Healthcare Research and Quality
AMD age-related macular degeneration
APHA American Public Health Association
ASPPH Association of Schools and Programs of Public Health
AOA American Optometric Association
AOTA American Occupational Therapy Association
AUPO Association of University Professors of Ophthalmology
AWV annual wellness visit
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×
BLS Bureau of Labor Statistics
BPEDS Baltimore Pediatric Eye Disease Study
BPHC Bureau of Primary Health Care
BRFSS Behavioral Risk Factor Surveillance System
BROS Blind Rehabilitation Outpatient Specialist
CCG categorical condition group
CCTV closed caption television
CDC Centers for Disease Control and Prevention
CEA Cost-Effectiveness Analysis
CED coverage with evidence development
CHC community health center
CHIP Children’s Health Insurance Program
CHNA community health needs assessment
CLVT certified low vision therapist
CMS Centers for Medicare & Medicaid Services
COMS certified orientation and mobility specialist
CQI continuous quality improvement
CVRT certified vision rehabilitation therapist
DME diabetic macular edema
DoD U.S. Department of Defense
DOL U.S. Department of Labor
DOT U.S. Department of Transportation
DSI dual sensory impairment
ED U.S. Department of Education
EEOC Equal Employment Opportunity Commission
EHR electronic health record
EPA U.S. Environmental Protection Agency
EPSDT early and periodic screening, diagnostic, and treatment
FDA U.S. Food and Drug Administration
FEDVIP Federal Employees Dental and Vision Insurance Program
FPL federal poverty level
FQHC federally qualified health center
FSA flexible spending account
HEED Health Economics Evaluations Database
HHS U.S. Department of Health and Human Services
HRA health risk assessment
HRSA Health Resources and Services Administration
HSA health savings account
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×
HUD U.S. Department of Housing and Urban Development
ICD International Classification of Diseases
IDEA Individuals with Disabilities Education Act
IHS Indian Health Service
ILVS interdisciplinary low vision service
IPPE initial preventive physical exam
IOL intraocular lens
IOM Institute of Medicine
IOP intraocular pressure
KAP Knowledge, Attitudes, and Practices
LALES Los Angeles Latino Eye Study
LCD local coverage determination
LCIF Lions Club International Foundation
LHD local health department
MCBS Medicare Claims Beneficiary Survey
MCHB multicultural health broker
MEPEDS Multi-Ethnic Pediatric Eye Disease Study
MEPS Medicare Expenditure Panel Survey
NAAL National Assessment of Adult Literacy
NACCHO National Association of County and City Health Officials
NACDD National Association of Chronic Disease Directors
NAMCS National Ambulatory Medical Care Survey
NAPVI National Association for Parents of Children with Vision Impairments
NBEO National Board of Examiners in Optometry
NCD national coverage determination
NCQA National Committee for Quality Assurance
NEHEP National Eye Health Education Program
NEI National Eye Institute
NEOS New England Ophthalmological Society
NHAMC National Hospital Ambulatory Medical Care Survey
NHANES National Health and Nutrition Examination Survey
NHIS National Health Interview Survey
NHS EED National Health Service Economic Evaluation Database
NHSC National Health Service Corps
NIDDK National Institute of Diabetes and Digestive and Kidney Diseases
NIH National Institutes of Health
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×
NIOSH National Institute for Occupational Safety and Health
NQF National Quality Forum
NRT nicotine replacement therapy
OHPDP Office of Health Promotion and Disease Prevention
OSHA Occupational Safety and Health Administration
PACT Patient Aligned Care Team
PBA Prevent Blindness America
PCMH patient-centered medical home
PEP protective eyewear promotion
PHAB Public Health Accreditation Board
PHD public health department
QALY quality-adjusted life year
QOL quality of life
RCT randomized controlled trial
RLSB Royal London Society for Blind People
ROC Resuscitations Outcomes Consortium
SES socioeconomic status
TAYE Think About Your Eyes
USDA U.S. Department of Agriculture
USPSTF U.S. Preventive Services Task Force
UV ultraviolet
VA U.S. Department of Veterans Affairs
VEGF vascular endothelial growth factor
VHI Vision Health Initiative
VHIPP Vision Health Integration and Preservation Program
VISOR Vision Impairment Services in Outpatient Rehabilitation
VPUS Vision Problems in the U.S.
VSP Vision Service Plan
WHO World Health Organization
Page xvii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
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Preface

Losing one’s eyesight, at any age, is frightening. That fear has merit: compared to their peers, people with vision loss have reduced independence and quality of life, lower performance in school, lower wages and job attainment, and higher health costs. Fortunately, two of the most common causes of vision loss among adults (i.e., refractive errors and cataracts) can be readily treated with proper access to, and utilization of, currently available care. This report estimates that undiagnosed or untreated refractive error alone affects between 8.2 and 15.9 million people in the United States. Uncorrectable vision impairment affects another 6.4 million people. The toll of correctable vision loss among children who do not received adequate detection, follow-up, and treatment is troubling. Ensuring that people receive proper visual acuity screenings and preventive eye care services and adhere to effective eye protection practices would eliminate thousands of preventable or correctable cases of vision impairment that result each year from amblyopia and eye injuries. Success in simply applying current knowledge would reduce significant health care disparities, because avoidable vision loss disproportionately affects minorities and the poor. Failure of the United States to address these sources of preventable suffering and disparity is simply not acceptable.

But the population health imperative for eye health does not end with eliminating avoidable vision loss. Even if all vision impairment due to refractive errors, cataracts, or avoidable conditions vanished, millions of people would still be visually impaired. Although recent advances in eye care are impressive and have reduced the vision loss that results from genetic conditions and common, age-related eye diseases (e.g., age-related

Page xviii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
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macular degeneration, glaucoma, diabetic retinopathy), there remains no cure. Due to the aging of our population and the strongly age-related incidence of many eye diseases, we project a near doubling, by 2050, in the prevalence of “chronic vision impairment.” The good news for people living with vision impairment and blindness is that vision impairment is a surmountable obstacle. With proper training, equipment, and accommodations, people with vision impairment can lead independent, productive, joyful lives. The problem is that many individuals today do not receive the full complement of resources they need to overcome vision-related disability.

An important and immediate population health need is to bolster our ability as a nation to manage the rising challenge of chronic vision impairment. Despite enormous potential costs for individuals, caregivers, and society, chronic vision impairment receives little emphasis in most national and public health agendas focused on chronic conditions. Chronic vision impairment frequently co-occurs with, and may be a risk factor for, many comorbid conditions including other sensory impairments, depression, anxiety, and cognitive impairment. Comorbidities add to the challenge of living with and accommodating vision loss, and in turn, vision impairment complicates one’s ability to manage other health conditions. Due to its prevalence and potential interference with other health domains, chronic vision impairment must not only receive greater attention as a chronic condition in its own right, but also be a part of all dialogues and action plans geared toward maximizing health and well-being in an aging society.

The primary goal of this Committee was to outline population health strategies to promote eye health and reduce vision impairment and its consequences in the United States. The ultimate objective is straight-forward: (1) no person should live with vision impairment that could have been avoided or could be treated and (2) every person with chronic vision impairment should have access to community and health services that minimize the impact of vision loss on overall health and life. Making this objective a reality will be complicated. It will require action from national, state, and local stakeholders. It will require practical changes to policies and systems as well as cultural changes that involve shifts in paradigms and ways of thinking.

This report represents the collective conclusions and recommendations of a diverse group of experts, each of whom brought their expertise and perspectives. The Committee recognizes and salutes the many devoted people across the nation already working tirelessly to promote eye and vision health and lessen the burden of vision impairment. This report emphasizes the need to address the underlying social and environmental conditions that contribute to unacceptable health disparities as well as to make quality clinical eye care and support services available to everyone. To accomplish this will take the concerted action of eye professionals, payers,

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
×

clinical care systems, public health, and community organizations. We can eliminate preventable vision loss and ensure that each person with chronic vision impairment has every opportunity to live a full and productive life. We need to do so.

Steven M. Teutsch, Chair

Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2016. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press. doi: 10.17226/23471.
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The ability to see deeply affects how human beings perceive and interpret the world around them. For most people, eyesight is part of everyday communication, social activities, educational and professional pursuits, the care of others, and the maintenance of personal health, independence, and mobility. Functioning eyes and vision system can reduce an adult’s risk of chronic health conditions, death, falls and injuries, social isolation, depression, and other psychological problems. In children, properly maintained eye and vision health contributes to a child’s social development, academic achievement, and better health across the lifespan.

The public generally recognizes its reliance on sight and fears its loss, but emphasis on eye and vision health, in general, has not been integrated into daily life to the same extent as other health promotion activities, such as teeth brushing; hand washing; physical and mental exercise; and various injury prevention behaviors. A larger population health approach is needed to engage a wide range of stakeholders in coordinated efforts that can sustain the scope of behavior change. The shaping of socioeconomic environments can eventually lead to new social norms that promote eye and vision health.

Making Eye Health a Population Health Imperative: Vision for Tomorrow proposes a new population-centered 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. Building on the momentum of previous public health efforts, this report also introduces 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 cohesive areas for action at federal, state, and local levels.

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