Eye care providers are well aware of the importance of eye and vision health across our patients’ life spans, yet eye diseases do not even appear among the 20 chronic disease priorities listed as by the Department of Health and Human Services. Patients have shared stories about their fears of losing vision and the sincere expression of hope for continued enjoyment of good vision throughout their lives, as evidenced by 87.5% of respondents to a recent survey, who associated good visual health with a high quality of life. Yet too often, we have witnessed the long-term consequences when patients enter our offices far too late to avoid severe vision impairment. Seeing individuals at risk earlier in their disease process provides a greater opportunity to intervene soon enough before permanent damage occurs. With an emphasis on population health and prevention, the Medicare Access and CHIP Reauthorization Act (MACRA) provides a fertile environment to enhance eye health across the nation. Thus, now more than ever, it is important for the eye care community to actively engage non-eye and vision care specialists, including other physicians, public health professionals, scientists, teachers, government agencies, employees, and business people not only in health care system improvement but also in efforts to mainstream eye and vision health with population health strategies.
There have been positive and negative trends that have occurred in the last several decades. Rapid advances in ophthalmic technology, diagnostics, and therapeutics have dramatically improved clinical management. At the same time, we have also witnessed growing isolation of eye and vision health from medicine and other surgical disciplines and the exclusion of chronic vision impairment from larger efforts to promote patient health and wellbeing and drive national health policy. This omission affects public health agenda priorities, reimbursement policies, and federal health policies, to the detriment of patients.
In September 2016 the National Academies of Sciences, Engineering, and Medicine published the report “Making Eye Health a Population Health Imperative: Vision for Tomorrow,” which identified eye and vision health as an important measure of, and contributor to, healthy populations. The Academies, which now include the programmatic arm of the former Institute of Medicine, are independent scientific organizations that serve as scientific advisors on critical societal issues, including health and medicine. Previous reports such as “Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care” and “To Err is Human: Building a Safer Health System” have catalyzed important advances in quality of care, patient safety, and health equity in health care systems across this country.
In its current report the committee recommended public health approaches to reduce vision impairment and promote eye health in the United States. Committee membership included individuals with expertise in ophthalmology, optometry, epidemiology, public health, geriatrics, internal medicine, economics, research, and personal experience with vision loss. The report is a comprehensive review of the available literature, including epidemiology, prevention, disparities, workforce projections, access to and quality of care, and integration of eye health into broader public health strategies.
The recommendations of this consensus document provide a blueprint for addressing the social and environmental determinants of health, including the provision of eye care services that can advance eye and vision health and reduce inequities in health outcomes, particularly among vulnerable populations. The report’s 9 recommendations seek to address a number of current gaps and challenge key stakeholders to (1) galvanize the nation to reduce the burden of vision impairment in the United States; (2) establish a public awareness campaign to encourage eye and vision health; (3) create a surveillance system; (4) develop a common research agenda focused on the leading causes of vision impairment; (5) generate a unified set of evidence-based clinical and rehabilitation guidelines; (6) promote a diverse workforce that delivers culturally proficient, patient-centered care; (7) enhance public health and health care system partnerships to integrate eye and vision health into current programs and policies; (8) provide grant support to expand state and local public health capacities around eye and vision health; and (9) engage communities in translating a broad national agenda for eye and vision health into well-defined actions that reflect local needs, cultures, and values. The full report also provides many useful examples and arguments to help achieve conditions where people have the fullest capacity to see and ability to achieve their full potential. The question remains whether or not this comprehensive review of eye and vision health will make a difference in the current fragmented marketplace.
The authors of this editorial believe that a major cultural shift is required to inculcate eye health into population and community health. The eye community can take important actions to help make eye and vision health a societal priority, particularly at a time when population health constitutes the new currency for judging the effectiveness of care delivery. First, we can work together to coordinate our care with other providers. Our patients, particularly those who are elderly, are often faced with the prospect of managing several conditions. We can proactively address the effect of chronic vision impairment on the management of other illnesses and conditions and work more effectively as a team with relevant providers. Second, we can educate non–eye care providers, particularly those providers who are at the forefront of primary care, and lay people about eye and vision health. In some cases, these partnerships may include new entities. For example, we can partner with local public health departments to provide the necessary expertise and advocate for necessary resources and policies at federal, state, and local levels to support eye and vision health as a programmatic emphasis. Third, the eye care community can work together to produce a single set of evidence-based clinical and rehabilitation guidelines to provide consistent messaging about eye and vision care used by all who provide eye care. Fourth, we can collaborate with other medical professionals and public health practitioners to improve surveillance and research by participating in any eye and vision health surveillance system, as well as incorporating eye and vision health measures into existing clinical and public health data collection platforms. And finally, we can advocate for our patients not only as clinicians but also as partners with those outside of the eye care community to create a true population health focus on eye and vision health in this country. The Academies’ report is a perfect opportunity to seize the day and create a system of vision health for everyone.