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Physicians should assist in raising awareness of glaucoma, funding
As the number of patients increases and research funding declines, physicians must highlight the importance of glaucoma issues.
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With the number of glaucoma cases projected to rise significantly as the population ages, physicians should be aware of the financial aspects of treating and researching the disease, experts say. They will also need to heighten public awareness of glaucoma.
“There’s a huge population of individuals who have vision loss from glaucoma, and further vision loss could be prevented if they were treated, but they can’t be treated because they’re unaware that they even have the disease,” Anne L. Coleman, MD, PhD, said. “In improving public awareness about glaucoma, we hope that will also help with public funding for research.”
 Robert N. Weinreb, MD, left, with James F. Jorkasky and Anne L. Coleman, MD, PhD, at ASCRS. Image: NAEVR | ||
Dr. Coleman, an OSN Glaucoma Section Member, said that an estimated 50% or more of people in the United States with glaucoma are undiagnosed. In the Latino community, that rate is even higher, at an estimated 75% undiagnosed.
Those rates could rise: Researchers estimate that the number of Americans with blindness, low vision or an age-related eye disease will grow by nearly one-third by 2020, to about 50 million people. Of those, an estimated 3.6 million could have open-angle glaucoma.
Such an increase will necessitate a campaign of increased awareness about glaucoma to the general public, especially to those groups at highest risk of progressive glaucoma, Dr. Coleman said in a telephone interview with OSN. In light of a 2005 ruling by the U.S. Preventive Services Task Force that found insufficient evidence to recommend glaucoma screening, physicians will need to be the driving force behind providing affordable screenings, she said.
Another need as the number of glaucoma cases increases will be further research into the cause and cure of the disease, according to James F. Jorkasky, executive director of the National Alliance for Eye and Vision Research and Alliance for Eye and Vision Research (NAEVR/AEVR), nonprofit advocacy and education coalitions, respectively. Mr. Jorkasky said the last 5 years of flat government funding for the National Institutes of Health and the National Eye Institute has resulted in a decline in grants and an inability for follow-up work on landmark clinical studies and projects.
Without an increase of 6.6% in the 2009 federal budget, the NEI will be unable to meet the current biomedical inflation rate of 3.5% and have funding to pursue promising new research based on past breakthroughs, Mr. Jorkasky said in a telephone interview.
Physicians will also need to be aware of the financial reimbursement side of their practices and its impact on the care administered, according to Bradford J. Shingleton, MD. At Glaucoma Day, held before the American Society of Cataract and Refractive Surgery meeting, Dr. Shingleton said physicians can assess treatment costs in their own practices by analyzing spending practices vs. the average cost of care per glaucoma patient.
Raising physician awareness
Physicians have already begun to address the increasing need for glaucoma awareness and care, Dr. Coleman said. They have been holding free glaucoma screenings, advising patients to have at-risk family members screened and writing e-mails to their congressional representatives to highlight the importance of glaucoma research, among other activities.
They should continue such work, Dr. Coleman said. She recommended that physicians share their knowledge and ideas for outreach work with the entire ophthalmic community so that everyone can benefit. Glaucoma specialists should become “public health ambassadors” for the disease, addressing all aspects of treatment and funding, including helping to find a solution to treating the uninsured.
“Physicians really do have a personal responsibility to society to help decrease the burden of blinding eye diseases,” Dr. Coleman said. “Not only do they do it when they’re seeing patients, but they also need to start educating government and other individuals with whom they come in contact to help society.”
Dr. Shingleton, an OSN Glaucoma Section Member and president of the ASCRS, said that practice patterns can assist physicians in assessing financial reimbursement issues. Future Medicare fee schedules could be adversely affected by government budget cuts, while the number of uninsured patients continues to rise.
Proper coding and documentation of patient treatment is critical to reimbursement, Dr. Shingleton said.
“Practice planning is critical,” he said. “The burden is on us, unfortunately, to process more patients. That’s what it boils down to. So you need to figure out how best to do that.”
Dr. Shingleton said physicians must be efficient with both time and personnel when assigning tasks in all aspects of patient care.
Raising public, government awareness
The glaucoma community has been rallying around public awareness and researching issues, including hosting events such as Glaucoma Advocacy Day and supporting passage of a World Glaucoma Day resolution in the U.S. House of Representatives, Dr. Coleman said.
On March 6, about 60 ophthalmologists met with their respective congressional representatives and senators in Washington, D.C., before the American Glaucoma Society meeting there. As part of the first Glaucoma Advocacy Day, they discussed funding issues and the need for more awareness of the disease to reduce the number of undiagnosed cases. To underscore the importance of screening, AGS members also screened about 85 House staff members for glaucoma.
“The AGS members were on the Hill at a really pivotal point, as the House and Senate were taking action on the respective budget resolutions,” Mr. Jorkasky said.
He added that in the last five federal funding cycles, the NEI purchasing power has been reduced by 18% due to flat funding and biomedical inflation. The continued low funding has caused the average payment level for a grant to increase only marginally from the current $360,000.
One week after Advocacy Day, the House and Senate passed a $3 trillion budget resolution that included $2.1 billion in NIH funding for 2009. That nonbinding amendment acts as a guideline for spending bills to be created later, according to Mr. Jorkasky.
Advocacy group raises awareness for vision research funding The National Alliance for Eye and Vision Research is a coalition of 55 professional, consumer and industry organizations involved in eye and vision research. It was founded in 1997 as an advocacy coalition affiliated with the nonprofit educational foundation Alliance for Eye and Vision Research, and it has helped educate Congress, the media and the public about treatable blindness and other ophthalmic issues.
Both groups have strong ties to the academic ophthalmic community, as they were founded by the American Academy of Ophthalmology, the Association for Research in Vision and Ophthalmology and the Association of University Professors of Ophthalmology.
This year, AEVR is celebrating 15 years of serving the vision research community. Since NAEVR was founded, its mission has expanded from advocating with Congress to support increased National Institutes of Health and National Eye Institute funding to assisting the NEI in organizing endpoint meetings and discussing therapies with the U.S. Food and Drug Administration.
Stephen J. Ryan, MD, NAEVR/AEVR board president, has been with the coalitions since their inception and is pleased with the progress.
“NAEVR/AEVR have taken on a much broader portfolio of issues that enhance the initial role as ‘friends of the NEI’ and which demonstrate value to the vision research community,” Dr. Ryan said. “These include overall NIH management and budget issues as they relate to NEI, and NEI collaborations within NIH, with other department of Health and Human Services agencies and with private funding foundations. … Regarding HHS collaborations, I am most proud of NAEVR’s work with ARVO in facilitating public meetings for NEI to discuss with the FDA the impact of research results on the clinical trial and product approval process.”
Dr. Ryan credited James F. Jorkasky, executive director of NAEVR/AEVR, with increasing the coalitions’ influence and exposure in Washington.
In a telephone interview, Anne L. Coleman, MD, PhD, also said that Mr. Jorkasky has been instrumental in keeping the groups’ ocular concerns in the minds of federal policymakers.
“It’s very easy for vision and eye diseases to be placed on the back burner when people are talking about mortality,” Dr. Coleman said. “They focus more on cancer and AIDS but forget the importance of vision. … He does a great job in keeping vision in the foreground.”
To learn more about NAEVR/AEVR, visit www.eyeresearch.org.
For more information:
- Anne L. Coleman, MD, PhD, can be reached at UCLA, 100 Stein Plaza 2-118, Los Angeles, CA 90095-7004; 310-825-5298; fax: 310-206-7773; e-mail: colemana@ucla.edu.
- James F. Jorkasky can be reached at the National Alliance for Eye and Vision Research/Alliance for Eye and Vision Research, 12300 Twinbrook Parkway, Suite 250, Rockville, MD 20852-1606; 240-221-2905; fax: 240-221-0370; e-mail: jamesj@eyeresearch.org.
- Bradford J. Shingleton, MD, can be reached at Ophthalmic Consultants of Boston Inc., 50 Staniford St., Suite 600, Boston, MA 02114; 617-367-4800; fax: 617-589-0552; e-mail: bjshingleton@eyeboston.com.
- Erin L. Boyle is an OSN Staff Writer who covers all aspects of ophthalmology.