NASEM report: Eye, vision health not recognized as population health priority

A consensus study establishes the scope of vision problems, barriers to eye health and system-wide issues.

Issue: November 2016

Nearly 16 million Americans are living with vision impairment that is undiagnosed or untreated because eye and vision health lags in priority in the U.S., according to a new report from the National Academies of Sciences, Engineering and Medicine.

The 450-page report, based on 2 years of analysis, recommends a nationwide call to action from the U.S. Department of Health and Human Services in an attempt to reduce or eliminate correctable and avoidable vision impairment by 2030, as well as delay onset and progression of unavoidable chronic eye disease, minimize the impact of chronic vision impairment, and increase eye care and vision health services in underserved populations, according to a synopsis of the report.

The report was sponsored by the American Academy of Ophthalmology, American Academy of Optometry (AAO), American Optometric Association (AOA), Association for Research in Vision and Ophthalmology, Centers for Disease Control and Prevention (CDC), National Alliance for Eye and Vision Research, National Center for Children’s Vision and Eye Health, National Eye Institute (NEI), Prevent Blindness and Research to Prevent Blindness.

“The focus of population health approaches to eye and vision health should be on creating the conditions in which people can have the fullest capacity to see and that enable individuals to achieve their full potential,” according to the Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health in a summary of the report.

“Despite evidence that vision impairment increases the risk of mortality and morbidity from other chronic conditions and related injuries and is associated with a reduced quality of life, eye and vision health are not adequately recognized as a population health priority or as a means by which to achieve better health equity,” the committee stated.

Strategies

Making Eye Health a Population Imperative: Vision for Tomorrow, outlines a public health approach made up of five foundational strategies:

Facilitate public awareness through timely access to accurate and locally relevant information;
Generate evidence to guide decisions and evidence-based actions;
Expand access to appropriate clinical care;
Enhance public health capacities to support vision-related activities; and
Promote community actions that encourage eye- and vision-healthy environments.

Specific recommendations call on the U.S. Department of Health and Human Services, CDC, local health departments and cabinet level agencies to increase and improve awareness, surveillance, research and policy development.

Sponsors weigh in

“The ... report is an expression of the vision health improvements that family eye doctors and our community partners have worked tirelessly to achieve and it shines a crucial spotlight on eye and vision health issues and the need to responsibly address them,” AOA President Andrea Thau, OD, said in a release from the AOA.

“With today’s technology and tools, along with the strongest-ever collection of doctors of optometry, we are putting these recommendations to work to deliver evidence-based care and ensure that everyone has access to in-person comprehensive eye examinations and needed clinical eye care,” Thau continued.

“We set out to design actionable, achievable recommendations that would set out a clear plan for the future of vision health,” Lori Grover, OD, PhD, said in the AOA release.

Grover is a member of the Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health and the AOA’s Evidence-Based Optometry Committee and senior vice president for health policy at King Devick Test Inc.

“The direction and recommendations, if concertedly acted upon in educational and health policy arenas and in a clinically reasonable manner, would effectuate long-term and sustainable reduction in preventable vision impairment and its impacts, improving population health outcomes,” she said.

The NEI echoed the sentiments in its own press release, commending the National Academies of Sciences, Engineering and Medicine (NASEM) and the study committee for their “thorough and thoughtful investigation and its insightful recommendations.”

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The AAO supports the report’s recommendations, “to improve collaboration, coordination and synergy across the health care spectrum to ultimately make the most impact on patient care,” according to an AAO press release.

“The report provides a comprehensive framework that should be operationalized for clinicians such that appropriate emphasis is given in broad social, economic, cultural, health and environmental conditions, and policies in the practice environment,” AAO spokesperson Anthony F. DiStefano, OD, MPH, FAAO, said in the release.

“This report is the start of an immense opportunity to bring vision care to the forefront through a coordinated population health-based philosophy,” AAO President Brett G. Bence, OD, FAAO, said in the release. “The academy looks forward to collaborating with other professional organizations and stakeholders as we are called upon to contribute in the implementation of these recommendations.”

Prevent Blindness’ efforts

Co-sponsor Prevent Blindness said in a press release: “The report strongly points to a need for future epidemiological research that better characterizes disparities in terms of prevalence, incidence and severity of disease.”

The report also notes the absence of significant funding to support this sector, highlighting the need for increased federal resources dedicated to eye health as well as the active involvement of external stakeholders, while calling out the significant role that governmental public health agencies must play in national health strategies, Prevent Blindness said.

The potential for emerging technologies were acknowledged, such as telescreening and cell phone applications, to expand the availability of vision screening, while recognizing the challenges that the technologies bring, the group continued.

The committee believes in “a common message and a set of unified, evidence-based practice guidelines in establishing a solid foundation upon which to tackle this public health challenge,” according to the Prevent Blindness release.

Through the work of Prevent Blindness’ National Center for Children’s Vision and Eye Health (NCCVEH), many of the recommendations from the NASEM report are already underway, the group said. Established in 2009 by the Maternal and Child Bureau at the Health Resources and Services Administration, the NCCVEH published peer-reviewed protocols supporting a comprehensive system of care for children’s vision.

“Together with our network of affiliates and partner organizations, we are eager to expand our own best practices and join with our colleagues in government, community and professional organizations, industry, and across all sectors to work collaboratively in advancing the impressive agenda NASEM sets before us,” Hugh R. Parry, president and CEO of Prevent Blindness said in the release. “Together we truly can put an end to preventable vision loss in the U.S.” – by Abigail Sutton

Reference:
Making Eye Health a Population Health Imperative: Vision for Tomorrow. http://nationalacademies.org/hmd/reports/2016/making-eye-health-a-population-health-imperative-vision-for-tomorrow.aspx. Posted September 15, 2016. Accessed October 18, 2016.