Using Health Surveillance Data to Assess Barriers to Vision Care in the State of Ohio

In 2016, the National Academies of Science, Engineering, and Medicine (NASEM) released a report outlining the importance of vision as a public health challenge.1  The findings of this report highlighted the need for increased integration of vision into more holistic approaches to healthcare.  The authors examined core principles and public health strategies needed to reduce visual impairment and promote eye health in the United States, which they noted was under-resourced and under-appreciated.  This assessment included short- and long-term strategies that prioritized eye and vision health through collaborative actions across a variety of topics, settings, and different sectors of communities and levels of government.  At the conclusion of the report, the committee outlined several recommendations to address the gaps in knowledge, research, clinical practice, and policy as it relates to vision health and vision impairment.  These recommendations included a need to identify and eliminate barriers within healthcare and public health systems to eye care, especially comprehensive eye exams, appropriate screenings, and follow-up services, as well as items and services intended to improve the functioning of individuals with vision impairment.  The report underscored the need to encourage physicians and health professionals to ask and engage in discussions about eye and vision health as part of patients’ regular office visits.  These discussions could be particularly impactful when encouraging patients to seek eye care services, as the most common causes of irreversible vision loss are often asymptomatic in the earliest stages.  Early detection and effective management of many sight threatening conditions could result in a considerable reduction in avoidable vision loss.  The National Eye Institute, for example, notes that 95% of vision loss caused by diabetic eye disease is avoidable.2  This is a considerable public health challenge, as diabetic eye disease represents the most common cause of permanent vision loss in the working-age adult population in the United States.3

Understanding barriers to care is an important step in addressing this challenge.  In addition to more collaborative approaches to address vision health, the NASEM report noted a need to build state and local public health capacity, coordinated by the Centers for Disease Control and Prevention.  This recommendation recognized the importance of partnerships between state-based chronic disease programs and other clinical and non-clinical stakeholders.  The NASEM recommendations stressed the need to integrate eye-health outcomes, objective clinical measures, and risk/protective factors into existing clinical-health and population-health data collection forms and systems.  This includes analyzing, interpreting, and disseminating information to the public in a timely and transparent manner.  Some of the most useful data are those found in population-based epidemiologic and clinical research on the major causes and risks and protective factors for vision impairment.

As part of a pilot project funded by the Centers for Disease Control and Prevention and the National Association of Chronic Disease Directors, Ohio State University, the Ohio Department of Aging, and the Ohio Affiliate of Prevent Blindness began working on a collaborative project, using population health surveillance data to identify important barriers to vision care utilization.  The state of Ohio has been uniquely proactive when collecting vision-oriented data through population health surveys, including the Behavioral Risk Factor Surveillance System (BRFSS), which can be used to better understand vision care utilization patterns and access to insurance.  Using data collected from 2005-2011 (pre-Medicaid expansion) and comparing to data collected from 2018-2019 (post-Medicaid expansion), we found that utilization of vision care services remained relatively stable, despite the fact that the number of individuals reporting insurance coverage that included vision care services increased across all demographic categories.  The primary reason for not seeking vision care services remained consistent, with the main reason for not seeking vision care services was the perception that there was no need to do so.

Because of the asymptomatic nature of many sight-threatening diseases, increased access and utilization of vision care services has the potential to reduce preventable vision loss.  Health literacy and recognition of the importance of vision health continues to represent a considerable barrier to addressing avoidable vision loss.  Previous research suggests that primary care physicians can play an important role in facilitating discussions that result in improved utilization of vision care services.  A report by the National Eye Institute released in 2005 found that primary care physicians were more influential in recommending eye care than any other individual, including an individual’s friends and family.4  Those experiencing vision loss also experience other systemic chronic conditions at higher rates than those without vision loss.5,6,7  Our recent findings suggest that the future of vision health in the state of Ohio could truly benefit from the influence of primary care physicians in advancing health literacy in vision eye care.

Acknowledgement: This article was made possible with the support of Prevent Blindness, Ohio Affiliate.

References:

  1. 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
  2. National Institute of Diabetes and Digestive and Kidney Disease, Diabetic Eye Disease. Preventing Diabetic Problems:  https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/diabetic-eye-disease. Accessed 09/02/2021
  3. Vitale S, Cotch MF, Sperduto RD. Prevalence of visual impairment in the United States. 2006 May 10;295(18):2158-63. doi: 10.1001/jama.295.18.2158
  4. National Eye Institute & Lions Clubs International Foundation. (2007). 2005 Survey of Public Knowledge, Attitudes, and Practices Related to Eye Health and Disease. Bethesda, MD: National Eye Institute. Available at: http://www.nei.nih.gov/nehep/kap/.
  5. Crews JE, Chou CF, Sekar S, Saaddine JB. The Prevalence of Chronic Conditions and Poor Health Among People With and Without Vision Impairment, Aged ≥65 Years, 2010-2014. Am J Ophthalmol. 2017 Oct;182:18-30. doi: 10.1016/j.ajo.2017.06.038.
  6. VanNasdale DA, Jones-Jordan LA, Hurley MS, Shelton ER, Robich ML, Crews JE. Association between Vision Impairment and Physical Quality of Life Assessed Using National Surveillance Data. Optom Vis Sci. 2021 Sep 1;98(9):1063-1069. doi: 10.1097/OPX.0000000000001773
  7. Centers for Disease Control and Prevention (CDC). State Profiles on Vision and Eye Health. Available at: https://www.cdc.gov/visionhealth/data/state-profiles/index.htm. Accessed April 4, 2022.
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