NASEM report points to need for a stronger national vision strategy
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Vision loss was the last thing on my mind when my twin granddaughters were born prematurely and fighting for their lives in a neonatal intensive care unit 18 years ago. Born a little past 25 weeks, the twins needed to have oxygen therapy to help their lungs develop. But the oxygen therapy carried a heavy side effect; potential retinopathy of prematurity, which is when the retina becomes scarred and in serious cases can lead to blindness.

It was a terrifying and stressful time for our family and my son-in-law’s family. Thankfully, both of the twins survived. One of my granddaughters experienced some vision loss from the experience and over the years she has had laser surgeries and wears corrective contact lenses to improve her vision. My family’s personal experience is one of the reasons I served on the Congressional Vision Caucus, which I also had the honor of co-chairing for a few years. The Congressional Vision Caucus is a bipartisan coalition that’s dedicated to raising awareness about vision loss and prevention, and advocating for policies that ensure resources are directed toward research, prevention and treatment of eye disease.

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Blindness and vision loss effects people of all ages in the U.S. and has a larger economic and quality of life impact than most people realize. The National Academies of Sciences, Engineering and Medicine (formerly known as the Institute of Medicine) estimates that 6.42 million people have uncorrectable vision impairment in the U.S. and that 142 million adults over the age of 40 experience vision problems. In 2013, a NORC at the University of Chicago study estimated that eye disorders and vision loss impose a $139 billion economic burden on the U.S. economy. Of this, $47.4 billion is a direct cost to the government and taxpayers including direct medical costs and long-term care.

Young children and their parents may not be aware of reduced vision function and so early vision screenings are important for early intervention. A child with a vision problem may have trouble reading a book or seeing the chalkboard at school. Amblyopia, also known as lazy eye, usually develops from birth to age seven and is one of the most common forms of vision impairment among children. Without early treatment, the effected eye could shut off completely leaving a child with vision in only one eye.

While some form of vision screening is required for school-age children in 40 states, only 16 states require it for preschool-aged children. Currently, there are no national standards for conducting vision screenings and data on how many children receive vision screenings is incomplete because of varying data sources. It’s also difficult to track how many children after failed screenings receive follow up diagnostic exams and eventual treatment.

Later in life, vision loss and impairment are also connected to other illnesses such as diabetes, hypertension, and heart disease. While someone with diabetes is focused on managing their disease, he or she may not be thinking about the added risk of diabetic retinopathy. Diabetic retinopathy can start off with no symptoms or only mild vision problems but can eventually cause blindness. Fortunately, it can be treated to slow or stop its progression but it takes awareness on the part of the patient to seek preventative monitoring and treatment. Along with other chronic diseases, blindness and vision impairment increases with age particularly among people older than 75. It has a heavy effect on their quality of life because it reduces their ability to read, drive a car, watch television or handle personal accounts. Studies have shown that vision loss among the elderly population is associated with chronic health conditions, falls and injuries, depression, social isolation and death.

Compounding this problem is lack of access to care and insurance issues. Many public and private health insurance policies, including Medicare, do not cover eye examinations for low-risk or asymptomatic patients, corrective lenses and visual assistive devices. This means that many people must purchase additional vision insurance, pay costs out of pocket to access care, or go without the care and interventions they need.

Released in September, the National Academies’ report on vision loss, “Making Eye Health a Population Health Imperative: Vision for Tomorrow” lays out a great roadmap for addressing correctable and avoidable vision impairment. The report recommends that the U.S. Department of Health and Human Services (HHS) and Centers for Disease Control (CDC) develop more coordinated programs with other federal agencies, professional organizations, researchers and other stakeholders to eliminate correctable and avoidable vision impairment by 2030. The CDC and HHS should convene task forces and workgroups to develop a research agenda that includes epidemiological and clinical research so that there is more information and evidence that can guide policy decisions around vision impairment. Currently, there is no single set of evidence-based clinical and rehabilitation practice guidelines that are universally used for prevention, screening, monitoring and diagnosis of eye and vision problems. Having a set of guidelines is not only important to improve treatment but to help determine payment policies, including coverage determination for corrective lenses and visual assistive devices.

The report also recommends that state and local public health departments partner with health care systems on community health needs assessments to identify barriers to vision-related services and find ways to improve access to comprehensive eye exams, screenings and follow-up services. The CDC should expand its vision grant program and Congress should provide CDC with more funding support for such initiatives, including awareness programs on eye injuries to reduce such accidents.

Our family feels blessed that my granddaughter received the treatment that she needed to maintain her vision. By improving the national framework for how we study and address vision loss issues, we can ensure that everyone in our country has access to the treatment and care they need to lead healthy and productive lives.

Philip Gingrey, MD is a former U.S. Congressman having served Georgia's 11th  congressional district from 2003 to 2015.  He is currently a Senior Adviser with the District Policy Group at Drinker Biddle & Reath LLP, whose clients include Prevent Blindness, a co-sponsor of the NASEM study referenced in the column.


The views expressed by this author are their own and are not the views of The Hill.