Out of sight, out of mind: 61 million Americans are at risk for serious eye trouble and they don't even know it
All indications are that one of the serious and worsening health problems of our day and the days to come is out of sight and out of mind: preventable blindness.
According to national statistics compiled by the Center for Disease Control and Prevention (CDC) in its Vision Health Initiative (VHI), an estimated 61 million Americans are considered at "high risk for serious vision loss" and that half of these Americans have not visited an eye doctor in the past 12 months.
Not visiting the eye doctor is particularly problematic when one considers another estimate by the CDC: "[H]alf of visual impairment and blindness can be prevented through early diagnosis and timely treatment."
What's more, according to the peer-reviewed medical journal JAMA, the number of people with blindness and visual impairment (VI) is as of now projected to double by 2050.
In 2015, a total of 1.02 million people were blind, and approximately 3.22 million people in the United States had VI (best-corrected visual acuity in the better-seeing eye), whereas up to 8.2 million people had VI due to uncorrected refractive error. By 2050, the numbers of these conditions are projected to double to approximately 2.01 million people with blindness, 6.95 million people with VI, and 16.4 million with VI due to uncorrected refractive error.
The groups affected in the greatest numbers in 2015 were non-Hispanic whites, women and older adults, while visual impairment and blindness is most prevalent among African-Americans.
Here prevalence is used in a medical sense — "The proportion of individuals in a population having a disease or characteristic. Prevalence is a statistical concept referring to the number of cases of a disease that are present in a particular population at a given time, whereas incidence refers to the number of new cases that develop in a given period of time."
JAMA concurred with the CDC that the data suggests "vision screening for refractive error and early eye disease may reduce or prevent a high proportion of individuals from experiencing unnecessary vision loss and blindness, decrease associated costs to the US economy for medical services and lost productivity, and contribute to better quality of life."
So, what is being done to address this issue as eye problems stack up against the eye care industry's ability to treat?
In Sept. 2016, the National Academies of Sciences, Engineering, and Medicine (NASEM), with the CDC as a sponsor, released a report as a call-to-action on this issue, in the hopes that preventable blindness will be conquered by the year 2030.
"Avoidable vision impairment occurs too frequently in the United States and is the logical result of a series of outdated assumptions, missed opportunities, and manifold shortfalls in public health policy and health care delivery," the report reads. "The long-term goal of a population health approach for eye and vision health should be to transform vision impairment from a common to a rare condition, reducing associated health inequities."
NASEM listed awareness, expanded capacity for and access to care, and community action as critical for this endeavor.
Dr. Elizabeth Yeu, an ophthalmologist and cornea specialist based in Norfolk, Va., is considered one of the leading eye specialists in the United States.
She reiterated to Rare the urgency of the plight of some 61 million Americans considered at "high risk" of vision loss.
"At this point in time there are 61 million Americans who are at high risk for severe vision loss because of diabetes, macular degeneration, glaucoma, certain diseases that are inherent that can be related to the body, but others that are very specific to the eye," she said. "Only half of those Americans actually sought out an eye exam last year."
"Most Americans, we just don't realize how delicate eyesight is. The problem is some of these diseases that we already discussed, vision loss is a late manifestation. It's a late finding, which is already an advanced disease state," she said. "You don't have a sign like redness or pain in these diseases that we're talking about."
Dr. Yeu recommended getting annual comprehensive eye exams.
"Be proactive. Get that annual comprehensive eye exam because the earlier the treatment, the better the chances are that you're going to be able to save your sight," she said.
Dr. Yeu provided an example of 'the earlier the better treatment,' telling the story of examining a patient in his sixties with a history of boxing in his younger days.
"My aha moment of what can happen when an asymptomatic disease can be too late and the detriment has occurred, a gentleman who was 62 came to me with a loss of vision, one eye worse than the other," she said. "We do our testing and it comes to show that he was a boxer and boxed for a very long time earlier in life."
"He never really had any eye problems except for repeated blunt force trauma that had occurred," she said. "Long story short, one eye was already completely end stage glaucoma. There was no chance for the vision. The other eye was in the advanced stages, but there was at least some vision left."
"Had he sought out and recognized that blunt force trauma to the eye repeatedly can increase your incidence of glaucoma then this could have been prevented," she said. "Although we deal with so many things that cause redness, pain and some of the more obvious symptoms of an acute situation, there are those chronic things that can be very silent."
Allergan Eye Care Senior Vice President Herm Cukier told Rare that his company was pleased to announce the See America℠ initiative working with eye care professionals like Dr. Yeu in a coordinated response to the NASEM report's call-to-action.
Cukier said that Allergan's grappling with the crisis is not about business but an embrace of responsibility.
"As leaders in the field we have a broader responsibility than the technological innovations we bring to market. What we really want to do is partner with experts like Dr. Yeu and others, stakeholders on a policy level — federal, state and local level — to raise the awareness," he said. "This is isn't about a product, this isn't about business. This is really about recognizing as leaders that we have a responsibility to play this critical role."
"The reality is that this [crisis] doesn't have to happen. What really needs to happen is people need to become aware, need to become engaged and they need to take action," he said.
Cukier said that the See America℠ initiative is a three-pronged approach that reflects NASEM's recommendations: awareness, access and advancement in the realm of research and development.
He said that an influencer strategy involving healthcare professionals, athletes, musicians and the fashion world will be critical to spark a social conversation.
"This is about raising the awareness, about creating the spark to get people to recognize that there is a need for themselves and for their families and for their communities. That the technology and the access is there," he said. "We're going to be using influencers in sport, in music, in fashion — we're creating a social conversation really getting into people's lives and cultures in a way that hasn't quite been done before."
Allergan officially announced the launch of the campaign in a press release Tuesday.
"Allergan plc (NYSE: AGN), a global leader in eye care for nearly 70 years, announces a bold commitment to fight preventable blindness in the United States with a new initiative—See America," the release read. "Through See America, Allergan sets out to make vision health a priority for all Americans, increase awareness of the diseases that can cause preventable blindness and, critically, help improve access to vision care for those who need it most."
"Vision loss from diseases such as glaucoma and diabetic retinopathy is affecting and destroying the lives of too many—with cases of preventable blindness increasing at such a frightening rate," Herm Cukier said. "We are launching See America to stress the importance of eye health. The time to act is now."
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