Another day, another study that finds poverty is linked to adverse and often preventable health outcomes. This time, it’s vision loss.
Last week, the Centers for Disease Control and Prevention published new data finding that poverty is significantly correlated with severe vision loss, which is defined as being blind or having serious difficulties seeing even with glasses. In examining data from the American Community Survey, researchers found that among counties in the top quartile for severe vision loss, more than 55 percent were also in the top quartile for poverty. The South is home to more than three-quarters — 77.3 percent — of U.S. counties in the top quartile for severe vision loss prevalence, followed by the West, the Midwest and the Northeast. More than 83 percent of the 437 counties in the top quartiles for both poverty and severe vision loss were located in the South as well. In CDC’s Morbidity and Mortality Weekly Report (MMWR), study authors Karen Kirtland, Jinan Saaddine, Linda Geiss, Ted Thompson, Mary Cotch and Paul Lee write:
Vision loss and blindness are among the top 10 disabilities in the United States, causing substantial social, economic, and psychological effects, including increased morbidity, increased mortality, and decreased quality of life. …A better understanding of the underlying barriers and facilitators of access and use of eye care services at the local level is needed to enable the development of more effective interventions and policies, and to help planners and practitioners serve the growing population with and at risk for vision loss more efficiently.
The study notes that about 4 million people ages 40 and older in the U.S. are blind or have vision loss, and the data suggests this number will climb to 10 million by 2050. According to Prevent Blindness America, the economic toll of vision loss and eye disorders was $139 billion in 2013, making them among the nation’s costliest health conditions. Unfortunately, the Affordable Care Act only requires that insurers participating in the new marketplace cover pediatric vision care — adult vision coverage is optional (consumers can purchase a stand-alone vision plan, but such plans don't qualify for subsidies, putting them out of reach for many Americans). Medicare only covers comprehensive dilated eye exams for people with diabetes and those at high risk of glaucoma.
The MMWR study examined Census data from 2009–2013 to calculate county-level estimates of severe vision loss and poverty among adults ages 18 years old and older. The authors noted that flushing out this data at the county level, as opposed to depending on existing state- and national-level data, can be extremely helpful, as related policies and interventions are often developed and put into action at the community level. Among the more than 3,100 counties studied, researchers found that eight states had at least 6 percent of their counties in the top quartiles for both severe vision loss and poverty — those states were Alabama, Arkansas, Georgia, Kentucky, Mississippi, North Carolina, Tennessee and Texas.
Overall, researchers found “distinct geographic patterns” to severe vision loss, with the South home to a disproportionately high prevalence of people living with serious vision problems. County-level prevalence of severe vision loss varied across U.S. counties, ranging from less than 1 percent to 18.4 percent. None of the counties in the top quartile for both severe vision loss and poverty were located in the Northeast.
While the researchers noted that their study has some limitations, such as being based on self-reported data, their results do line up with previous studies on the associations between vision loss and poverty. For example, a 2013 study published in JAMA Ophthalmology found that the use of eye care services “decreased progressively” as socioeconomic disadvantage went up. In that study, researchers noted that among Americans who reported limiting their medical care visits during the recent recession, eye care was one of the most commonly skipped services. The JAMA study stated that access to regular eye care is needed to reduce the burden of vision loss among patients with age-related eye disease; however, people living in low-income households face real barriers, such as an inability to pay, high insurance deductibles and limited access to eye doctors.
Of course, widening access to affordable preventive vision care services would be an ideal way to narrow the eye health gap. But public health workers have a role in preventing and lessening vision loss as well. The MMWR study recommends that officials in counties with high rates of severe vision loss offer education on behaviors that support optimal eye health, such as maintaining a healthy weight, not smoking, using proper eye safety precautions and learning about one’s family eye health history.
The MMWR study states: “Further investigations are needed to better understand the sociodemographic disparities of vision loss, how to minimize risk factors associated with vision loss, and how to improve access and use of eye care services.”
To read a full copy of the study, visit MMWR.
The above video courtesy Prevent Blindness America.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
Fantastic article that highlights an area that I agree is not getting any where near its due attention.
This is a subject that is near and dear to me as I am a pediatric optometrist who practices in a medicaid clinic.
I would like to add that not only is having reduced vision a harbinger of bad economic outcomes, the prison population has an extremely disparate percentage who suffer from reduced vision. Of course, this makes perfect sense. If the child can't see, they can't learn. If they can't learn, employment opportunities are sparse, to say the least. This drives many to engage in criminal behavior to errantly try and get ahead.
In addition to the excellent points in this article, here are some other issues that I see from where I'm at.
1) Medicaid reimburements are poor, leading to few docs accepting them.
At my clinic, we make it work by having an efficient, high volume model. I have tech's and scribes and in a given day, I see 30 patients, sometimes as high as 40. We also have our own central lab that fills the orders for spectacles. Without capturing money on the back end through spectacle sales, we would not be able to make this model work.
The enterprise I work for is only a few years old and has met a huge need for this population. There is still a need for more clinics specializing in meeting the needs of this population
Thankfully, medicaid payments have been improving as of late, but there are may states where the model employed by my company would not work. In Washington state and Idaho, for example, the state runs/contracts their own eyeglass lab. Which means that doctors can't collect the extra compensation. Sure, it drives the cost down for medicaid as they are the ones profiting off of the eyeglass sales . . . but it comes at the price of accessibility as no OD's want to take on medicaid as it generally ends up being a write off.
2) Educating the public on the importance of early eye exams: as a minimum, every child should be seen at 8 months, 2 years and prior to starting school. There are many conditions that do not present with any obvious signs/symptoms for the parents to observe. Kids are very good at adapting to visual difficulty, and further, since they have no frame of reference for what proper vision is, if you ask them how their vision is, they will answer 'fine' even if they are seeing extremely poorly.
The earlier eye problems are found, the easier they are to treat. For conditions such as amblyopia, even delaying treatment until age 8 tends to have a far worse prognosis than when it is caught in a 2 year old.
3) Another difficulty is parental involvement. For amblyopia, no matter how much I stress the importance of full time wear of the glasses, using patching and other therapies, quite often we see the kid the next year . . . and his glasses got lost/broke 11 months ago and now the kid is even MORE amblyopic.
Some parents just don't know better, and sadly, some just don't care, period.
Some who care simply have such poor control over their children that they dont' listen and refuse to wear their glasses.
Just a few weeks back we had a 12 year old boy who had just a monster prescription, about +6.00 - 8.00 x 180 in each eye. He had resolutely refused to wear his glasses since he was a toddler. As a result, his visual cortex never developed properly and he is extremely amblyopia, with a best corrected acuity of about 20/80 in each eye. Being age 12, his neural plasticity is now concrete and that is the best he will ever be able to see.
He will likely never be able to drive (legally). He could barely read. On the flip side, since he sees better than 20/125 he does not qualify as blind so there is likely little to no public assistance/disability.
All this was determined by his poor choices as a small child. Unfair for sure, but that is the way biology and real life tend to be. It is brutal in that it doesn't care if this child is going to suffer for the rest of his life due to decisions made as an elementary student.
His future looks bleak, sadly.
The bottom line is that the public needs to know and understand that our brain is not born with the ability to use our eyes. It is learned just as we learn to use our legs and walk.
If anything gets in the way, lifelong impediments can develop by age 12...
Most insurance policies do not cover vision at all, unless you have an accident or need surgery. Just going to get an eye exam is at least $50 even at Walmart and glasses can run into several hundred dollars (gouged since only one company owns the framing services). Insurances cover hearing loss and hearing aids but not vision loss and glasses. Any insurance you can get is a rip off.