Making Eye Health a Population Imperative: A Question of Priorities

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In 2014, the prevalence of vision loss in the United States was estimated at nearly 3% with an estimated cost of $145 Billion and rising.1 While surveys of public opinion over the past 30 years have repeatedly shown that vision loss is one of the greatest concerns among the public and second only to cancer,2 eye health literacy remains low,3 and there has been little success influencing how patients, providers, and our health care institutions work together to provide and maintain eye health and vision. To move beyond where we are now, we will have to address numerous challenges, and the recent report from the National Academies of Science, Engineering, and Medicine, Making Eye Health a Population Health Imperative: Vision for Tomorrow (released on September 15, 2016), is a significant contribution toward that goal, which helps to identify and articulate the challenges that exist.4
To address these challenges will require that we also be intentional about setting priories. Health care in the USA is under intense pressure to do better—to improve access, to improve care outcomes, to reduce costs, and most importantly, to improve the health of our citizens. It is common to think of health and wellness on a continuum (Fig. 1), and currently, most of our public investments in health are directed toward one end of this spectrum—treating illness and supporting disease-focused research. Substantially less time and funding are dedicated to prevention and wellness although those investments yield measurable improvements in health. Changing that imbalance will require that we face some surprising realities and intentionally set about the long hard road of redefining our national priorities. To illustrate this point, consider the following comparison. Over the projected life of the F-35 Joint Strike Fighter program, we are expected to invest $1.5 trillion dollars in this single defense program initiative.5 In 2016, we invested $31 billion funding the National Institutes of Health.6 Funding for the F-35 program could fund all current health and science research supported by the National Institutes of Health for more than 48 years.
For generations, oral health, hearing, and vision have been separated from general health, in training, care delivery, research funding, and importantly, in healthcare reimbursement.7,8 Despite well-documented connections between systemic health, quality of life and each of these disciplines, our health care system remains fundamentally divided in ways that do not prioritize or truly support health and well-being. Most health training programs in medicine and other health professions devote relatively little time to evaluation and understanding of the eye, despite the need. This artificial and unhelpful division means that eye care, whether provided by optometrists or ophthalmologists, is generally not well connected to the rest of the health care system. This makes vision care and eye health care confusing to the public and inefficient. The National Academies of Science, Engineering, and Medicine report nicely highlights this need and offers specific opportunities to move beyond where we are today to better connect eye care and the rest of the health care system. Meaningful improvements in eye health and vision care are possible and will come when educators, providers, researchers, institutions, professional societies, and the public demand it.
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