Making Eye Health a Population Imperative: Putting Plans into Action

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Last September 15th, the National Academies of Science, Engineering, and Medicine released a 450 page report “Making Eye Health a Population Imperative: A Vision for Tomorrow.”1 The report was developed by a multidisciplinary committee (the Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health) charged with examining “the core principles and public health strategies to reduce visual impairment and promote eye health in the United States.”1 The result of the effort is a remarkable expression of current vision care and public health research organized within a population health paradigm with recommendations for improving eye and vision health nationally.
The Committee established five core actions areas (1) facilitating public awareness, (2) generating evidence, (3) expanding access to care, (4) enhancing public health capacity, and (5) promoting community action), as a conceptual framework for the development of what became nine key recommendations. The recommendations are primarily directed at the United State Department of Health and Human Services (HHS) and the Center for Disease Control (CDC), along with state and local public health agencies, but depend upon a high level of collaboration with the eye care and public health communities. Importantly, the first recommendation looks to the US Department of Health and Human Services to issue a “Call to Action” thereby establishing eye and vision health as a national priority and which, if issued, would greatly increase the inclusion of eye and vision health in the national conversation on health policy.
The National Academies of Science, Engineering, and Medicine report concludes, (while recognizing a multitude of governmental programs that focus on vision loss), that “Despite these efforts, eye and vision health remain notably absent as a population health priority in the overarching public health and health care systems. It is also underrepresented in strategic plans that address the impact of chronic diseases and conditions within the United States.”1 In a January 2017 editorial in the American Journal of Ophthalmology, Higginbotham, Coleman and Teutsch (all members of the Committee) reinforced this noting that “we have witnessed growing isolation of eye and vision health from medicine and other surgical subspecialties and the exclusion of chronic vision impairment from larger efforts to promote patient health and well-being and drive national health policy.”2
The report’s nine recommendations have been the focus of most commentary since the release of the report.2–5 The report states that “the Committee’s recommendations are visionary and are meant to set in motion a variety of broad-based actions that can contribute to the prioritization of eye and vision health at national, state and local levels,”1 but also acknowledges that “[the report] also has drawbacks-most notably, it does not provide discrete, recommended actions for stakeholders at every level.”1 A deeper dive into the report identifies obstacles and research gaps that may be as helpful as or more helpful to organizations than the recommendations alone as they include specific actions that may be taken and suggest opportunities for collaboration. Indeed, a cursory reading of the report’s “Summary” and/or “Introduction” belies the depth and richness of this effort.
The fragmentation of the eye and vision health community and related health care delivery system is repeatedly referenced throughout the report. Issues highlighted include, but were not limited to: (1) the variety of professionals providing eye and vision care services; (2) different and conflicting evidence-based clinical care guidelines; (3) variations in state laws governing practices and professions in the medical and optometric communities; (4) barriers to care created by a bifurcation within the insurance system (vision care plans v.
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