Public Health and the EyeHigh-Risk Populations for Vision Loss and Eye Care Underutilization: A Review of the Literature and Ideas on Moving Forward
Section snippets
High-Risk Populations for Vision Loss
Defining high-risk populations for vision loss is no simple task. There is a wide range of eye diseases and conditions that lead to vision loss or blindness. So although there is some overlap in defining those at high risk for eye disease and resulting vision loss, each disease has its own specific set of risk factors. The major causes of vision loss in the United States include diabetic retinopathy, cataracts, glaucoma, age-related macular degeneration, and refractive error, as summarized in
High-risk Populations for Underutilization of Eye Care
With an aging population, understanding the issues surrounding access to and utilization of eye care services becomes increasingly important. Services are utilized less often in certain populations, and the definition of high-risk for underutilization varies with different studies in different locations. The American Academy of Ophthalmology offers guidelines for frequency of eye examinations according to age and risk factors.A Eye examinations are recommended for all persons aged 65 and older
Barriers to Care: Perceptions and Expectations
Along with the study of why health disparities exist and how to eliminate them has come the development and integration of several theories and models of human behavior. Two in particular, the Health Belief Model and the Social Learning/Social Cognitive Theory, are quite relevant to understanding the barriers to care. They both highlight the role of perceived outcomes of behavior and the influence of those perceptions of control over the behavior.15, 73, D These models have been applied to a
Moving Forward to Increasing Eye Care Utilization
We conclude that, even though defining groups at high risk for vision loss varies with eye disease or condition, minorities, people of low SES, and the elderly appear to be at greatest risk for vision loss. Despite their increased risk, members of minority groups, those of low SES, and the uninsured do not use or receive adequate eye care. Patients have expectations that, if unmet, may influence utilization, and patients' perceived barriers and attitudes toward eye care differ significantly
Conclusion
Much work has been done to identify high-risk populations in eye care. Utilization of eye care services differs among age groups, sexes, races/ethnicities, and socioeconomic levels. Several groups have even determined perceived barriers to care by directly asking patients themselves. There is still more information needed, however. A next step in reducing disparities in eye care is to seek the input of high-risk individuals on ways to improve their care. Understanding more about why they
Method of Literature Search
We performed a systematic review of the existing literature to answer the following questions:
- 1.
What defines “high risk” for vision loss in eye care?
- 2.
Who is at “high risk” for not using eye care?
- 3.
What are some of the barriers that hinder certain groups from obtaining proper eye care?
An initial Medline search was performed on September 3, 2007, and again on April 18, 2010, surveying literature published in English from 1966 to 2010, using combinations of relevant key words. The initial Medline
Disclosure
The authors reported no proprietary or commercial interest in any product mentioned or concept discussed in this article.
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2023, Ocular SurfaceCitation Excerpt :The need for further population-based interventions, however, is emphasized by recent evidence that suggests that visual impairment resulting from corneal infections remains heavily concentrated among the lowest socioeconomic classes, women, and the elderly [29,141,142]. While health disparities in the care of corneal infections have not been well-studied in higher income countries, it is not unreasonable to suggest that BK patients in MHICs are also affected by the patterns of unequal treatment access and delayed referrals that have been increasingly observed in ophthalmology [143–146]. Moreover, the preventable nature of most BK cases suggests that targeted health literacy campaigns – for instance those that promote meticulous contact lens hygiene [147,148] and safety glasses for injury-prone occupations [128,149,150] – have the potential to improve public health and reduce the overall burden of disease.
Improving Access to Eye Care: A Systematic Review of the Literature
2022, OphthalmologyCitation Excerpt :In addition, another study identified psychological and behavioral characteristics that influence how retinal screening occurs in young adults with diabetes, suggesting that personalized resources and greater understanding among health care professionals of the social issues that affect the likelihood of participating in retinal screenings may be impactful for their vision care.48 As with other ocular health disorders, expanded insurance coverage for diabetes would mitigate barriers to quality eye care currently faced by patients with this disease.49–55 A review by Saydah et al56 stated that more than 8 million adults with refractive errors that could be corrected could not afford to purchase the glasses that would improve their vision.
Disparities in Vision Health and Eye Care
2022, OphthalmologyCitation Excerpt :In addition to a diagnosis of type 1 or type 2 diabetes, there are several other diabetes-related risk factors for DR: higher hemoglobin A1c, insulin use, duration of disease, hypertension, and elevated blood glucose.176–178 Compared with White Americans, Black and Hispanic Americans tend to have a higher and more severe disease burden but lower rates of recommended screening and eye examinations.175,176,179,180 Moreover, despite advances in therapy, Black and Hispanic patients have more severe DR at the time treatment is initiated with anti-VEGF intravitreal injections.181