High-Risk Populations for Vision Loss and Eye Care Underutilization: A Review of the Literature and Ideas on Moving Forward

doi:10.1016/j.survophthal.2012.07.005

Survey of Ophthalmology

Volume 58, Issue 4, July–August 2013, Pages 348-358

https://doi.org/10.1016/j.survophthal.2012.07.005 Get rights and content

Abstract

Much work has been done to highlight and understand the significant disparities in the use of eye care services, but they continue to exist. We review the existing literature on utilization in high-risk populations to provide a context for understanding what “high-risk” means, to understand the utilization patterns among high-risk populations, and to highlight barriers to appropriate eye care utilization. We also discuss potential approaches to reduce these disparities.

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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Public Health and the EyeHigh-Risk Populations for Vision Loss and Eye Care Underutilization: A Review of the Literature and Ideas on Moving Forward

Abstract

Section snippets

High-Risk Populations for Vision Loss

High-risk Populations for Underutilization of Eye Care

Barriers to Care: Perceptions and Expectations

Moving Forward to Increasing Eye Care Utilization

Conclusion

Method of Literature Search

Disclosure

Patient Educ Couns

Ophthalmology

Surv Ophthalmol

Pat Edu Couns

Am J Prev Med

Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Surv Ophthalmol

Ophthalmology

Ophthalmology

Ophthalmology

Ophthalmology

Med Clin N Am

Risk factors for the incidence of advanced age-related macular degeneration in the Age-Related Eye Disease Study (AREDS): AREDS Report No. 19

Ophthalmology

The Advanced Glaucoma Intervention Study (AGIS): baseline risk factors for sustained loss of visual field and visual acuity in patients with advanced glaucoma

Am J Ophthalmol

Causes and prevalence of visual impairment among adults in the United States

Arch Ophthalmol

The prevalence of age-related macular degeneration among adults in the United States

Arch Ophthalmol

The prevalence of cataract and psuedophakia/aphakia among adults in the United States

Arch Ophthalmol

The Prevalence of diabetic retinopathy among adults in the United States

Arch Ophthalmol

The prevalence of open-angle glaucoma among adults in the United States

Arch Ophthalmol

The prevalence of refractive errors among adults in the United States, Western Europe and Australia

Arch Ophthalmol

Socioeconomic disparities in health: Pathways and policies

Health Affairs

Socioeconomic status and health: What we know and what we don’t

Ann New York Acad Sci

Factors that influence the receipt of eye care

Am J Health Behav

The future (history) of socioeconomic measurement and implications for improving health outcomes among African Americans

J Gerontol

Access to vision care in an urban low-income multiethnic population

Ophthalmol Epidem

Social cognitive theory of mass communication

A long-term prospective study of risk factors for glaucomatous visual field loss in patients with ocular hypertension

J Glaucoma

Socioeconomic status in health research: one size does not fit all

JAMA

Utilization of eye care services by Victorians likely to benefit from eye care

Clin Exp Ophthalmol

Impact of telephone counseling intervention on transitions in stage of change and adherence to interval mammography screening (United States)

Cancer Causes and Control

Office visits to ophthalmologists and other physicians for eye care among the U.S. population, 1990

Pub Health Rep

Important causes of visual impairment in the world today

JAMA

Patient expectations regarding eye care: focus group results

Arch Ophthalmology

Risk factors for cortical, nuclear, and posterior subcapsular cataracts

Am J Epidemiol

Knowledge, attitudes, and beliefs about dilated eye examinations among African-Americans

Inv Ophthalmology Vis Sci

Health disparities based on socioeconomic inequities: implications for urban health care

Acad Med

Effects of patient and physician practice socioeconomic status on the health care of privately insured managed care patients

Med Care

Patterns of care for open-angle glaucoma in managed care

Arch Ophthalmol

An evidence-based assessment of risk factors for the progression of ocular hypertension and glaucoma

Am J Ophthalmol

Why genes don’t count (for racial difference in health)

Public Health and the Eye
High-Risk Populations for Vision Loss and Eye Care Underutilization: A Review of the Literature and Ideas on Moving Forward