Optometry doesn’t play a great enough role in the long-term management of chronic disease globally. Eyecare practitioners must do more to bring eye health into public health strategic plans and deconstruct the silo that so often surrounds eye care.
This was the message from the American Academy of Optometry 2019’s plenary session in Orlando. Guest speakers from the World Health Organization (WHO) presented major points from the recently released 2019 World Report on Vision. The report’s findings and its implications for optometry were explored by Alarcos Cieza, PhD, from the WHO Kovin Naidoo, OD, PhD, FAAO, and Sandra Block, OD, MPH, FAAO.
World Vision Report
Dr. Cieza says that the WHO recently released its 2019 World Report on Vision, a collection of research meant to share insights and strategies on the current state of optical health globally.
The report estimates that there are at least 2.2 billion people globally with a vision impairment. While optometrists are well-acquainted with the prevalence of common ocular diseases, these concerns take on a new context when viewed from a national perspective.
The WHO reports that 196 million people have age-related macular degeneration (AMD) across the world-more than half of the entire U.S. population.
“The significance of these numbers is that they proclaim the huge need for eye care around the world,” Dr. Cieza says.
An increased demand for eyecare services will force practitioners to confront current challenges related to care access, like physician shortages. These concerns are compounded by the fact that populations in lower-income areas are at higher risk for vision impairment-related problems.
To manage this, optometrists should reflect on their interventions and consider how new strategies could be applied. In particular, better service coordination will be key.
“What we see is that there is a huge amount of services provided by the private sector without any kind of coordination,” she says. “Knowledge is not shared.”
Better coordination means, in part, examining which services need to be provided and reviewing the costs of those services. This is a crucial part of providing quality eye care to patients without the burden of undue financial hardship.
There is an urgency for action because we have a window of opportunity,” she says.”
The WHO has established specific targets for achieving improved health outcomes by 2030. To accomplish these targets, the report recommends that eyecare providers take specific actions towards progress:
• Make eye care a part of universal health coverage
• Implement integrated people-centered eye care in health systems
• Promote high-quality research that tells the full story of eye care
• Monitor trends and evaluate progress
“We hope that the eyecare sector feels the same urgency for action that we at the WHO feel,” Dr. Cieza says.
Public Health eyecare in developing nations
Optometry has a growing role to play in global health, and optometrists need to shift perspectives of the global environment for optometry.
“It is not about, ‘Who are the people who need services?’ It is about who should be prioritized when resources are limited,” Dr. Naidoo says.
Proper prioritization is vital in delivering eye care to underserved populations. Across many of the world’s public healthcare systems, there is a lack of optometry relevance which makes optical care even more difficult to provide.
Some developed countries, such as the United States, are exceptions to this, but eye care is marginalized across the world.
“We are falling far behind the population growth across the world,” he says.
And while the eyecare industry has had great successes in promoting care, these accomplishments underscore how much work there is yet to do.
Globally, there is a need for a new system that can help eyecare professionals deliver the same standard of care in developing nations as they do in countries like the United States. The expertise available in the United States has the potential to provide huge public health benefits to the rest of the world-provided that eyecare professionals can export those skills in relevant and valid ways to developing nations.
“You are the central, primary eye care for individuals in your healthcare system. In our countries, it’s not the same,” Dr. Naidoo says. “Optometrists are not the first point of contact.”
This deficit of talent will be a key obstacle to overcome, but it is not the only public health challenge worth mentioning. Access to care is an ongoing goal, as well as increased collaboration among governmental entities, schools, and other institutions.
Collaboration will be instrumental in overcoming public health eyecare challenges, both today, and in the future.
Focus on North America
Eye care is becoming a focal point for public health around the globe, but industry leaders, practitioners in North America have an important role to play in making care more accessible.
“The reality is, we do need to think about where we fit in the big picture,” Dr. Block says.
The World Report on Vision details strategies for better integrating eye care into public health systems, but there are challenges to overcome. One challenge is that the North American population is aging fast and experiencing more eye concerns than previously seen.
It is important to compare the U.S. to other countries. For example, Canada’s healthcare delivery model.
“The fact is, we in the United States have a significant increase in the cost of healthcare systems, and we need to do a better job,” she says.
In 2008, the United States spent 15 percent of its total gross domestic product (GDP) on health care. In 2017, it increased to 17 percent.
And while part of these costs are due to the advanced level of care offered in the U.S., the rest of it (like access to care and social determinants) can should be reviewed and reduced.
Addressing obstacles like these means considering new frameworks for healthcare delivery. Universal health care is a growing area of interest across the U.S., but improvements to systems don’t need to be drastic. ODs can improve healthcare by prioritizing vulnerable populations such as children and the elderly, for example.
“Aging combined with visual impairment, certainly, is one of our biggest challenges to address,” Dr. Block says.
Along with that, expanding services to better meet the needs of those without access to care, including those in rural communities, gains importance. These concepts will be instrumental in addressing care access gaps moving forward and providing continuous care to all patients.
“The impact of visual impairment is far greater than we had ever thought about,” Dr. Block says. “We need to do a better job in getting surveillance all the way through the United States and ensuring both optometry and ophthalmology are contributing to the data that is out there.”