Better Data Crucial to Ending Eye Health Disparities

Linda Roach

December 11, 2012

A panel of experts in ophthalmic epidemiology has recommended a coordinated national surveillance system for gathering population-based data on vision health that could explain and help reduce racial, ethnic, sociodemographic, and sex-related disparities in US eye health.

"With regard to vision health, disparities exist in the major eye diseases, but also extend greatly beyond eye function to visual impairment (function), disability, rehabilitation, and access to care, among others. The regular collection of data in a systematic fashion (ie, surveillance) is needed to characterize these health disparities better," April Zambelli-Weiner, PhD, formerly from Epidemiology International, Hunt Valley, Maryland, and other members of the panel write in their article.

These studies are crucial to designing and monitoring public health interventions to address this continuing problem, they add.

The 14-member group published its conclusions in an editorial and 7 peer-reviewed articles compiled as a special supplement to the December issue of the American Journal of Ophthalmology.

The panel, convened in 2010 by the Centers for Disease Control and Prevention (CDC), consisted of ophthalmic researchers, clinicians, and epidemiologists from the United States, Great Britain, and Canada. It has made 6 broad recommendations for how a vision surveillance system should operate, with the CDC as the coordinating agency. The recommendations range from standardizing the metrics that researchers use in population studies to using electronic health records as a new source of data.

The group also has a terse assessment of what the ultimate goal of improved surveillance should be: "We believe that, for those who have visual loss that affects function from cataracts or refractive error or other conditions that can be effectively 'cured,' there should be NO severe visual loss, eliminating any disparity in the outcomes of visual loss and blindness," the panel writes in its recommendations.

In addition, the authors suggest that future population-based studies include contrast sensitivity as a new measure of participants' visual acuity. In the last decade, small studies on the quality of vision have shown that normal aging reduces contrast sensitivity and can have a large effect on functional visual acuity, especially under mesopic conditions in the elderly. However, the prevalence of visual disability caused by this problem is unknown.

Awareness of US racial and ethnic disparities in the prevalence of eye diseases and vision impairment began rising in the 1980s with the publication of results from large population-based epidemiology projects such as the Beaver Dam Eye Study and the Baltimore Eye Survey.

The latter study reported in 1990, for instance, that the prevalence of glaucoma among black Americans was 4 to 5 times the age-adjusted prevalence in white participants. In 2006, Vitale et al used federal health survey data to estimate that 6.9% of blacks and 9.2% of Hispanics have impaired vision that could be easily remedied simply by giving them eyeglasses.

Jinan B. Saaddine, MD, MPH, a medical epidemiologist for the CDC and a coauthor of the current studies, noted that the group's 1980-2010 literature review confirmed that disparities in US visual health exist, persist, and are poorly understood.

"We need innovative interventions to reduce unnecessary vision loss, especially among disadvantaged groups," Dr. Saaddine, the team leader for the CDC's vision health initiative (part of the federal Healthy People 2020 project), told Medscape Medical News.

A unified, consistent visual health surveillance system is fundamental to reaching the initiative's goals of reducing visual impairment caused by uncorrected refractive error, diabetic retinopathy, glaucoma, cataract and age-related macular degeneration, she added.

"If you look at the federal Healthy People 2020 goals for vision health, it's clear that we need a surveillance system that can assess and monitor progress towards those goals. And currently we don't have one," Dr. Saaddine concluded.

Rohit Varma, MD, MPH, principal investigator in the Latino Eye Study, a large, ongoing Southern California study of vision health, told Medscape Medical News he agrees that there is a need for better surveillance of eye problems in the United States.

"I have a good sense of what is happening in this study's population, but there's a whole lot more that I don't know, and which a vision surveillance system would provide," said Dr. Varma, who recently became professor and chairman of ophthalmology at the Illinois Eye and Ear Infirmary in Chicago.

"I know Mexican-Americans in [Los Angeles], but I don't know what's happening in Puerto Rican– or in Cuban- or in Dominican-Americans, and so on," he said. "If you have a consistent surveillance system that assesses vision health over time, that will give us a real good handle of the trajectory of how well we're doing and where we need to invest more."

The CDC sponsored and convened the expert panel on vision surveillance, which received no outside funding. Publication was supported by the CDC Vision Health Initiative. One of the cochairs of the panel also is a consultant to Pfizer, Quorum Consulting, and Genentech. Other coauthors and panel members: are consultants to the CDC, Alcon, Bausch & Lomb, Merck, Pfizer, QLT, Epidemiology International Inc, AstraZeneca, sanofi-aventis, Takeda, Genentech, Pfizer, and CoMentis. One coauthor is a consultant to Abbott Medical Optics, has received lecture fees from Allergan, has received a grant form General Motors, and holds the patent for a method/device for early age-related macular degeneration detection. Dr. Varma is a consultant for Allergan, AqueSys, Genentech, Merck, and Replenish. He has also received grant support in the past year from Genentech, the National Eye Institute, and Replenish. Dr. Saaddine has disclosed no relevant financial relationships.

Am J Ophthalmol. 2012;154:S1-S70. Supplement