Preventable vision loss unacceptable, report says; AOA offers solutions

Avoidable vision impairment regrettably proves a stumbling block for many Americans, the result of an overall inattentiveness paid to eye health and vision care underscored by a new, AOA-sponsored report confirming optometry's deep-rooted concerns.

Released September 15 by the National Academies of Sciences, Engineering and Medicine (National Academies), the "Making Eye Health a Population Imperative: Vision for Tomorrow" report examines the toll of poor eye and vision health through a public health lens, inferring many approaches long-advocated by AOA and emboldening optometry's resolve for further action.

(This report) is an expression of the vision health improvements AOA and our partners in the community have worked tirelessly to accomplish.

"AOA has been one of the h2est voices advocating for better public eye health and vision care," says AOA President Andrea P. Thau, O.D. "We hope this report spurs other stakeholders to follow our lead and convinces policymakers to act and improve access to needed eye health and vision care."

Coordinated efforts are necessary to expand public health capacities and encourage sound policy decisions that will ensure no person lives with preventable or untreated vision impairment, the authors note—precisely the aim that AOA actively champions and expressed throughout this public health study. As an acknowledged leader and recognized authority for eye and vision care worldwide, AOA embraced this opportunity to once again come together with the entire eye health community to set a new vision for tomorrow's care.

"The National Academies' report is an expression of the vision health improvements that family eye doctors and our community partners have worked tirelessly to accomplish, and it shines a crucial spotlight on eye and vision health issues and the need to responsibly address them," Dr. Thau says.

"With today's technology and tools, along with the h2est-ever collection of doctors of optometry, together we can implement these recommendations with further AOA guidance to deliver quality, evidence-based care to change the face of vision health and ensure that everyone has access to in-person comprehensive eye examinations and needed clinical eye care"

National Academies report makes recommendations

The National Academies report is the end-result of an 18-month consensus study—with panel input from AOA members Sandra Block, O.D., Lori Grover, O.D., Ph.D., and Edwin Marshall, O.D.; paper reviews by Sue Cotter, O.D., Jorge Cuadros, O.D., Ph.D., Susan Primo, O.D., and John Townsend, O.D.; and influential presentations by Drs. Thau, Cotter, Cuadros, Primo, and AOA Past President David A. Cockrell, O.D.—conducted by the Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health. Sponsored by AOA, the consensus study aimed to set a roadmap toward improved, equitable vision health by soliciting common-sense perspectives and feedback from the eye care community that has been lacking in previous public health studies.

Notably, AOA's feedback stressed holding comprehensive eye examinations as the gold standard of care by America's family eye doctors.

To address such challenges, the proposed plan calls for collaboration among numerous stakeholders and outlines nine recommendations, many of which echo AOA efforts to expand clinical eye care and regular, in-person comprehensive eye examinations. These recommendations focus on five foundational strategies, including:

1. Facilitate public awareness through timely access to accurate and locally relevant information.Recommendation: U.S. Department of Health and Human Services (HHS)-led public health call to action and awareness campaign.
2. Generate evidence to guide policy decisions and evidence-based actions.Recommendations: Centers for Disease Control and Prevention (CDC)-coordinated surveillance system; and HHS-led interagency workgroup to develop a common research agenda.
3. Expand access to appropriate clinical care.Recommendations: HHS-convened interdisciplinary panels to develop a single set of evidence-based clinical guidelines; and eye health profession-led programs to proactively recruit and educate a diverse workforce, and incorporate prevention and detection of visual impairments as part of core competencies.
4. Enhance public health capacities to support vision-related activities.Recommendations: State and local public health department partnerships with health care systems to align public health and clinical practice objectives, programs and strategies about eye and vision health to eliminate barriers and increase access to eye care, especially comprehensive eye examinations; and CDC prioritization and expansion of vision grant programs to build state and local public health capacity.
5. Promote community actions that encourage eye- and vision-healthy environments.Recommendation: Community collaboration with state and local health departments, and cabinet-level agencies, independent federal agencies and the Office of the White House, to translate a broad national agenda to promote eye and vision health into actions that encourage policies and conditions that improve and foster environments that minimize the impact of vision impairment. "We set out to design actionable, achievable recommendations that would set out a clear plan for the future of vision health," says Dr. Grover, National Academies consensus study member and AOA Evidence-Based Optometry Committee member. "The direction and potential recommendations, if concertedly acted upon in educational and health policy arenas and in a clinically reasonable manner, would effectuate long-term and sustainable reduction in preventable vision impairment and its impacts, improving population health outcomes."

AOA already implements many National Academies' recommendations

This plan, as a whole, elevates efforts that family eye doctors and AOA have made to expand eye care services and comprehensive eye examinations.

Many of these recommendations are already in action with many of the same eye health stakeholders, including:

• Think About Your Eyes, a national awareness campaign, continues to educate Americans on the need for better vision health since 2013, motivating them toward annual eye care and linking patients to doctors of optometry should they not already have one.
• CDC, optometry and ophthalmology continue to bring a cohesive surveillance system to life, and AOA MORE (Measures and Outcomes Registry for Eyecare) is a crucial component for this system.
• AOA already espouses a process for developing evidence-based clinical guidelines, and AOA's imminent pediatric vision guidelines follow the National Academies' own "Clinical Practice Guidelines We Can Trust," providing the only set of evidence-based guidelines for children's vision care available. Adherence to these guidelines would expand access to in-person, comprehensive eye examinations.
• The Affordable Care Act's Pediatric Essential Vision Health Benefit makes vision care, including comprehensive eye examinations and glasses for children from birth through age 18, a required element of insurance coverage and an example of the changes we need to improve access to important vision care.

The AOA is committed to advancing Americans' overall vision and eye health by knocking down barriers to care and improving access to critical resources, and will continue leading collaborative efforts to make these recommendations a reality.

Read more about AOA's key participation on the National Academies report committee in the May 2016 AOA Focus feature, "A Seat at the Table."