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Vision Impairment and Blindness

Most eye diseases are not life-threatening but may be indicative of an underlying life-threatening condition. Nonetheless, eye diseases are sight-threatening and are of public health importance and priority. This is because blindness and vision impairment have long affected populations and studies have shown that most cases are preventable. Blindness and vision impairment has been shown to be associated with several social determinants of health and disparities exist. Prevalence and incidence projections also show an upward trajectory. Eye diseases and conditions affect all ages but to different degrees. It imposes disability, affects the quality of life, and it is more expensive to treat than to prevent. Blindness and vision impairment evokes fear and anxiety among people.

Diabetes has widely been accepted as a public health problem, calling for mass public education, diet modification, open space in neighborhoods for exercise, addressing food deserts, etc. Public health efforts have been effective in diabetes awareness where now, the layperson may associate diabetes with high levels of sugar. However, this increased awareness has not translated to the importance of eye care even when diabetes is a leading cause of blindness in the US. A similar statement can be made for the many other systemic diseases that have ocular manifestations.

Vision impairment is often a comorbidity that makes the management of life-threatening diseases difficult, leading to poor health outcomes. Among other goals, public health seeks to protect and promote healthy lives, prevent disease and disability. Subsequently, since there is some protecting, promoting, and prevention to do where blindness and vision impairment is concerned, it remains a public health concern and warrants public health priority.

 Pubtometry

"Pubtometry" is a compound word from Public Health and Optometry. A literal intersection of the two fields of healthcare. 

By virtue of managing eye conditions of individuals who collectively make up the public, eye care should be public health-oriented. Intersecting public health and optometry means using principles of both professions to improve the vision and eye health of populations. The management of eye conditions is done from a population perspective, taking into consideration the disparities that occur by race, ethnicity, gender, socioeconomic status, geographic location, disability status, or sexual orientation.

Public health does not imply non-individual health but rather, recognizing that a person's health outcome does not occur in isolation. A population is only as healthy as the individuals in it. Health outcomes occur in a web of socioeconomic factors and health determinants such as environment and communities. Individual health and population health are not absolute or independent concepts but complementary. It is knowing the public health implications of diseases like diabetes that allows Public Health to push for the availability of grocery stores and open spaces e.g. parks in neighborhoods. This allows individual access to healthy foods and space to exercise  as part of their diabetes management. 

Public health optometrists can use their expertise to address infectious eye disease outbreaks, influence access to eye care, eye health policies, and funding. We have an increasing population, an aging population, and environmental changes, all of which affect the dynamics of our healthcare system.

 

A fusion of the two professions is important because healthcare delivery will continue to change unpredictably, and the organization and administration of eye health delivery will have to follow suit. Optometry will very much benefit from active involvement in public health where eye health care policies and administration are concerned.

The Role of Optometry in Public Health and Global Health

The role of optometry in public health is integral in protecting vision and eye health in the United States and globally. We are not able to achieve holistic health care without addressing the state of vision and eye health in our communities. Advances made in medicine, health care delivery, and disease prevention have all contributed to increased life expectancy and longevity. This achievement brings challenges of chronic systemic diseases, many of which have ocular manifestations.

It is not news to hear of the burden of diabetes, heart disease, and cancer but their associated ocular implications often go unmentioned. Vision loss often does not occur in isolation and what have we truly achieved by increasing the longevity of lives but not the quality of said life? Vision loss is often comorbidity to other health problems and can result in poor health outcomes if ill-managed. If blindness and vision impairment are eliminated from the hurdles of aging, the quality of life of the elderly will be much improved.

The United Nations' Sustainable Development Strategy  (SDS) goals to end poverty, fight inequalities and address climate change are not truly attainable without improving vision and eye health. Recognizing the vital role of vision and eye health in attaining the SDS goals led to the United Nations General Assembly to adopt the first-ever resolution on vision: Vision for Everyone. This calls for local action for global results.

The Role of Public Health in Optometry

There are multiple reasons why the importance of eyecare eludes the public's awareness. It is often not prioritized in health programs and policies thus dismissing the substantial impact of blindness and vision impairment on economic and social development. Owing to the impact of vision loss and impairment on the overall health and quality of life, and the inequities that exist in eye care access, the need for public health-oriented optometry should be emphasized.

Principles of public health can serve optometry in promoting eye care and access in communities. Epidemiologic studies in eye care will provide foundational information for clinical practice. Eye care programs can be evaluated through a public health lens to ensure quality services are made available to communities. Public health can lead to the enactment of policies that lead to visual health equity.

On a national level, the Healthy People initiative identifies public health priorities and calls for a collective effort from individuals, communities, and organizations to improve health and eliminate health disparities over a decade. Specific to vision, the initiative aims to improve visual health through prevention, early detection, timely treatment, injury prevention, and rehabilitation.