With the support of the Aging Eye Public Private Partnership (AEPPP) the Ohio Department of Health surveyed 9,823 randomly selected Ohio residents age 40 years and older in 2005 and 2006 to learn about the scope of vision loss in Ohio, public awareness about health behaviors and available resources that can prevent vision loss.
The survey called the Behavioral Risk Factor Surveillance System (BRFSS) was developed by the Centers for Disease Control and Prevention (CDC) and is one of the nation’s largest health surveys. It includes interviews from 247,000 households and is the primary means whereby States collect their data on health status and health behaviors.
In 2005, for the first time, the BRFSS offered additional survey questions about vision to interviewees aged 50+. Because of the momentum generated by the Aging Eye Public Private Partnership, Ohio was one of 5 states in 2005, one of 10 states in 2006 and one of 6 states in 2007 electing to collect this additional data from the households that it surveys through the Ohio Department of Health.
The results from the Ohio Survey are eye-openers that provide vision stakeholders and policy-makers with new Ohio-specific information from which to set our future agenda to protect the eye health of Ohioans. Following is some of what we have learned from the BRFSS data collected in Ohio:
Cases of glaucoma and age-related macular degeneration are nearly two times higher in Ohio compared to national data in regard to the number of people affected.
- Nearly 11% of Ohio seniors, aged 65+ reported being told by an eye doctor or other health professional that they have glaucoma.
If 11% of Ohio’s seniors report having glaucoma, 166,470 seniors are affected. This is nearly double current national estimates. It is also known that only half of those with the “sneak thief of sight” are aware they have the disease. If this is true, then we can assume that there may be another 166,470 Ohio seniors who have glaucoma and don’t know it… for an estimated total of 333,000 Ohio seniors with glaucoma.
- 8.6% or 130,149 Ohio seniors aged 65+ and 2.1% of Ohioans aged 50-64 (17,608) report being told by an eye doctor or other health professional that they have age-related macular degeneration (AMD).
This is a total of 147,757 Ohioans with AMD. This is more than double of current national estimates of Americans in this age group with AMD.
- In Ohio, 131,034 people ages 18+ that know they have diabetes report having diabetic retinopathy (20.4%).
Because as many as 29% of people with diabetes don't know they have the disease, there may be as many as 904,678 Ohioans ages 18+ with diabetes with 184,554 of them having diabetic retinopathy.
Diabetic Retinopathy involves abnormal growth of blood vessels in the back of the eye which can leak resulting in loss of vision. It is a common complication of diabetes and between 40 to 45 percent of Americans diagnosed with diabetes have some stage of diabetic retinopathy.
- 54% of seniors, aged 65+, reported being told by an eye doctor or other health professional that they now have cataracts.
Applying this percentage to Ohio’s current population, aged 65+, there are 817,219 Ohio seniors who now have or have had a cataract. This is consistent with national data.
- African Americans are at greater risk for certain age-related eye diseases than are other ethnicities, and the eye diseases often appear at earlier ages. The likelihood of developing an age-related eye disease is compounded by family history, lifestyle choices, presence of chronic disease, and previous eye injuries. The BRFSS Vision Module data show that African Americans age 40-49 were 4 times more likely to have glaucoma and more than 2 times more likely to have cataracts than were Caucasians of the same age. Also, African Americans age 65+ with diabetes were 71% more likely to develop diabetic retinopathy than were Caucasians age 65+ with diabetes.
- Caucasian populations age 65+ were 97% more likely to have developed AMD than African Americans of the same age.
- Ohioans with diabetes were more than twice as likely to develop glaucoma and 45% more likely to develop cataracts than were Ohioans without diabetes.
Persons with diabetes are at an increased risk for vision problems and development of age-related eye diseases in addition to diabetic retinopathy. Special efforts need to be taken to educate about the importance of eye care, the early identification of vision problems, regular comprehensive eye exams, and increased access to eye care for uninsured or underinsured Ohioans with diabetes.
Also, Ohioans age 40-49 with diabetes were 1.8times more, or almost twice as likely, to report having moderate difficulty reading print than were Ohioans of the same age without diabetes. This can lead to an impaired ability to perform effectively at work and ultimately cost the individual their job and the employer’s additional dollars due to reduced employee performance.
- Individuals age 65+ with a history of smoking have a 1.66 times greater prevalence of age-related Macular Degeneration (AMD); a 1.64 times greater prevalence of Diabetic Retinopathy; and a 1.92 times greater prevalence of Glaucoma compared to persons who have never smoked.
- Eye injuries in the workplace dramatically increase the likelihood of age-related eye diseases later in life. Ohio BRFSS Vision Module data has shown that individuals age 65+ who experience an eye injury at work were 71% more likely to develop Glaucoma than were individuals of the same age who had never experienced an eye injury at work.
- Vision loss and age-related eye disease increase the likelihood that Ohioans will experience depression and poor health images. Individuals age 40-49 with an age-related eye disease were 12 times more likely to list their general health status as “poor” and three times more likely to indicate “Dissatisfied” as their Life Satisfaction rating than their peers without an age-related disease.
- Poor vision and age-related eye diseases increase the likelihood that older adults will experience debilitating and life threatening falls. Adults age 65+ who have an age-related eye disease were 50% more likely to have experienced a fall than persons of the same age without an eye disease.
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- The top two reasons for not visiting an eye doctor included “no reason to go” and cost/lack of insurance.
This may point to a need for public awareness regarding preventive eye care. Regular eye exams are important even if there is “no reason to go” as many eye problems that can lead to vision loss have no symptoms and occur slowly. Often, vision lost cannot be restored and the later a vision problem is caught, the less successful its treatment might be.
13% of seniors (age 65+) and 25% of Ohioans aged 50-64 reported that cost or lack of insurance prevented them from getting an eye exam. While 60% of Ohioans aged 50-64 and 47% of Ohioans aged 65+ report having some type of health insurance coverage for eye care, there is still a gap in access to needed eye care, especially for working-aged Ohioans, at a time when preventive care can be most effective long-term.
- Despite the fact that Medicare covers medical eye care expenses for age-related macular degeneration, diabetic retinopathy, glaucoma and cataract, only 47% of Ohioans aged 65+ reported having some type of health insurance coverage for eye care and 13% of reported that cost or lack of insurance prevented them from getting an eye exam.
Since January 2002, Medicare has covered 80% of the fee for a comprehensive eye exam for those age 50 and over with risk factors – family history of glaucoma, African Americans, diabetes. We might draw the conclusion that less than half of Medicare beneficiaries are aware that they have this Medicare benefit or are unsure when it is appropriate to access this benefit.
- 11.4% of seniors, aged 65+ report that their last visit to an eye doctor was more than 2 years ago – this is nearly one out of every nine Ohio seniors (172,000) who are not getting periodic, professional eye care.
This may be an indication that seniors are not aware that the risk for vision loss dramatically increases with age and that most eye diseases that steal vision occur slowly, without any noticeable symptoms that allow for self-diagnosis. Preventive care is the best defense. It may also be an indication of consumer decisions regarding preventive health care in general. Most people do not seek care unless they notice that something is wrong, whether or not they are aware of the importance of preventive care. This may also be an indication that seniors are not aware that Medicare covers 80% of the fee for a comprehensive eye exam for seniors with risk factors – family history of glaucoma, African Americans, diabetes.
- Annual income and education achievement play a significant role in the likelihood that an individual will receive a screening eye exam by an eye care professional.
College graduates age 50-64 were 38% more likely to receive an eye exam within the past two years than were Ohioans of the same age who did not complete high school. Also, individuals age 40-49 with annual incomes between $15,000 and $24,999 were 62% less likely to receive a comprehensive eye exam than those earning $25-$34,999 annually. Special efforts need to be taken to educate these two populations on the importance of regular comprehensive eye care and how they can access these services.
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Prevent Blindness Ohio, founded in 1957, is Ohio’s leading volunteer, nonprofit public health organization dedicated to preventing blindness and preserving sight. It serves all 88 Ohio counties, providing direct services to more than 600,000 Ohioans annually and educating millions of consumers about what they can do to protect and preserve their precious gift of sight. Prevent Blindness Ohio is an affiliate of Prevent Blindness America, the country’s second-oldest national voluntary health organization. For more information or to make a contribution, visit our website at www.pbohio.org or call 800-301-2020.
