In 2014, the Health and Medicine Division (formerly the Institute of Medicine) of the National Academies of Science, Engineering, and Medicine convened a panel of experts representing a broad range of perspectives. They were tasked to develop strategies that could improve the nation’s eye health and reduce the impact of vision impairment. The committee’s official charge was “to examine the core principles and public health strategies to reduce vision impairment and promote eye health in the United States” (available at http://www.nationalacademies.org/hmd/Activities/PublicHealth/ReduceVisionImpairment.aspx). The initial scope of this project evolved, and by late 2016, the committee’s work included five meetings, two public workshops, one public comment session, one commissioned paper, and countless hours of committee calls and communications. The product of this effort was nine detailed core recommendations identifying short- and long-term eye and vision health priorities that cut across the health continuum. Through collaborative action, the committee identified and addressed issues involving health care settings, stakeholders, determinants of health, interrelated health conditions, surveillance and research needs, government roles, standard language and definitions, care integration and delivery, community and public health partnerships, provider workforce needs, and other key factors affecting eye health over the entire life span. These findings are summarized in a 450-page report, defined by the National Academies of Science, Engineering, and Medicine as a “document [of] evidence-based consensus of an authoring committee of experts… peer reviewed and approved by the National Academies….” This document provides a wealth of information for interested stakeholders. In addition to the core recommendations, it features new conceptual frameworks, visual diagrams, tables, figures, and other evidentiary tools and resources. These tools and resources are designed to help guide and support new initiatives, future policies, and planning by professionals, educators, researchers, decision makers, and the public.
There are numerous opportunities identified in this report that can lead to meaningful population health benefits. Initially framed as a smaller and more focused effort, the expansion of the report into additional chapters was a direct result of the committee’s thorough and systematic approach to identifying available evidence, understanding existing needs, and identifying essential gaps in current knowledge and practices.
A comprehensive continuum of eye and vision care is identified in the report that highlights prevention, early and accurate diagnosis, and proper care to reduce the impact of vision impairment. To improve eye and vision care and achieve health equity, a population health strategy was developed. This strategy identified specific objectives and included detailed conceptual models targeting specific determinants of health across the full life span. There is a wealth of information identifying clinical and translational research opportunities that will inform clinical researchers and clinicians alike regarding gaps in our current knowledge base. Because effective communication is so important, the report includes an in-depth attempt to define key terminology that will help stakeholders speak a common language. A substantial portion of the report directly calls for greater awareness by the medical community and the public for the important role that comprehensive eye and vision care has on population health. Three key examples include the following: that comprehensive eye examinations are recognized as the criterion standard for improving the nation’s eye, vision, and overall health; that doctors of optometry are recognized as physicians and have physician parity with colleagues in ophthalmology and medicine as per earlier Centers for Medicare & Medicaid Services (CMS) policy; and that irreversible vision impairment (e.g., due to diabetes, heart disease, glaucoma, and other major US chronic diseases and conditions) is also recognized as a true chronic condition. Chronic vision impairment is highlighted throughout the report as an outcome of utmost concern to population health requiring prevention and appropriate, early care because of its far-reaching negative effect on overall health status and quality of life.
As with any document of this nature, progress toward actionable items will depend on many factors. Funding remains a high priority for increasing our capacity for health surveillance, research, and access to care. Politics and economics will continue to influence policies relating to health care delivery and strategies designed to reduce the impact of chronic conditions including vision impairment. We also face very real challenges regarding the dissemination, awareness, and stakeholder participation in the effort to realize the benefits envisioned by the authors of this initiative. It is assumed that by nature of this report’s origins there will be universal buy-in, and attention will be paid. Aside from national-level governmental entities referenced in the report including the Department of Health and Human Resources, the National Institutes of Health/National Eye Institute, and the Centers for Disease Control and Prevention, other national stakeholders will need to translate and adopt messages relevant to their roles and strategic objectives. Leadership capable of building consensus across traditional boundaries will be necessary to achieve the objectives laid out in this report.
While it is a challenge to adequately summarize this extensive and complex report, one constituency has found a meaningful way to quickly promote the report to its membership. The American Optometric Association—one of several eye and vision care professional associations (along with the American Academy of Optometry and the American Academy of Ophthalmology) who sponsored the report—effectively disseminated the report’s release by highlighting its relevance on September 15 (available at http://www.aoa.org/newsroom/americas-vision-health-and-care-must-be-national-priority-states-new-report?sso=y).
They summarized findings according to the key action-oriented recommendations from the report (Fig. 1):
* Facilitate public awareness through timely access to accurate and locally relevant information.
* Generate evidence to guide policy decisions and evidence-based actions.
* Expand access to appropriate clinical care.
* Enhance public health capacities to support vision-related activities.
* Promote community actions that encourage eye- and vision-healthy environments.
These five strategic actions effectively frame the report by crossing over recommendations and evidence from the supporting text, while also offering a quick “hit list” for busy eye doctors to better understand the value of the report. It provides an abbreviated road map for better understanding the current status, what needs to happen for change to occur, and where intervention can be targeted to best effect from the perspective of doctors of optometry across the nation. It is the hope of those of us who served on the committee that this report will be widely read, serve as a catalyst for action, and inspire advocacy in all forms for eye and vision health that improves population health.