Last September 15th, the National Academies of Science, Engineering, and Medicine released a 450 page report “Making Eye Health a Population Imperative: A Vision for Tomorrow.”1 The report was developed by a multidisciplinary committee (the Committee on Public Health Approaches to Reduce Vision Impairment and Promote Eye Health) charged with examining “the core principles and public health strategies to reduce visual impairment and promote eye health in the United States.”1 The result of the effort is a remarkable expression of current vision care and public health research organized within a population health paradigm with recommendations for improving eye and vision health nationally.
The Committee established five core actions areas (1) facilitating public awareness, (2) generating evidence, (3) expanding access to care, (4) enhancing public health capacity, and (5) promoting community action), as a conceptual framework for the development of what became nine key recommendations. The recommendations are primarily directed at the United State Department of Health and Human Services (HHS) and the Center for Disease Control (CDC), along with state and local public health agencies, but depend upon a high level of collaboration with the eye care and public health communities. Importantly, the first recommendation looks to the US Department of Health and Human Services to issue a “Call to Action” thereby establishing eye and vision health as a national priority and which, if issued, would greatly increase the inclusion of eye and vision health in the national conversation on health policy.
The National Academies of Science, Engineering, and Medicine report concludes, (while recognizing a multitude of governmental programs that focus on vision loss), that “Despite these efforts, eye and vision health remain notably absent as a population health priority in the overarching public health and health care systems. It is also underrepresented in strategic plans that address the impact of chronic diseases and conditions within the United States.”1 In a January 2017 editorial in the American Journal of Ophthalmology, Higginbotham, Coleman and Teutsch (all members of the Committee) reinforced this noting that “we have witnessed growing isolation of eye and vision health from medicine and other surgical subspecialties and the exclusion of chronic vision impairment from larger efforts to promote patient health and well-being and drive national health policy.”2
The report’s nine recommendations have been the focus of most commentary since the release of the report.2–5 The report states that “the Committee’s recommendations are visionary and are meant to set in motion a variety of broad-based actions that can contribute to the prioritization of eye and vision health at national, state and local levels,”1 but also acknowledges that “[the report] also has drawbacks-most notably, it does not provide discrete, recommended actions for stakeholders at every level.”1 A deeper dive into the report identifies obstacles and research gaps that may be as helpful as or more helpful to organizations than the recommendations alone as they include specific actions that may be taken and suggest opportunities for collaboration. Indeed, a cursory reading of the report’s “Summary” and/or “Introduction” belies the depth and richness of this effort.
The fragmentation of the eye and vision health community and related health care delivery system is repeatedly referenced throughout the report. Issues highlighted include, but were not limited to: (1) the variety of professionals providing eye and vision care services; (2) different and conflicting evidence-based clinical care guidelines; (3) variations in state laws governing practices and professions in the medical and optometric communities; (4) barriers to care created by a bifurcation within the insurance system (vision care plans v. medical eye care plans); (5) the suboptimal use of electronic health records that limits inter professional practice; and (6) divergent findings in workforce studies that are largely conducted by advocacy groups. The report also notes that ongoing conflict over scope of practice issues “hampers efforts to create a unified advocacy platform from which to advance population eye and vision health.”1
While identifying factors that have contributed to fragmentation and that are obstacles to the realization of the report’s recommendations, the absence of “discrete, recommended actions for stakeholders” does not mean that report lacks specificity. In the body of the report there are “Boxes” that highlight key research gaps and opportunities. The boxes specify areas that could be embraced on an organizational level. A few examples include: (1) the absence of a national eye and visual health surveillance strategy; (2) the lack of a research database with information such as visual impairment, comorbidities, quality of life, and associated social determinants, (among others); (3) improved training programs to promote collaborative practice and shared knowledge about eye and vision health among health providers; (4) identification of models of integrated eye and vision care to the assess the potential of accountable care organizations and patient-centered medical homes to improve eye and vision health and to promote the development of cost-effective integrated models for eye and vision care; (5) assessment of the impact of school- and community-based vision screenings on eye and vision health; (6) the determination of whether or not the current [collective] workforce distribution should be maintained or expanded; and (7) a clarification of the association between the diversity in the eye and vision care workforce and barriers to care for minority patients. These are but a few areas in which greater study and program development are needed.
While leadership at the federal level is critical, the agenda laid out in the report provides significant guidance for local action as well. Many of the research and program gaps listed fall within the domain of the Schools and Colleges of Optometry, Departments of Ophthalmology, Schools of Public Health, and organizations with academic missions including the American Academy of Optometry, the American Academy of Ophthalmology and the American Public Health Association. These institutions with a common commitment to research have an opportunity to advance the vision of the National Academies of Science, Engineering, and Medicine report.
While all stakeholders in the eye and vision care community should advocate, individually and collectively for US Department of Health and Human Services to issue a “Call to Action” as proposed in recommendation #1, all should be examining the National Academies of Science, Engineering, and Medicine report and incorporating its findings into their strategic planning process with an eye toward opportunities for interorganizational and interorganizational collaboration.
1. National Academies of Sciences, Engineering, and Medicine. Making Eye Health a Population Health Imperative: Vision for Tomorrow. Washington, DC: The National Academies Press; 2016.