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Purpose: To investigate patterns of ancillary imaging testing among vitreoretinal specialists for patients with vitreoretinal disease in the United States (US).Methods: Optical coherence tomography (OCT), color fundus photography (CFP), and fluorescein angiography (FA), ordered by vitreoretinal specialists and documented within the American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) between 01 January 2018 and 31 December 2020, were retrospectively assessed. Trends in imaging modality choice were analyzed by payer type, geographic region, and practice type. Sub-analyses were conducted according to categorization of vitreoretinal specialists into those treating a high versus low volume of patients with neovascular age-related macular degeneration (nAMD).Results: OCT was the most common imaging modality used, followed by CFP and FA. Following normalization, the highest volume of OCT procedures performed were identified among Medicare Advantage and Medicare Fee-for-Service beneficiaries, within the South of the US, and at medium and large practices. Minimal differences were observed for CFP and FA volume across payer types and regions. Across practice types, the largest volume of CFP and FA procedures were identified in small and private equity owned practices, respectively. Vitreoretinal specialists with a high nAMD volume more frequently performed OCT than those with a low nAMD volume.Conclusion: Vitreoretinal specialists demonstrated a strong preference for OCT, with real-world associations according to payer type, geographic location, and practice type. Volume of nAMD patients seen impacted the likelihood of specialists ordering OCTs.Plain Language Summary: Optical coherence tomography (OCT), color fundus photography (CFP), and fluorescein angiography (FA) are key imaging modalities used by vitreoretinal specialists in routine eye care. This study aimed to uncover patterns of OCT, CFP, and FA usage in the United States from 2018 to 2020, and investigated the impact of volume of patients with neovascular age-related macular degeneration on these trends. Higher rates of OCT use, compared with CFP and FA, were identified in the US. [ABSTRACT FROM AUTHOR]

Understanding approaches to sustainability in cataract surgery and their risks and benefits. In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single-use supplies to reusables or implementing a hub-and-spoke–style operating room setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

The article discusses 2024 research which showed gaps in Medicaid coverage for vision care across the U.S. Topics covered include the provision of routine eye exams in most fee-for-service Medicaid programs, the continuing need for policy changes to improve coverage and access, and the barriers of cost-sharing requirements. Also noted is the projected doubling of adults with vision impairment in the next 25 years due to the U.S.'s aging population.

The United States (US) federal government uses health provider shortage areas (HPSAs) to define patient accessibility to primary care physicians. It is unclear whether HPSAs can be applied to eye care providers (ECPs). Our study determined the applicability of federal HPSA designations to ECP availability in the US. Cross-sectional study. US general population and ophthalmologists/optometrists in the Medicare database. The primary care HPSA score, visual impairment prevalence, and ECP location were determined for each census tract or county using data from the US Department of Health and Human Services, the Centers for Disease Control and Prevention, and Centers for Medicare and Medicaid Services. Association of HPSA with vision loss and ECP density was examined. The 2-step floating catchment area approach was used to newly define eye care shortage areas (patient accessibility score [PAS], higher being worse accessibility) for every county in the US, by weighting the 2-step FCA scores by prevalence of vision loss and ECP density. Multivariable logistic regression was used to identify sociodemographic variables associated with areas of ECP shortage. Among 72 735 census tracts included, statistically significant but weak correlations of HPSA score with visual impairment (VI) (r = 0.38; P < 0.0001) and ECP density per county population (r = –0.18; P < 0.0001) were found. Only 54.0% of census tracts with < 25th percentile ECP density per county were HPSAs (P < 0.0001). Of census tracts > than 75th percentile for VI only 58.0% were HPSAs (P < 0.0001). Multivariable regression found a higher odds of ECP PAS ≥ 75th percentile (worse accessibility) in rural counties (adjusted odds ratio [aOR], 2.47; 95% confidence interval [CI], 1.93–3.67; P < 0.001) and counties with a greater prevalence of residents with less than a high school education (aOR, 1.21; 95% CI, 1.19–1.25; P < 0.001), residents ≥ 65 years of age (aOR, 1.10; 95% CI, 1.07–1.13; P < 0.001), and uninsured residents (aOR, 1.04; 95% CI, 1.01–1.06; P < 0.001). Counties with a greater proportion of men (aOR, 0.93; 95% CI, 0.89–0.967; P < 0.001) or White residents (aOR, 0.99; 95% CI, 0.98–0.99) had a lower odds of ECP PAS ≥ 75th percentile. Current HPSAs only weakly correlate with ECP supply. We propose a new approach to identify counties with high need but limited access to eye care. Proprietary or commercial disclosure may be found after the references. [ABSTRACT FROM AUTHOR]

To investigate factors associated with prolonged length of stay and high cost among pediatric hospitalizations with a primary ophthalmic diagnosis. This retrospective, cross-sectional study utilized data on pediatric admissions with a primary ophthalmic diagnosis from the multicenter 2016 Kids' Inpatient Database. Multivariable logistic regression models adjusted for demographic, hospital, and admission characteristics were used to evaluate factors associated with prolonged stay and high cost, defined as exceeding the 75th percentile (>4 days and $12,642, respectively). An estimated 6,811 pediatric hospitalizations with a primary ophthalmic diagnosis in the United States in 2016 were included. On adjusted analysis, a prolonged length of stay was more likely with Medicaid (vs. private insurance, OR = 1.19, 95% CI: [1.02, 1.40], p =.03), non-trauma (vs. trauma, OR = 2.77, 95% CI: [2.12, 3.63], p <.001) and urban teaching hospitals (vs. rural, OR = 3.48, 95% CI: [1.04, 11.69], p =.04). A high cost of stay was more likely with higher income levels (Quartile 3 vs. 1, OR = 1.30, 95% CI: [1.02, 1.67], p =.04; Quartile 4 vs. 1, OR = 1.49, 95% CI: [1.08, 2.05], p =.02), private insurance (vs. Medicaid, OR = 1.26, 95% CI: [1.04, 1.53], p =.02), Western hospitals (vs. South, OR = 2.74, 95% CI: [1.83, 4.12], p <.001), and trauma (vs. non-trauma, OR = 3.29, 95% CI: [2.57, 4.21], p <.001). Children and young adults had higher odds of prolonged stay, while adolescents and young adults had higher odds of high cost compared to toddlers (p <.05 for all). Additional work addressing the factors associated with higher resource utilization may help promote the delivery of quality inpatient pediatric eye care. [ABSTRACT FROM AUTHOR]

Disparities in access to pediatric vision care for school-age children remain a pressing issue in the United States. School-based vision programs (SBVPs) are regarded as a means to advance health equity, especially for disadvantaged students. While SBVPs can be beneficial, these programs are only part of the solution. Interdisciplinary collaborations are needed to strengthen the pediatric eye care delivery system and advocate for broader access to needed eye services. This discussion will frame the role of SBVPs in conjunction with research, advocacy, community engagement, and medical education to advance health equity in pediatric eye care. [ABSTRACT FROM AUTHOR]

Pediatric vision screening detects children at risk for visual conditions with the goal of connecting those in need with an eye care provider for evaluation and treatment. The primary aim for vision screening in younger children is the detection of those at risk for amblyopia, which can result in irreversible vision loss if left untreated. In older children, screening goals broaden to include the detection of risk for uncorrected refractive error. In the United States, professional organization guidelines and state-mandated requirements for vision screening vary widely across both the timing and components of screening. In this article, we describe the goals and components of pediatric vision screenings, current challenges, novel approaches to providing follow-up services through school-based vision programs, and future directions. [ABSTRACT FROM AUTHOR]

Purpose: To create a survey that assesses the economic factors impacting the viability of pediatric ophthalmology between January 2021 and July 2022. Methods: A 12-question survey was distributed to United States–based pediatric ophthalmologists on the American Association for Pediatric Ophthalmology and Strabismus discussion board and various social media fora. Demographic, economic, and workforce pattern data were collected and analyzed. Results: A total of 243 pediatric ophthalmologists completed the survey. One hundred seven (44.0%) respondents reported a surgical revenue decrease between 10% and 25%, 117 (48.1%) a clinical revenue decrease of less than 10%, 111 (45.6%) an overall income decrease of less than 10%, and 127 (52.2%) an overhead cost increase between 10% and 25%. Seventy-two (29.6%) respondents reported subsidizing income with pursuits outside of pediatric ophthalmology, 27 (11.1%) stopped operating due to reimbursement cuts, 75 (30.8%) limited the number of Medicaid or other public funded patients, 16 (6.5%) retired in the past 3 years, and 92 (37.8%) would not recommend a resident pursue a pediatric ophthalmology fellowship. Conclusions: There is a potential upheaval in the field of pediatric ophthalmology marked by increasing levels of disillusionment among current providers, a progressive decline in the number of trainees pursuing fellowship programs, and workforce issues suggestive of diversification of practice patterns outside of pediatric ophthalmology. The current economic crisis, in conjunction with these complex workforce issues, is and will continue to create a shortage of practicing pediatric ophthalmologists, seriously limiting access to pediatric and adult strabismus eye care. [J Pediatr Ophthalmol Strabismus. 2022;59(6):362–368.] [ABSTRACT FROM AUTHOR]

Structural barriers, which impede access to healthcare, are often seen as tangible expressions of structural racism. Those who experience more structural barriers to healthcare access are likely to experience poor health. Expanding on this notion, our research integrated the Internalized Racism Framework (James, 2022) with the Structural Vulnerability Framework (Bourgois et al., 2017; Metzl and Hansen, 2014) to explore how encountering barriers to healthcare access influences healthcare seeking attitudes across four health domains: mental, medical, dental, and vision. Our study included a sample of 780 Black American adults (average age = 37.68) who were recruited to participate in an anonymous web-based cross-sectional survey. Our findings revealed that internalized racism explained the direct effect of healthcare access structural barriers on healthcare attitudes in the mental, medical, and vision health domains, but not in the dental health domain. Specifically, the experience of more structural barriers in accessing healthcare (mental, medical, and vision) correlated with heightened internalized racism, which, in turn, was associated with more negative attitudes towards seeking (mental, medical, and vision) healthcare. Notably, our results also showed variations in the frequency and types of structural barriers encountered across the four health domains, along with differences in participants' positive healthcare seeking attitudes. Our findings underscore an urgent need for targeted interventions addressing both structural and internalized racism. Removing healthcare access barriers is crucial for fostering equitable healthcare access for Black Americans. Future research should explore additional factors influencing healthcare seeking attitudes, as well as strategies that mitigate the negative effects of racism on said attitudes. • Experiencing more healthcare barriers is associated with internalized racism. • Internalized racism is associated with more negative health seeking attitudes. • Dental healthcare access barriers are related to dental health seeking attitudes. • Medical healthcare access barriers are related to medical health seeking attitudes. [ABSTRACT FROM AUTHOR]

Purpose: Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia.Optum’s de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes.POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75–0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63–0.68) and OCT (RR 0.67, 95% CI: 0.64–0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83–0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70–0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58–0.69) than those without dementia.POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care.Methods: Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia.Optum’s de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes.POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75–0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63–0.68) and OCT (RR 0.67, 95% CI: 0.64–0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83–0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70–0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58–0.69) than those without dementia.POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care.Results: Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia.Optum’s de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes.POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75–0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63–0.68) and OCT (RR 0.67, 95% CI: 0.64–0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83–0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70–0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58–0.69) than those without dementia.POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care.Conclusions: Dementia is common among patients with primary open angle glaucoma (POAG) and neovascular age-related macular degeneration (nAMD). This study compares visit frequency, diagnostic test utilization, and treatment patterns for POAG and nAMD among persons with vs. without dementia.Optum’s de-identified Clinformatics® Data Mart Database (January 1, 2000-June 30, 2022) was used for this study. Two cohorts were created from newly diagnosed POAG or nAMD patients. Within each cohort, an exposure cohort was created of newly diagnosed dementia patients. The primary outcome was the number of visits to an eye care provider. Secondary analyses for the POAG cohort assessed the number of visual field tests, optical coherence tomography (OCT), and glaucoma medication prescription coverage. The secondary analysis for the nAMD cohort included the number of injections performed. Poisson regression was used to determine the relative rates of outcomes.POAG patients with dementia had reduced rates of eye care visits (RR 0.76, 95% CI: 0.75–0.77), lower rates of testing utilization for visual fields (RR 0.66, 95% CI: 0.63–0.68) and OCT (RR 0.67, 95% CI: 0.64–0.69), and a lower rate of glaucoma prescription medication coverage (RR 0.83, 95% CI: 0.83–0.83). nAMD patients with dementia had reduced rates of eye care visits (RR 0.74, 95% CI: 0.70–0.79) and received fewer intravitreal injections (RR 0.64, 95% CI: 0.58–0.69) than those without dementia.POAG and nAMD patients with dementia obtained less eye care and less monitoring and treatment of their disease. These findings suggest that this population may be vulnerable to gaps in ophthalmic care. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the prevalence of Demodex blepharitis by its pathognomonic sign, collarettes, in patients presenting for any reason to eye care clinics in the United States. Patients and Methods: In this retrospective study by 7 investigators at 6 eye care clinics, case records of consecutive patients who underwent a slit-lamp examination, regardless of chief complaint, were reviewed for Demodex blepharitis, as identified by the presence of collarettes. Patient characteristics, including age, gender, race, relevant ocular and systemic diagnoses, ocular medications, lid hygiene practices and contact lens wear, were also recorded. Results: Of 1032 patients (mean age: 60.2 ± 17.8 years), 57.7% had Demodex blepharitis. While the prevalence of Demodex blepharitis in patients with dry eye disease (DED) (58.9%) and cataract (55.7%) was similar to the overall prevalence of Demodex blepharitis, it was higher in patients with blepharitis (69.1%) and glaucoma (64.8%). Among patients with collarettes, 44.0% had never been diagnosed with blepharitis. Among those on anti-inflammatory DED treatment, 60.0% had Demodex blepharitis. Demodex blepharitis prevalence was significantly higher among those using topical tea tree oil versus those who were not (74.5% versus 56.7% p = 0.014); prevalence was comparable among those using/not using lid wipes (56.9% versus 55.5%). Conclusion: Demodex blepharitis, based on the pathognomonic finding of collarettes, is common and likely underdiagnosed among patients seeking eye care. These collarettes are still found in patients using over-the-counter treatments for blepharitis. The present study highlights the importance of screening patients for collarettes and Demodex blepharitis as part of every slit-lamp examination. [ABSTRACT FROM AUTHOR]

Vision loss and blindness are among the top ten disabilities in the United States, yet access and utilization of eye care remains low. Vision Detroit aimed to address eye-care disparities via community-based screenings. By investigating burden of eye disease and barriers to eye-care utilization in an underserved urban community, we may direct efforts to improve access. Twenty-three screenings were conducted from March 2015-November 2017. Patient information gathered at screenings were demographics, medical and social history, eye exam/referral history, insurance status, primary care physician (PCP) status, and patient-perceived eye-care barriers. Three-hundred-eighty patients were screened, 42% African American and 51% Hispanic. Average age was 53 ± 16.4 years, 70% reported vision problems, 50% reported over two years of vision problems, and average habitual visual acuity in best-seeing eye was 20/37. Eye-care underutilization was reported in 61% of type-2 diabetics. Older age and PCP recommendations/referrals were associated with increased utilization in all patients. Insurance was the most common barrier (53%); of the 55% insured, 31% reported financial barriers. Employed patients were more likely than unemployed to report a time barrier (odds ratio = 1.76, 95% confidence interval 1.03–3.01). Those with high school or less education reported "unaware of need", "unsure where to go", "transportation", and "insurance" as barriers more often. Visual burden was pervasive, yet access was suboptimal. Financial, logistical, and awareness barriers were common. PCP referral and older age were associated with increased utilization. Those less educated reported more barriers, highlighting the need to address fiscal concerns and eye-health education. [ABSTRACT FROM AUTHOR]

Purpose: To assess changes in vision care availability at Federally Qualified Health Centers (FQHCs) between 2017 and 2021 and whether neighborhood-level demographic social risk factors (SRFs) associated with eye care services provided by FQHCs., Design: Secondary data analysis of the Health Resources and Services Administration (HRSA) data and 2017-2021 American Community Survey (ACS)., Participants: Federally Qualified Health Centers., Methods: Patient and neighborhood characteristics for SRFs were summarized. Differences in FQHCs providing and not providing vision care were compared via Wilcoxon-Mann-Whitney tests for continuous measures and chi-square tests for categorical measures. Logistic regression models were used to test the associations between neighborhood measures and FQHCs providing vision care, adjusted for patient characteristics., Main Outcome Measures: Odds ratios (ORs) with 95% confidence intervals (CIs) for neighborhood-level predictors of FQHCs providing vision care services., Results: Overall, 28.5% of FQHCs (n = 375/1318) provided vision care in 2017 versus 32% (n = 435/1362) in 2021 with some increases and decreases in both the number of FQHCs and those with and without vision services. Only 2.6% of people who accessed FQHC services received eye care in 2021. Among the 435 FQHCs that provided vision care in 2021, 27.1% (n = 118) had added vision services between 2017 and 2021, 71.5% (n = 311) had been offering vision services since at least 2017, and 1.4% (n = 6) were newly established. FQHCs providing vision care in 2021 were more likely to be in neighborhoods with a higher percentage of Hispanic/Latino individuals (OR, 1.08, 95% CI, 1.02-1.14, P = 0.0094), Medicaid-insured individuals (OR, 1.08, 95% CI, 1.02-1.14, P = 0.0120), and no car households (OR, 1.07, 95% CI, 1.01-1.13, P = 0.0142). However, FQHCs with vision care, compared to FQHCs without vision care, served a lower percentage of Hispanic/Latino individuals (27.2% vs. 33.9%, P = 0.0007), Medicaid-insured patients (42.8% vs. 46.8%, P < 0.0001), and patients living at or below 100% of the federal poverty line (61.3% vs. 66.3%, P < 0.0001)., Conclusions: Vision care services are available at a few FQHCs, localized to a few states. Expanding eye care access at FQHCs would meet patients where they seek care to mitigate vision loss to underserved communities., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references., (Copyright © 2024 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: In the United States, women are at a higher risk of developing vision impairment or a serious eye disease (such as age-related macular degeneration, thyroid eye disease, or chronic dry eye disease) than men. Disparities in eye diseases due to biology widen even further when considering factors such as social determinants of health; gaps in research data, literature, and policy; insufficient provider and patient education; and limitations in screening and treatment options. Sex and gender disparities in eye health are clinically under-addressed and burdensome on both patient quality of life and the health care and economic systems, resulting in a pressing population health issue that negatively impacts women. Design: The Society for Women's Health Research convened a working group of expert clinicians, researchers, and patient advocates to review the current state of science regarding sex and gender disparities in women's eye health, identify knowledge gaps and unmet needs, and explore better means to advance research, improve patient care, and raise awareness of key issues. Discussion: The SWHR Women's Eye Health Working Group identified priority areas in research, clinical care, and education to reduce disparities and improve patient care in women's eye health. The working group recommends using a systems approach that incorporates a comprehensive research framework with a sex and gender lens to guide future work and that increases health care provider and public education, as well as engagement by expanding partnerships among ophthalmologic providers, researchers, and non-vision stakeholders. [ABSTRACT FROM AUTHOR]

Children with autism spectrum disorder have a high risk of vision problems yet little is known about their vision care. This cross-sectional survey study, therefore, examined vision care among 351 children with autism spectrum disorder ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Vision care variables were vision tested with pictures, shapes, or letters in the past 2 years; vision tested by an eye care practitioner (e.g. ophthalmologist, optometrist) in the past 2 years; prescribed corrective eyeglasses; and wore eyeglasses as recommended. Covariates included sociodemographic, child functioning, and family functioning variables. Multivariable models were fit for each vision care variable. Though 78% of children with autism spectrum disorder had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism spectrum disorder prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Multivariable analysis results demonstrated statistically significant differences in vision care among children with autism spectrum disorder by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism spectrum disorder do not receive recommended vision care and highlight potentially modifiable disparities in vision care. Children with autism are at high risk for vision problems, which may compound core social and behavioral symptoms if untreated. Despite recommendations for school-aged children with autism to receive routine vision testing by an eye care practitioner (ophthalmologist or optometrist), little is known about their vision care. This study, therefore, examined vision care among 351 children with autism ages 6–17 years in the United States or Canada who were enrolled in the Autism Treatment Network Registry. Parents were surveyed using the following vision care measures: (1) child's vision was tested with pictures, shapes, or letters in the past 2 years; (2) child's vision was tested by an eye care practitioner in the past 2 years; (3) child was prescribed corrective eyeglasses; and (4) child wore eyeglasses as recommended. Sociodemographic characteristics such as parent education level, child functioning characteristics such as child communication abilities, and family functioning characteristics such as caregiver strain were also assessed in relationship to vision care. Although 78% of children with autism had their vision tested, only 57% had an eye care practitioner test their vision in the past 2 years. Among the 30% of children with autism prescribed corrective eyeglasses, 78% wore their eyeglasses as recommended. Differences in vision care were additionally found among children with autism by parent education, household income, communication abilities, intellectual functioning, and caregiver strain. Overall, study results suggest many school-aged children with autism do not receive recommended vision care and highlight potentially modifiable disparities in vision care. [ABSTRACT FROM AUTHOR]

Background: Teleophthalmology programs are expanding, but have not been adapted into many emergency departments (EDs) in the United States. Introduction: Determining the potential demand for teleophthalmology services in the United States. EDs could enable development of new strategies to improve access to eye care in resource-limited regions. Methods: Telephone surveys were administered to ED physicians and nurses in Florida. Perceptions of ophthalmologist availability, equipment availability, and perceived utility of teleophthalmology services were measured. Results: Responses were from 104 of 207 facilities (50.2%); 88/181 (48.6%) designated as nonrural hospitals (NRHs) and 16/26 (61.5%) as rural hospitals (RHs). NRHs reported a median of 1 ophthalmologist available on call compared with a median of 0 at RHs (p < 0.001). NRHs were more likely to have a slit lamp (98.9% NRH, 50.0% RH; p < 0.001) and tonometer (100% NRH, 75.0% RH; p < 0.001). On a scale from 1 (lowest) to 5, most (68/93; 73.1%) perceived the value of teleophthalmology for remote consults as a 4 or 5. The most common perceived benefit of teleophthalmology use was to provide second/expert opinion (26.5% of responses). The most commonly cited perceived disadvantage was the physical unavailability of an ophthalmologist for examination and follow-up care (35.5% of responses). Discussion: RHs have less access to ophthalmologists and ophthalmic equipment when managing eye-related complaints in the ED. At both RHs and NRHs, providers face limitations in managing eye complaints and perceived teleophthalmology as a potentially valuable tool for remote expert consultation. Conclusions: Results suggest teleophthalmology services may be used to improve access to expert ophthalmic care, particularly in rural communities. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate changes in corneal anatomy and quality of vision following LASIK refractive surgery for mild to high myopia using the WaveLight® Refractive Suite (Alcon® Laboratories Inc., USA). Setting. Rothschild Foundation, Paris, France. Design. Prospective interventional case series. Methods. We examined 60 myopic eyes (average SE −4.5 D, from −9.3 to −0.75 D) of 30 patients from 21.3 to 38.7 years old. Pachymetry, keratometry, Q factor, corneal aberrations, visual acuity (VA), contrast sensitivity, dry eye assessment, and quality of vision were measured preoperatively, one day (D1), and 1, 3, and 6 months postoperatively. Results. 6 months postoperatively, keratometry became flatter, and the Q factor became more oblate (from −0.18 ± 0.08 to +0.19 ± 0.06). Pachymetry decreased by 117.9 ± 62.2 µm at D1 and increased by 37.87 ± 32.6 µm between D1 and M6. Refraction was emmetropic at D1 and remained stable thereafter. Six months after surgery, VA was slightly but nonsignificantly improved (<0.05 log MAR), whereas contrast sensitivity remained unchanged. Quality of vision was not affected by surgery and was more related to dry eye symptoms than to corneal HOAs (r2 = 0.49; p < 0.001 vs. r2 = 0.03; p < 0.001). Conclusions. LASIK surgery for moderate to high myopia, performed with the WaveLight® Refractive Suite, showed good postoperative outcomes, with demonstrated safety, predictability, efficiency, and stability. This is probably due to well-controlled spherical aberration and the use of large optical zones. Besides, we can assume that the patients' quality of vision depends more on the postoperative dry eye disease generated by the laser than on the induced HOAs. [ABSTRACT FROM AUTHOR]

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Approximately 25% of school-aged children in the United States have vision abnormalities, most commonly refractive error that can be corrected with spectacles. Limited follow-up adherence after failed school-based vision screening led to an increase in school-based eye care programs that provide screening, eye examinations, and spectacle prescription at the school. These programs address the access barrier and often provide the first point of contact between children and eye care. Nevertheless, several lower prevalence conditions, such as amblyopia, strabismus, and glaucoma, cannot be adequately treated in the school setting, and some require frequent and long-term follow-up, necessitating referral to eye care providers in the community. We conducted a literature review and identified 10 programs that provided school-based screening, examinations, and spectacle prescription and reviewed their referral rates, criteria, mechanisms, adherence, ocular findings at referral, and long-term care plans. Most programs referred 1% to 5% of screened children. Most communicated with parents or guardians through referral letters and used various strategies to incentivize adherence. Referral adherence was 20-50% in the four programs that reported these data. School-based eye care programs rarely referred children for long-term follow-up care needs, such as updating spectacle prescriptions annually. [ABSTRACT FROM AUTHOR]

Purpose: To gain a better understanding of eye care professionals' (ECPs) perceptions regarding the benefits of silicone hydrogel (SiH) daily disposable contact lenses (DDCL), particularly with respect to health, comfort and patient satisfaction.Methods: A survey was conducted with 300 ECPs in the United States, United Kingdom and Japan during November 2017. The survey comprised 34 statements relating to SiH DDCLs, to which the ECPs provided their level of agreement using a 6 point Likert scale. A minimum of 70% agreement was set to define majority agreement. Categories of statements included Health, Comfort, Patient Experience, and Standard of Care.Results: ECPs rated the highest levels of agreement to perceptions within the Patient Experiences and Health categories. The six statements receiving the highest ratings were "Silicone hydrogel 1 day lenses satisfy today's patients' demanding lifestyles" (93% agreement); "Silicone hydrogel 1 day lenses are the best choice to safeguard my patients' eye health related to contact lens wear" (92%); "Silicone hydrogel 1 day lenses provide the best benefits to my patients" (92%); "Silicone hydrogel 1 day lenses provide better long term eye health for my patients than hydrogel 1 day lenses" (91%); "Silicone hydrogel is the healthiest lens material for my daily disposable patients" (90%); and "Silicone hydrogel 1 day lenses provide a better wearing experience for my patients than hydrogel 1 day lenses" (90%).Conclusion: ECPs perceive that SiH DDCLs offer long-term eye health
and comfort for the patient and although the ECPs surveyed would not necessarily prescribe SiH DDCLs to all their patients, they would prescribe them to most of their patients. The results support the premise that while ECPs consider SiH 1 day contact lenses as the current "standard of care"; the principal barrier continues to be the perceived higher cost of these lenses. [ABSTRACT FROM AUTHOR]

To determine the agreement of 6 established visual field (VF) progression algorithms in a large dataset of VFs from multiple institutions and to determine predictors of discordance among these algorithms. Retrospective longitudinal cohort study. Visual fields from 5 major eye care institutions in the United States were analyzed, including a subset of eyes with at least 5 Swedish interactive threshold algorithm standard 24-2 VFs that met our reliability criteria. Of a total of 831 240 VFs, a subset of 90 713 VFs from 13 156 eyes of 8499 patients met the inclusion criteria. Six commonly used VF progression algorithms (mean deviation [MD] slope, VF index slope, Advanced Glaucoma Intervention Study, Collaborative Initial Glaucoma Treatment Study, pointwise linear regression, and permutation of pointwise linear regression) were applied to this cohort, and each eye was determined to be stable or progressing using each measure. Agreement between individual algorithms was tested using Cohen's κ coefficient. Bivariate and multivariate analyses were used to determine predictors of discordance (3 algorithms progressing and 3 algorithms stable). Agreement and discordance between algorithms. Individual algorithms showed poor to moderate agreement with each other when compared directly (κ range, 0.12–0.52). Based on at least 4 algorithms, 11.7% of eyes progressed. Major predictors of discordance or lack of agreement among algorithms were more depressed initial MD (P < 0.01) and older age at first available VF (P < 0.01). A greater number of VFs (P < 0.01), more years of follow-up (P < 0.01), and eye care institution (P = 0.03) also were associated with discordance. This extremely large comparative series demonstrated that existing algorithms have limited agreement and that agreement varies with clinical parameters, including institution. These issues underscore the challenges to the clinical use and application of progression algorithms and of applying big-data results to individual practices. [ABSTRACT FROM AUTHOR]

Objective: Diabetic retinopathy (DR) is the leading cause of blindness among working-age adults, and although screening with eye exams is effective, screening rates are low. We evaluated eye exam visits over a 5-year period in a large population of insured patients 10-64 years of age with diabetes.Research Design and Methods: We used claims data from IBM Watson Health to identify patients with diabetes and continuous insurance coverage from 2010 to 2014. Diabetes and DR were defined using ICD-9 Clinical Modification codes. We calculated eye exam visit frequency by diabetes type over a 5-year period and estimated period prevalence and cumulative incidence of DR among those receiving an eye exam.Results: Among the 298,383 insured patients with type 2 diabetes and no diagnosed DR, almost half had no eye exam visits over the 5-year period and only 15.3% met the American Diabetes Association (ADA) recommendations for annual or biennial eye exams. For the 2,949 patients with type 1 diabetes, one-third had no eye exam visits and 26.3% met ADA recommendations. The 5-year period prevalence and cumulative incidence of DR were 24.4% and 15.8%, respectively, for patients with type 2 diabetes and 54.0% and 33.4% for patients with type 1 diabetes.Conclusions: The frequency of eye exams was alarmingly low, adding to the abundant literature that systemic changes in health care may be needed to detect and prevent vision-threatening eye disease among people with diabetes. [ABSTRACT FROM AUTHOR]

Diabetic retinopathy is prevalent among American adults with diabetes. Tight control of glycemic levels, BP, and lipids can help reduce patients' risk of developing diabetic retinopathy, which can lead to severe visual loss and blindness if not treated. Teleophthalmology done in primary care offices can increase the number of patients who are screened, saving patients' vision through early detection and treatment of diabetic retinopathy. [ABSTRACT FROM AUTHOR]

Archaeological and archival data from a World War II internment camp where a predominantly Japanese American population was incarcerated offers a glimpse into the United States government's compliance with the Geneva Prisoners of War Convention of 1929. The Geneva Convention outlines the basic necessities afforded to prisoners of war and non-citizens, such as access to leisure activities; alcohol; dental and ophthalmological care; and medical facilities. The study of vision and eye-related artefacts, such as safety goggles and eye medicine, provides an opportunity to examine how prisoners' health was managed by the United States government during World War II. [ABSTRACT FROM AUTHOR]

Contact lens-related eye infections, which can lead to serious outcomes, including blindness, are associated with several risk factors, including sleeping in lenses, exposing lenses to water, not adhering to replacement schedules, and reusing disinfecting solution (1). In some studies, adolescent and young adult contact lens wearers have been reported to be more likely than older adult contact lens wearers to develop eye infections (2,3) and more likely to have poor contact lens hygiene practices (2). In 2015, CDC reported the number and demographics of adult contact lens wearers in the United States to define the population at risk for contact lens-related eye infections (4); however, this estimate did not include adolescents. To better understand this group of younger contact lens wearers and guide prevention efforts, a population-based survey was used to assess contact lens wear, care behaviors, risk factors, and demographics among persons aged 12-17 years (referred to as adolescents in this report), young adults aged 18-24 years, and older adults aged ≥25 years in the United States. In 2016, an estimated 3.6 million adolescents (14.5%) wore contact lenses. Of the adolescents who wore contact lenses, 85% reported at least one behavior that put them at risk for a contact lens-related eye infection, compared with 81% of young adults, and 88% of older adults. These findings can inform the creation of age-specific targeted prevention messages aimed at contact lens wearers and establish a baseline for evaluating trends in contact lens wear, care habits, and contact lens-related risk behaviors. [ABSTRACT FROM AUTHOR]

This study extends the existing stream of research on channel relationship by examining the antecedents and consequences of firm commitment (i.e., affective and calculative) among small-sized firms in the United States (US) eyecare industry. Achieving strong growth in today's primary eyecare market presents a challenge for many independents as they face new uncertainties from competition and regulatory reforms. Compounded by their inability to offer lower prices as well as lacking individual negotiating power with manufacturers, many small independent opticals have turned to buying groups to help reduce product acquisition costs as well as to stay competitive as independent entities. A mail survey of 200 independent opticals was conducted, and the data was analysed using structural equation modelling. The two dependent variables of interest are repurchase intentions and relational tolerance. The effect of affective commitment is positive and significant for both repurchase intentions and relational tolerance while calculative commitment only had a positive impact on relational tolerance. Findings further suggest that both transactional and relational-specific investments help govern the relationship between buying groups and independents in an uncertain environment. Transaction specific investment increase independents' calculative commitment as it creates value in the form of cost saving and profit enhancement. At the same time, this study corroborates arguments from social exchange theory regarding the role of relational mechanisms in reducing opportunism by enhancing independents' affective commitment. However, while the bright side of social capital has often been the focus on buyer-seller relationships, the positive relationship between relational embeddedness and calculative commitment supports the emergent notion of the dark side of social capital. [ABSTRACT FROM AUTHOR]

Objectives: Eye care in the Veterans Affairs Health Care System is challenged with increasing demand and higher prevalence of patients with complex ocular conditions. Understanding factors that impact eye care productivity and access is necessary for appropriate allocation of resources. The purpose of this study was to determine the impact of various eye clinic personnel on eye care provider productivity and patient access.Methods: Utilizing data from the Veterans Health Administration National Data Warehouse, workload and level of staffing were analyzed. Trends in the data were analyzed using descriptive and regression analyses employing both linear and curve fitting modeling methods.Results: There was a significant positive correlation between ophthalmology technicians and ophthalmologist productivity (p < 0.001), number of unique patients seen per year per provider (p = 0.047), and total yearly number of office visits per provider (p < 0.001). Similarly, there was a significant positive correlation between number of ophthalmology residents and productivity (p = 0.046) and number of clinic visits per provider (p < 0.001) but not the number of unique patients seen. Positive correlation was found between optometry technicians and the number of unique patients' seen by optometrists (p = 0.041) and total number of clinic visits per provider (p < 0.001) but not optometrist productivity. No significant correlations were present for nurses, nurse practitioners, physician assistants, or clerical staff.Conclusion: Eye care technicians provide a cost-effective multiplier effect for provider productivity, especially in ophthalmology clinics, allowing significant increases in total clinic visits and number of unique patients seen per year. [ABSTRACT FROM AUTHOR]

The article offers insight to the laws governing health care under U.S. False Claims Act (FCA). Topics discussed include analysis of the misapplication of the FCA to health care quality cases; history of how health care came under the FCA; and United States v. NHC Healthcare Corp. case addressing the same.

Education about how to administer eye drops may improve a patient's ability to instill his or her eye drops correctly. Our objectives were to (a) document the methods providers use to educate glaucoma patients about eye drop technique; (b) determine whether eye drop technique education varies by provider and patient characteristics; and (c) evaluate whether education predicts improved patient technique. We conducted an 8-month longitudinal study of 279 glaucoma patients and 15 providers in which we recorded on videotape the content of glaucoma office visits at two time points (baseline and 4- to 6-week follow-up) and videotaped patient eye drop technique at three time points (baseline, 4- to 6-week followup, and 8-month follow-up). Mann-Whitney rank sum tests were used to determine whether education was associated with improved patient eye drop technique over time. Ninety-four patients (34%) received technique education at either visit; 31% received verbal education and 10% received a technique demonstration. Only 24 patients (47%) who were new to eye drops received technique education at the baseline visit. Patients who were new to drops at baseline (p = .008) and patients who asked a question about drops (p < .001) were more likely to receive technique education. Education was not associated with improved technique. Eye drop technique education occurs infrequently during glaucoma office visits. Future studies should compare the effectiveness of different educational methods, such as patient demonstration versus provider verbal instruction, to determine which method is best at improving patient eye drop technique. [ABSTRACT FROM AUTHOR]

Sight-threatening eye diseases such as strabismus (misaligned eyes) and amblyopia (lazy eye) develop during childhood. The earlier in life these diseases are diagnosed and effectively treated, the greater the chance of preventing irreversible long-term sight loss. Using 2001-14 claims data for nearly 900,000 US children with health insurance, we followed a cohort for up to fourteen years from birth, to assess whether household net worth affected rates of visits to ophthalmologists and optometrists or rates of diagnoses of strabismus and amblyopia. We found considerably lower use of eye care services among children in less affluent families than among those in more affluent ones, resulting in estimates of nearly 13,000 missed strabismus diagnoses and over 5,000 missed amblyopia diagnoses in a ten-year period. Despite ongoing efforts to improve screening rates for serious childhood ocular disorders, more attention should be directed to overcoming economic barriers that keep children from obtaining necessary eye care services. [ABSTRACT FROM AUTHOR]

Background Medicaid is the main public health insurance program for individuals with low income in the United States. Some state Medicaid programs cover preventive eye care services and vision correction, while others cover emergency eye care only. Similar to other optional benefits, states may add and drop adult vision benefits over time. Research objective This article examines whether providing adult vision benefits is associated with an increase in the percentage of low-income individuals with appropriately corrected distance vision as measured during an eye exam. Methodology We estimate the effect of Medicaid vision coverage on the likelihood of having appropriately corrected distance vision using examination data from the 2001–2008 National Health and Nutrition Examination Survey. We compare vision outcomes for Medicaid beneficiaries (n = 712) and other low income adults not enrolled in Medicaid (n = 4786) before and after changes to state vision coverage policies. Findings Between 29 and 33 states provided Medicaid adult vision benefits during 2001–2008, depending on the year. Our findings imply that Medicaid adult vision coverage is associated with a significant increase in the percentage of Medicaid beneficiaries with appropriately corrected distance vision of up to 10 percentage points. Conclusion Providing vision coverage to adults on Medicaid significantly increases the likelihood of appropriate correction of distance vision. Further research on the impact of vision coverage on related functional outcomes and the effects of Medicaid coverage of other services may be appropriate. [ABSTRACT FROM AUTHOR]

Background. There are limited research and substantial uncertainty about the level of eye care utilization in the United States. Objectives. Our study estimated eye care utilization using, to our knowledge, every known nationally representative, publicly available database with information on office-based optometry or ophthalmology services. Research Design. We analyzed the following national databases to estimate eye care utilization: the Medical Expenditure Panel Survey (MEPS), National Health Interview Survey (NHIS), Joint Canada/US Survey of Health (JCUSH), Behavioral Risk Factor Surveillance System (BRFSS), and the National Ambulatory Medical Care Survey (NAMCS). Subjects. US adults aged 18 and older. Measures. Self-reported utilization of eye care services. Results. The weighted number of adults seeing or talking with any eye doctor ranges from 87.9 million to 99.5 million, and the number of visits annually ranges from 72.9 million to 142.6 million. There were an estimated 17.2 million optometry visits and 55.8 million ophthalmology visits. Conclusions. The definitions and estimates of eye care services vary widely across national databases, leading to substantial differences in national estimates of eye care utilization. [ABSTRACT FROM AUTHOR]

The article discusses an analysis by the U.S. Centers for Disease Control and Prevention (CDC) on the geographic disparity of severe vision loss (SVL) in the U.S. from 2009-2013. The study examined the prevalence of SVL and its correlation with poverty level. It also identified the underlying barriers and facilitators of access and use of eye care services at the local level including lack of health insurance coverage and neighborhood environment.

The article offers information on the Sjögren's syndrome (SS), the most common autoimmune disorder among women. It is a slowly progressive and inflammatory autoimmune condition targeting the body's moisture-producing glands and women are 10 times more likely to have SS than men. It further discusses actual etiology of SS, pathophysiologic complexity of SS and treatment of SS.

This article analyzes and theorizes the current knowledge silos at the intersection of omics science, ophthalmology, personalized medicine, and global visual health. Visual disorders represent one of the largest health care expenditures in the United States, costing $139 billion per year. In middle-income and industrialized countries, glaucoma is a World Health Organization priority category eye disease, known for difficulties in its early diagnosis, chronic progressive nature, and large person-to-person differences in drug efficacy and safety. A complex disease, glaucoma is best conceptualized as a syndrome displaying an ostensibly common clinical end-point, but with vastly heterogeneous molecular underpinnings and host-environment interactions. About 12% of all global blindness is attributable to glaucoma. Glaucomics is a term that we coin here so as to introduce omics science and systems diagnostics to ophthalmology, a field that can benefit enormously from personalized medicine, and which has sadly lagged behind in systems diagnostics compared to fields such as oncology. We define glaucomics as the integrated use of multi-omics and systems science approaches towards rational discovery, development, and tandem applications of diagnostics and therapeutics, for glaucoma specifically, and for personalized visual health, more broadly. We propose that glaucoma is one of the neglected lowest hanging fruits and actionable targets for omics and systems diagnostics in 21st century ophthalmology for the salient reasons we describe here. Additionally, we offer an analysis on two of the most pertinent neglected tropical diseases (NTDs), trachoma and river blindness, which continue to plague visual health in developing countries. We conclude with a call for research on omics applications in glaucoma and personalized visual health. [ABSTRACT FROM AUTHOR]

Objective: To model the factors that are associated with the use of eye care services among the US population with and without diabetes, stratifying by age group. Design: Meta-analysis. Participants: We analyzed data from 3 datasets: the Behavioral Risk Factors Surveillance System combined years 2006-2009, the National Health and Nutrition Examination Survey combined years 2005-2008, and the National Health Interview Survey year 2008. For all 3 datasets, we analyzed data from all survey participants aged 40 years or older who participated in vision-related survey modules. Methods: We performed multivariate logistic regression analyses to assess associations between any eye care use within the previous year and 14 indicators of patient demographics and health. We estimated separate regressions for persons with and without diabetes stratified by age group. We combined estimates across datasets using a random effects model estimated using Markov Chain Monte Carlo algorithms. Main Outcome Measures: Use of eye care in the previous year and personal factors associated with eye care use. Results: Annual eye care use rates ranged from 46% to 51 % in participants without diabetes and 64% to 72% in participants with diabetes. For people with and without diabetes, health insurance, an eye disease diagnosis, and higher income were associated with higher odds of eye care use. Being male was associated with lower odds of eye care use in some diabetes status and age group categories. Other variables, such as more education, being married, black race, Hispanic/Latino ethnicity, health status, heavy drinking, and limited ability to read small print, were associated with eye care use in only some diabetes status and age group categories. Conclusions: Our findings indicate that economic and ocular health factors are associated with the greatest odds of annual eye care use. Access to health insurance and income levels greater than $35 000 US dollars (value at the time of interview) are associated with eye care use independently of other demographic factors. [ABSTRACT FROM AUTHOR]

Prisons have become the primary health care provider for some of the poorest and sickest women in the United States. By virtue of both biological sex and gender, incarcerated women have health needs different from those of their male counterparts. The purpose of this qualitative investigation was to understand better women's perceptions of how prison has affected their physical health. We conducted this investigation in a maximum-security women's prison in the United States using focus group methodology (12 focus groups, made up of 65 women). Women described several specific prison-based factors that affected their physical health: limited and complicated access to care; nutritional concerns; limited physical activity; and smoking in prison. We discuss these findings in relation to the gender-based health issues facing incarcerated women. [ABSTRACT FROM AUTHOR]

Purpose: To identify risk factors associated with central retinal vein occlusion (CRVO) among a diverse group of patients throughout the United States. Design: Longitudinal cohort study. Participants: All beneficiaries aged ≥55 years who were continuously enrolled in a managed care network for at least 2 years and who had ≥2 visits to an eye care provider from 2001 to 2009. Methods: Insurance billing codes were used to identify individuals with a newly diagnosed CRVO. Multivariable Cox regression was performed to determine the factors associated with CRVO development. Main Outcome Measures: Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of being diagnosed with CRVO. Results: Of the 494 165 enrollees who met the study inclusion criteria, 1302 (0.26%) were diagnosed with CRVO over 5.4 (±1.8) years. After adjustment for known confounders, blacks had a 58% increased risk of CRVO compared with whites (HR, 1.58; 95% CI, 1.25–1.99), and women had a 25% decreased risk of CRVO compared with men (HR, 0.75; 95% CI, 0.66–0.85). A diagnosis of stroke increased the hazard of CRVO by 44% (HR, 1.44; 95% CI, 1.23–1.68), and hypercoagulable state was associated with a 145% increased CRVO risk (HR, 2.45; 95% CI, 1.40–4.28). Individuals with end-organ damage from hypertension (HTN) or diabetes mellitus (DM) had a 92% (HR, 1.92; 95% CI, 1.52–2.42) and 53% (HR, 1.53; 95% CI, 1.28–1.84) increased risk of CRVO, respectively, relative to those without these conditions. Conclusions: This study confirms that HTN and vascular diseases are important risk factors for CRVO. We also identify black race as being associated with CRVO, which was not well appreciated previously. Furthermore, we show that compared with patients without DM, individuals with end-organ damage from DM have a heightened risk of CRVO, whereas those with uncomplicated DM are not at increased risk of CRVO. This finding may provide a potential explanation for the conflicting reports in the literature on the association between CRVO and DM. Information from analyses such as this can be used to create a risk calculator to identify possible individuals at greatest risk for CRVO. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. [Copyright &y& Elsevier]

PURPOSE: To estimate the prevalence of annual eye care among visually impaired United States residents aged 40 years or older, by state, race/ethnicity, education, and annual income. DESIGN: Cross-sectional study. METHODS: In analyses of 2006-2009 Behavioral Risk Factor Surveillance System data from 21 states, we used multivariate regression to estimate the state-level prevalence of yearly eye doctor visit in the study population by race/ethnicity (non-Hispanic white, non-Hispanic black, Hispanic, and other), annual income (=$35 000 and <$35 000), and education (< high school, high school, and > high school). RESULTS: The age-adjusted state-level prevalence of yearly eye doctor visits ranged from 48% (Missouri) to 69% (Maryland). In Alabama, Colorado, Indiana, Iowa, New Mexico, and North Carolina, the prevalence was significantly higher among respondents with more than a high school education than among those with a high school education or less (P < .05). The prevalence was positively associated with annual income levels in Alabama, Georgia, New Mexico, New York, Texas, and West Virginia and negatively associated with annual income levels in Massachusetts. After controlling for age, sex, race/ethnicity, education, and income, we also found significant disparities in the prevalence of yearly eye doctor visits among states. CONCLUSION: Among visually impaired US residents aged 40 or older, the prevalence of yearly eye examinations varied significantly by race/ethnicity, income, and education, both overall and within states. Continued and possibly enhanced collection of eye care utilization data, such as we analyzed here, may help states address disparities in vision health and identify population groups most in need of intervention programs. [ABSTRACT FROM AUTHOR]

PURPOSE: To discuss the current trend toward greater use of electronic health records and how these records could enhance public health surveillance of eye health and vision-related conditions. DESIGN: Perspective, comparing systems. METHODS: We describe 3 currently available sources of electronic health data (Kaiser Permanente, the Veterans Health Administration, and the Centers for Medicare & Medicaid Services) and how these sources can contribute to a comprehensive vision and eye health surveillance system. RESULTS: Each of the 3 sources of electronic health data can contribute meaningfully to a comprehensive vision and eye health surveillance system, but none currently provide all the information required. The use of electronic health records for vision and eye health surveillance has both advantages and disadvantages. CONCLUSIONS: Electronic health records may provide additional information needed to create a comprehensive vision and eye health surveillance system. Recommendations for incorporating electronic health records into such a system are presented. [ABSTRACT FROM AUTHOR]

PURPOSE: To examine the ability of current surveillance systems to assess and monitor disparities in: (1) vision impairment, (2) eye disease, (3) vision-related functioning, (4) access to vision and eye care, and (5) access to supports and services for those needing vision rehabilitation. DESIGN: Review of surveillance systems and instruments. METHODS: We defined surveys and surveillance systems as data collection systems that used an active survey or data abstraction instrument, regardless of the sampling unit, and excluded strictly administrative data sources. We assessed 8 surveys against key surveillance attributes of representativeness, flexibility, and timeliness, as well as their contribution to establishing a national vision surveillance system. RESULTS: The key challenges facing a national vision surveillance system are: (1) the lack of consistent outcome data with adequate sample size and coverage to enable identification and tracking of vision health disparities, (2) lack of standardized data elements, and (3) a paucity of data that influence disability such as behavioral and environmental data. CONCLUSIONS: Current systems for assessing and monitoring vision health in the United States are limited and do not provide adequate information to guide interventions and policy decisions. Vision surveillance can help to document the burden of the condition, to identify high-risk populations, to develop strategies to reduce the individual and societal burden, and to guide public health programs and policies. Existing surveillance systems could be enhanced by integrating data and by periodically including patient-reported outcomes measurements including, but not limited to, specific barriers for people with vision impairment and related disabilities. [ABSTRACT FROM AUTHOR]