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Letter From the Chair of the NEHEP Planning Committee

November has been declared “American Diabetes Month” by the American Diabetes Association and “Diabetic Eye Disease Month” by Prevent Blindness America. Proper care for individuals with diabetes can prevent blindness, but how can we communicate the importance of regular eye exams to the millions of people with diabetes?

We can start by readying ourselves with facts about diabetes and its devastating consequences. The Centers for Disease Control and Prevention reported in 2004 that 6.3 percent of the U.S. population had diabetes,¹ and more recent estimates suggest that 7.8 percent of the population, or roughly 23.6 million people, have diabetes.² Vision researchers reported the same year that more than 4 million Americans (3.4%) aged 40 and older have some form of diabetic retinopathy, with the number projected to reach 6.1 million by the year 2020.³ Diabetes has also been linked to greater risk of and earlier consequences of cataracts.^4,5

Ethnicity is a factor in the prevalence of both diabetes and diabetic eye disease. In particular, Latinos have higher rates of diabetes and are at higher risk for diabetic eye disease.⁶ Beyond having disparate rates of disease, a 2005–2006 survey sponsored by the National Eye Institute (NEI) and Lions Club International Foundation found that only 37 percent of Hispanics had heard of diabetic eye disease as compared with 52 percent of non-Hispanic adults.⁷ Although glaucoma was not noted to be disproportionate among people with diabetes in a predominantly non-Latino population,⁸ a recent population-based study of Latinos did link diabetes to glaucoma risk.⁹ Research continues in an effort to better understand the mechanisms that trigger eye disease in those with diabetes.

As the prevalence of diabetes rises, diabetic retinopathy can be expected to rise along with it unless preventive action is taken. Because early diagnosis, timely treatment, and follow-up have been shown to prevent vision loss in more than 90 percent of patients,¹⁰ healthcare practice guidelines recommend a dilated eye exam at least once a year for all people with diabetes.¹¹ With such substantial health benefits so readily accessible, there is a pressing need for regular eye exams to be a target of health promotion efforts.
 
This issue of Outlook offers further insights. The article “Variables That Influence the Receipt of Eye Care” explores factors that predict routine screening and care to prevent vision loss, as well as whether those factors differ by race and ethnicity. The article “Diabetic Eye Disease: What You Can Do To Make a Difference” provides information about the many English and Spanish resources available from NEI along with suggestions for using them. In particular, these resources explain how a dilated eye exam can help prevent unnecessary vision loss among people with diabetes.

We hope you will avail yourself of the many resources NEI has to offer. We also ask you to be public health ambassadors in the broader effort to reduce the disease burden and risk of blindness for people with diabetes. “American Diabetes Month” and “Diabetic Eye Disease Month” might be catalysts, but it will take year-round dedication on the part of vision health professionals to raise awareness about proper eye care for people with diabetes. Let us know about your efforts. We would love to hear about them.

Anne Louise Coleman, M.D., Ph.D.
Chair, National Eye Health Education Program Planning Committee
Frances and Ray Stark Professor of Ophthalmology
Jules Stein Eye Institute
David Geffen School of Medicine at UCLA
and
Professor of Epidemiology
UCLA School of Public Health

References

¹ National Diabetes Awareness Month—November 2004. (2004). MMWR, 53(43), 1007.
² Centers for Disease Control and Prevention National Diabetes Fact Sheet. (2007). Available at http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf.
³ The Eye Diseases Prevalence Research Group. (2004). Prevalence of Diabetic Retinopathy Among Adults in the United States. Archives of Ophthalmology, 122(4): 552–63.
⁴ Klein, B. E., Klein, R., Moss, S. E. (1985). Prevalence of cataracts in a population-based study of persons with diabetes mellitus. Ophthalmology, 92(9): 1191–96.
⁵ Klein, B. E., Klein, R., Lee, K. E. (1998). Diabetes, cardiovascular disease, selected cardiovascular disease risk factors, and the 5-year incidence of age-related cataract and progression of lens opacities: The Beaver Dam Eye Study. American Journal of Ophthalmology, 26(6): 782–90.
⁶ Varma, R., Torres, M., Peña, F., Klein, R., Azen, S. P., Los Angeles Latino Eye Study Group. (2004). The prevalence of diabetic retinopathy in adult Latinos. The Los Angeles Latino Eye Study. Ophthalmology, 111(7), 1298–1306.
⁷ National Eye Institute & Lions Clubs International Foundation. (2007). 2005 survey of public knowledge, attitudes, and practices related to eye health and disease. Bethesda, MD: National Eye Institute. Available at: http://www.nei.nih.gov/kap/2005KAPFinalRpt.pdf.
⁸ Tielsch, J. M., Katz, J., Quigley, H. A., Javitt, J. C., Sommer, A. (1995). Diabetes, intraocular pressure, and primary open-angle glaucoma in the Baltimore Eye Survey. Ophthalmology, 102(1): 48–53.
⁹ Chopra, V., Varma, R., Francis, B., Wu, J., Torres, M., Azen, S. (2008). Type 2 Diabetes Mellitus and the Risk of Open-angle Glaucoma: The Los Angeles Latino Eye Study. Ophthalmology, 115(2): 227–232.
¹⁰ Ferris, I.  (1993). The Early Treatment Diabetic Retinopathy Study Research Group. How Effective are Treatments for Diabetic Retinopathy? Journal of the American Medical Association 269(10):1290–1291.
¹¹  American Diabetes Association. (1999). Clinical practice recommendations. Diabetes Care, 22 (Suppl. 1):S70–S73.

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Variables That Influence the Receipt of Eye Care: Focus Group Report

To better understand factors that influence the receipt of eye care, the National Eye Institute (NEI) conducted 20 focus groups across the United States to examine factors that influence preventive eye care, including both routine screening and care to prevent vision loss. The research also sought to explore whether those factors differ by race and ethnicity. A total of 180 males and females over the age of 40 participated in the discussions. Participants were self-identified as African American (54), Hispanic/Latino (54), White (36), and Asian (36). The overarching themes that emerged from the research and respective factors reported by the majority of participants were:

• Several attitudes influence the receipt of eye care:
• Eyesight is important to them.
• Healthcare system is a hassle.
• Poor relationships or lack thereof with providers.
• Eyesight is taken for granted.

• There is a lack of knowledge about preventive eye care and the importance of eye examinations:
• They did not feel knowledgeable about eye diseases and conditions.
• They do not seek out information about their eyes.
• Physicians do not share eye health information with them.

• Communication influences the receipt of eye care:
• Poor communication and a lack of time with providers negatively impacts beliefs and attitudes about receiving eye and/or healthcare services.
• Medical information is often difficult to understand.
• Language barriers that exist can lead to a misunderstanding of health messages and perceived mistreatment.

• Culture influences the receipt of eye care primarily for African-American and Hispanic/Latino racial/ethnic groups.
• Traditional, folk, and home remedies are used to cure eye problems before going to see an eye care professional.
• Undertones of perceived racial and ethnic discrimination and bias exist.
• There is a lack of preventive medicine practices embedded in the culture of certain minority racial and ethnic groups, particularly among Hispanics/Latinos.
• A tradition practiced among African Americans is a wait-and-see approach.

The feedback gathered in the focus groups resulted in the Identification of Variables That Influence the Receipt of Eye Care Focus Group Report.^1,2 In addition to the findings provided above, the report offers a wealth of information on a variety of factors that differ by race/ethnicity related to the receipt of eye care. In order to address some of the barriers to receiving eye care, there are also recommendations in this report to address the cost of eye care services; recognize cultural differences in receiving eye care; and continue outreach to make eye care more of a health priority.

References:

¹Alexander, R.L., Miller, N.A., Cotch, M.F., & Janiszewski, R. (2008). Factors that influence the receipt of eye care. American Journal of Health Behavior, 32(5), 547-556.
²National Eye Institute. (2005). Identification of Variables That Influence the Receipt of Eye Care. Available online at http://www.nei.nih.gov/nehep/research/REC_FocusGroupReport_10-25-05_wExec.pdf.

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Diabetic Eye Disease: What You Can Do To Make a Difference

Diabetic eye disease (DED) is a complication of diabetes. DED refers to a group of eye problems—the most common types of DED are diabetic retinopathy, cataract, and glaucoma. All can cause severe vision loss or even blindness. There are often no symptoms in the early stages of DED.

Healthcare practice guidelines recommend a dilated eye exam at least once a year for all people with diabetes.¹ Early diagnosis, timely treatment, and follow-up have been shown to prevent vision loss in more than 90 percent of patients.² However, studies indicate that many people with diabetes do not get an annual dilated eye exam. An estimated 50 percent of patients are diagnosed too late for treatment to be effective.³

You can help raise public awareness about the need for people with diabetes to have dilated eye exams by distributing information to your family, friends, coworkers, and mailing list members. The National Eye Institute (NEI) has a variety of materials in English and Spanish, including public service announcements (PSAs), brochures, posters, teaching resources for health professionals, and more.

The following are examples of materials and ideas about how to use them. You can find them at http://www.nei.nih.gov/diabeteseducation.

Educator’s Guide

What You Can Do: Inform health professionals about this easy-to-read flipchart to educate their patients with diabetes about important steps they can take to protect their vision.

How You Can Do It: Contact local hospitals, health clinics, and organizations that offer individual and group classes for people with diabetes to let them know about this resource. There is also a downloadable announcement about the Educator’s Guide to post on websites or in newsletters that reach health professionals who work with people with diabetes.

Medicare Benefit Card

What You Can Do: Help others obtain the diabetic eye disease and glaucoma benefit under Medicare. The card (also available in Spanish) contains information about benefit eligibility and where to go to learn more.

How You Can Do It: Distribute at health fairs, clinics, and other community locations. Place cards in your cafeteria or lunch room with a note to “Take one for someone you care about.” Work with local pharmacies to make the cards available to their customers.

DED Education Website

What You Can Do: Link others to a consumer-friendly site where they can learn about early detection, treatment, and follow-up care for diabetic eye disease.

How You Can Do It: Post the link on your intranet or website. Include information about the website in emails and newsletters to your constituents.

Spanish-language Poster—Lo bello entra por los ojos...no deje que la diabetes cierre esa ventana (Beauty enters through the eyes. Don’t let diabetes close the window.)

What You Can Do: Let those in the Hispanic/Latino community know about this poster that includes a reminder message about receiving an annual dilated eye exam and offers tips about how to engage in healthy behaviors to control diabetes.

How You Can Do It: Provide a poster to local grocery stores and bodegas and ask them to display it in a place where customers will see it. Be sure to provide information to let people know where they can order their own copies of the poster.

¡Ojo con su visión! (Watch Out for Your Vision!)—Photonovella

What You Can Do: Help those in the Hispanic/Latino community better understand diabetes and the importance of having a dilated eye exam at least once a year.

How You Can Do It: Distribute this newly revised, full-color comic book-style booklet at locations that provide programs to the Hispanic/Latino community, such as community clinics and centers, libraries, and houses of worship.

Don’t Lose Sight of Diabetic Eye Disease Brochure

 What You Can Do: Make sure that eye care professionals in your community know about this brochure which is available in English and Spanish.

How You Can Do It: Stop in at local eye care professionals’ offices and ask them to make it available to their patients. Leave a copy and be sure to provide information about how they can order a supply.

TRACK Magnet

What You Can Do: Find opportunities to have the magnet included with diabetes medications and supplies.

How You Can Do It: Ask local pharmacists and medical supply establishments to include a magnet when prescriptions or supplies for diabetes care are picked up.

Print and Radio Public Service Announcements (PSAs)

 What You Can Do: Enlist the mass media. NEI offers a variety of downloadable print and radio PSA scripts about the importance of dilated eye exams.

How You Can Do It: Use our ready-made scripts to record PSAs that your organization can play on your hold line or distribute to local radio stations. Download print PSAs, available in a variety of sizes, and ask the editor of your local newspaper to run them.

Don’t Lose Sight of Diabetic Eye Disease Drop-in Article

What You Can Do: Let people with diabetes and those who care about them know about the importance of having a dilated eye exam at least once a year.

How You Can Do It: Put this article in your company or organizational newsletter or post it on your company bulletin board or intranet. Contact the marketing or health education department at the nearest hospital to see if they can place the article in the publication that they produce and distribute to the community. Get in touch with a newspaper health editor and request that the article be printed.

For more ideas, download Educating Your Community About Diabetic Retinopathy. This resource contains facts about diabetic retinopathy, activity suggestions, promotional materials, and a reproducible brochure.

You can learn more about activities, resources, and materials for people with diabetes, including Hispanics/Latinos by visiting www.nei.nih.gov/nehep.

References:

¹American Diabetes Association. (1999). Clinical practice recommendations. Diabetes Care 22 (Suppl. 1):S70–S73.
²Ferris, I.  (1993). The Early Treatment Diabetic Retinopathy Study Research Group. How Effective are Treatments for Diabetic Retinopathy? Journal of the American Medical Association 269(10):1290–1291.
³National Health Interview Survey. (1998). National Center for Health Statistics, Centers for Disease Control and Prevention.

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NEI Launches Online News Magazine

The National Eye Institute (NEI) has launched Eye on NEI, a monthly online news magazine that gives readers an inside look at the vision research process, from the laboratory bench to the patient’s bedside.

The site features four sections:

• Insight, an in-depth story describing vision research in action;
• Visionary, an interview with an NEI scientist;
• Snapshot, an eye research or clinical image explained; and
• Ask the Doctor, an eye health question answered by an NEI clinician.

Previous stories include: a profile of a blind adventure athlete who is testing a breakthrough vision device known as BrainPort, an interview with a scientist who spent more than four decades working at NIH, an image of a rare genetic disorder that affects the retina, and an explanation of why people cry when cutting an onion. Stories can be shared via email or printed for distribution in offices and clinics.

To read the latest issue and sign up to receive monthly content, visit www.nei.nih.gov/EYEonNEI. To offer feedback or suggest a story idea, contact the editor at collinsat@nei.nih.gov.

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InfantSEE^® Pilot Program Tests New Awareness Efforts

As part of a continuous effort to raise awareness about infants’ vision and eye health in the U.S., the InfantSEE^® program, administered by Optometry’s Charity™—The American Optometric Association (AOA) Foundation launched a pilot project to test new ways of raising awareness and increasing the number of patients seen. Funded by the Centers for Disease Control and Prevention (CDC), the InfantSEE^® Project conducted an eight-state tour that provided more than 1,000 comprehensive eye and vision assessments to infants. The tour began in January 2009, in Madison, Wisconsin, with additional stops in Bismarck, North Dakota; Des Moines, Iowa; Chicago, Illinois; Seattle, Washington; and St. Louis, Missouri.  A statewide tour was made in West Virginia and the pilot project wrapped up in August with a statewide tour of Louisiana.

The InfantSEE^® program provides no-cost comprehensive eye and vision assessments for infants between 6 and 12 months of age. During this tour, new avenues were used to inform the general public about the InfantSEE^® program.  Grassroots partnerships and local advertising helped to successfully educate the public about the importance of infants’ vision and the availability of InfantSEE^® in local communities. Parents were encouraged to call participating offices to schedule InfantSEE^® appointments for their babies.

As an additional method of outreach, Vision Service Plan (VSP) provided the InfantSEE^® program with use of its mobile eye clinic to promote the program in the states of West Virginia and Louisiana. In addition to this unique outreach, the InfantSEE^® program was also able to form partnerships with State Maternal and Child Health Agencies in these two states. Both of these partnerships provided new methods for promoting the program to distinct populations.

Overall, the 2009 CDC InfantSEE^® Week pilot program provided a unique approach to promoting the program. Through the engagement of local optometrists as well as local and state optometric associations, the InfantSEE^® program has strengthened its ability to provide services to patients.

For more information about the InfantSEE^® program, visit www.infantsee.org  or contact Julie Mahoney, Administrator, at 314–983–4176 or JMMahoney@aoa.org.

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PBA Receives MCHB Grant To Create National Center To Save Sight

According to a study by the Centers for Disease Control and Prevention, more than 12.1 million school-aged children have some form of vision problem, yet only one in three children in America have received eye care services before the age of 6. The National Eye Institute (NEI) reports that the most prevalent and significant vision disorders of preschool children are amblyopia (lazy eye), strabismus (crossed eyes), and significant refractive error.

Healthy eyes and vision are critical to the success of children in the classroom. Because of this, Prevent Blindness America (PBA), the Nation’s oldest volunteer eye health and safety organization, has been awarded a multiyear grant from the Maternal and Child Health Bureau (MCHB), a bureau of the Health Resources and Services Administration, U.S. Department of Health and Human Services. PBA will use the funds to establish the National Universal Vision Screening for Young Children Coordinating Center, which will promote and ensure a continuum of eye care for young children within the healthcare system. The Center will focus on:

• Providing national leadership in the development of statewide vision screenings and eye health programs for all children prior to entering school.
• Developing and implementing a plan to assist states in coordinating existing vision screening activities.
• Collaboration with the states of Georgia, Illinois, Massachusetts, North Carolina, and Ohio to develop and implement a statewide strategy for universal vision screening, data collection, and creation of a standardized performance measure for vision screening.

PBA will also establish a National Expert Panel on Young Children’s Vision Screening as part of this groundbreaking grant award. The Panel will include representatives from the fields of ophthalmology, optometry, pediatrics and public health. This panel will also serve as an expert advisory panel to the National Coordinating Center. “Our children are our most important asset and we want to ensure that every child in America has been given the opportunity to succeed academically by being able to see clearly as they start school,” said Hugh R. Parry, president and CEO of Prevent Blindness America. “Through this generous grant from the Maternal and Child Health Bureau, we can create and implement programs that will help to place our children on a path to a lifetime of healthy vision.”  

For additional information, contact Sarah Hecker, Director, Media Relations,
Prevent Blindness America at 312–363–6035 or shecker@preventblindness.org, or
Jeff Todd, COO, Prevent Blindness America at 312–363–6026 or jtodd@preventblindness.org.

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Macular Degeneration Partnership Targets AMD Risk Groups

The Macular Degeneration Partnership’s (MDP) outreach program directly connects to groups most at risk for age-related macular degeneration (AMD). Through the AARP Vision Pavilion, the California Women’s Conference, and the Los Angeles Vision Symposium, MDP reached over 50,000 people. All three events focused on the importance of regular eye examinations and the benefits of lifestyle choices that reduce the risk of AMD.

The Vision Pavilion at this year’s AARP Life@50+ Expo enlisted the inimitable Doris Roberts, of “Everybody Loves Raymond” fame, to carry the message. Ms. Roberts delighted audiences with stories of her career and her campaign to fight ageism. She was joined by Steven D. Schwartz, M.D., Chief of the Retina Service at Jules Stein Eye Institute of the University of California, Los Angeles. Dr. Schwartz coupled his solid information on AMD with Doris’ zesty message to take charge of your life. Together, they highlighted the importance of regular eye exams and making lifestyle choices. Back at the Pavilion, Ms. Roberts signed autographs while MDP staff members distributed sunglasses, healthy food samples, and information on preventing vision loss. Another National Eye Health Education Program (NEHEP) partnership organization that regularly participates in the Vision Pavilion, the American Optometric Association, provided expert advice about eye health.

The California Women’s Conference connected MDP with 20,000 women of all ages. This was a great opportunity to reach another at-risk population with the message of getting regular eye exams and controlling lifestyle factors that contribute to macular degeneration. The conference is an annual event headed by California’s first lady, Maria Shriver.

The MDP is a program of the nonprofit Discovery Eye Foundation, which created the Los Angeles Vision Symposium, held on October 11. This day-long event featured Discovery researchers and other experts with presentations on macular degeneration, keratoconus, and glaucoma. A Vision Fair provided opportunities to try out assistive devices and connect with resources and services.

The next AARP Expo is September 2010 in Orlando, Florida. If you are interested in being part of the Vision Pavilion, please contact Judi Delgado at jdelgado@discoveryeye.org.

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Defining Blindness Prevention

Blindness Prevention is a consistent objective for many organizations and services, but there is no consensus about what this really means. Although the World Health Organization (WHO) describes blindness as a best corrected visual acuity of less than 3/60, the arbitrary nature of this clinical definition is well-recognized. Accordingly, practitioners of Blindness Prevention simply avoid the issue by describing various service activities that are intended to constitute blindness prevention, ranging from vision screening for sight limiting conditions (including uncorrected refractive error, amblyopia, diabetic retinopathy, and cataracts), to surgical interventions for treatable conditions (such as cataracts), to vision rehabilitation services for people with untreatable or untreated vision disorders. The blindness being prevented is actually avoidable visual loss and the related concept of prevention is as indeterminate as the concept of blindness. This imprecision poses a significant obstacle for developing standards for Blindness Prevention activities. WHO stratification of prevention into primary, secondary, and tertiary levels integrates nicely within a Model of Consequences of Pathology, which is predicated on the following semantic differentiations (Verbrugge, et al., 1994):

• Impairment: “Loss or abnormality of psychological, physiological, or anatomical structure or function at organ level.”
• Disability: “Restriction or lack of ability to perform an activity in normal manner.”
• Handicap: “Disadvantages due to impairment or disability that limits or prevents the fulfillment of a normal role (depends on age, sex, sociocultural factors) for the person.”

WHO’s Expert Committee on Disability Prevention and Rehabilitation (1981) identifies the following related prevention levels:

• First level (Impairment Prevention): This includes any measures to reduce the occurrence of impairment.
• Second level (Disability Prevention): This includes any measures to prevent an irreversible impairment from causing a disability.
• Third level (Handicap Prevention): This includes any measures to prevent an irreversible disability from causing a handicap.

Blindness Prevention goes well beyond preventing avoidable blindness and low vision through medical and health services interventions. It also includes the prevention of the impacts of unavoidable blindness and low vision on people being served by rehabilitation services. These latter prevention activities are often described in blindness prevention plans, but they are invariably overshadowed by prevention strategies that focus on medical and surgical interventions. Fortunately, accreditation standards for second and third levels of “blindness prevention” are already well established for accreditation authorities such as the National Accreditation Council (NAC) for Agencies Serving People with Blindness and Visual Impairment.

For more information, contact J. Graham Strong, O.D., M.Sc., Vice President of NAC at gstrong@sciborg.uwaterloo.ca.

References:

World Health Organization. (2003). Blindness and low vision. International Statistical Classification of Diseases and Related Health Problems. 10th revision, chapter VII. H54. Accessed online at http://www.who.int/classifications/icd/en/.

Verbrugge, L. M., Jette, A. M. (1994). The disablement process. Social Science & Medicine 38(1): 1–14. Accessed online on August 5, 2009, at http://deepblue.lib.umich.edu/bitstream/2027.42/31841/1/0000788.pdf.

Guidelines for programmes for the prevention of blindness. Geneva, World Health Organization, 1979: 9–47.

West, S., Sommer, A. (2001). Prevention of blindness and priorities for the future. Bulletin of the World Health Organization. 79(3): 244–248. Accessed online on August 5, 2009, at http://whqlibdoc.who.int/bulletin/2001/issue3/79(3)244-248.pdf.

Disability prevention and rehabilitation. Report of the WHO Expert Committee on Disability Prevention and Rehabilitation. Geneva, February 17–23, 1981. Accessed online on August 5, 2009, at http://whqlibdoc.who.int/trs/WHO_TRS_668.pdf.

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Wills Eye Institute Launches Online Learning Portal for Ophthalmologists

The Wills Eye Institute has launched the Wills Eye Knowledge Portal (www.willseyeonline.org), a comprehensive, state-of-the-art educational resource for ophthalmologists around the world. This new initiative features online lectures, cases, Chiefs’ Rounds, and surgical videos from all specialties, which are created from live events at the Wills Eye Institute, and offers physicians numerous online continuing medical education (CME) options.

Using the latest digital technologies, this innovative website (www.willseyeonline.org) features exclusive content created and produced by Wills Eye Institute’s team of specialists and provides physicians around the world with an outstanding learning environment in the field of ophthalmology.

“We are very proud to launch the Wills Eye Knowledge Portal and believe this site offers an unparalleled opportunity for ophthalmologists to benefit from the Wills Eye educational experience online,” said Joseph P. Bilson, Executive Director. “As the healthcare industry moves toward digital technology solutions, Wills Eye continues to provide physicians with the tools they need to achieve clinical and academic excellence in the convenience of their own home or office.”

A virtual tour of the Knowledge Portal, led by Dr. Julia Haller, Ophthalmologist-in-Chief at the Wills Eye Institute, is available online at www.willseyeonline.org.

For more information about the Wills Eye Knowledge Portal, contact Lisa Hark, Ph.D., project manager for Online Medical Education, Wills Eye Institute at 215–928–3045 or lhark@willseye.org.

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NOA Three Silent Killers Program

For more than 40 years, the National Optometric Association (NOA) continues to be a professional optometric organization focusing on “advancing the visual health of minority populations.” Its Three Silent Killers Program, sponsored in part by Alcon, a global healthcare company, has been NOA’s premiere program over the last five years. In response to the Healthy People 2010 initiative, NOA membership has chosen to promote good eye and general health among racial and other ethnic minorities. Specifically, NOA focuses on three sight-threatening conditions that are highly prevalent in these populations–glaucoma, diabetic eye disease, and high blood pressure.

NOA members use every opportunity to educate and inform patients of the importance of prevention and care of the three silent killers that strike minority groups more than other groups in the U.S. A panel of NOA doctors throughout the country log their communication with patients and their distribution of an easy-to-read, tri-fold color brochure about glaucoma, diabetes, and high blood pressure. The brochure discusses the importance of including routine eye examinations as part of an annual health assessment. Although these conditions rob individuals of their sight and possibly their life, they generally do not appear to cause problems until they are advanced. Routine care is the key to stopping these killers before it is too late. The NOA is using the Three Silent Killers Program to increase the proportion of persons having a dilated eye exam and reduce visual impairment due to diabetic eye disease and glaucoma.

If you would like to learn more about the Three Silent Killers Program or request copies of NOA’s informative brochure, contact LaSheta David, O.D., NOA, President at Dr.lpdavid@invisionfamilyeyecare.com. You can visit the NOA Website at www.natoptassoc.org.

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OSUCO Students Provide Service and Gain Experience

The Ohio State University College of Optometry (OSUCO) has a strong commitment to community outreach and engagement. This charge is evidenced in the college’s efforts to educate optometric students who are prepared and willing to take on the challenges of optometric practice in all aspects of society. The college currently supports community-based optometric facilities that include a homeless shelter, a mental hospital, nursing homes, “house calls,” the Central Ohio Blind School, and clinics established in underserved communities.

Each outreach facility targets special segments of the Central Ohio population, often reaching individuals in financial need and those who tend to have difficulty receiving vision care. Over the course of the past 2 years, over 4,500 patients have been examined in the OSUCO outreach clinics. In many instances, examinations are provided at no charge and eyewear is either provided for free or for a minimal fee, thanks to the generosity of a privately owned optical laboratory in Columbus.

The profound positive impact of these services is often evident to students and patients. During the course of an optometric exam at the homeless shelter, a patient suffering from alcohol addiction was diagnosed with a brain tumor. After a neurology referral, successful brain surgery, and rehabilitation, this gentleman has gone on to be reunited with his family and is currently gainfully employed.

National Eye Health Education Program (NEHEP) educational materials are vital tools in effective community outreach. NEHEP brochures are given to further educate patients about the nature of their health conditions and to reaffirm recommendations made during their vision exams. NEHEP materials are also essential for student organizations such as the OSU National Optometric Student Association (OSU-NOSA), whose mission is the reduction of vision loss due to diseases such as glaucoma, diabetes and high blood pressure. OSU-NOSA students routinely distribute NEHEP brochures to participants of community screenings and health fairs throughout the Central Ohio area. National Eye Institute (NEI) reports on vision health disparities are also invaluable sources of talking points when developing community discussion topics and presentations.

Community outreach is a multifaceted directive that requires financial backing, educational resources and committed individuals to be successful. With the help of NEHEP, OSUCO is reaching out beyond the boundaries of campus walls to bring knowledge and commitment to life, educating future healthcare providers and improving lives.

For more information contact, Jacqueline G. Davis, O.D., M.P.H., Assistant Professor of Clinical Optometry, OSUCO at 614–247–1685 (Monday and Tuesday), 614–293–2920 (Wednesday through Friday), or at JDavis@optometry.osu.edu.

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CDC’s Commitment to Vision Loss Prevention and Eye Health Promotion-New Website

The Vision Health Initiative (VHI), a group in the Centers for Disease Control and Prevention’s (CDC) Division of Diabetes Translation, has recently launched an expanded website portraying the mission, goals, and actions of VHI about vision loss prevention and eye health promotion.

Since 2003, VHI has partnered with diverse stakeholders including the National Eye Institute (NEI) and the National Eye Health Education Program (NEHEP), American Academy of Ophthalmology, American Optometric Association, and nonprofit organizations such as Prevent Blindness America among others, to design a coordinated public health framework to prevent blindness and vision impairment. The shared mission is to promote vision health and quality of life for all populations, throughout all life stages, by preventing and controlling eye disease, eye injury, and vision loss resulting in disability.

The newly retooled website (accessible at: www.cdc.gov/visionhealth) offers access to a vast array of information regarding VHI, past and current projects with diverse stakeholders, publications in peer reviewed journals, as well as vision-related resources for consumers and professionals alike.

The highlight of the vision health website is an interactive map displaying state-specific vision health statistics, which is the first of its kind. The site will allow states that used the Behavioral Risk Factor Surveillance System (BRFSS) vision module to produce reports and presentations on the status of vision health and access to eye care in their states. This is one of the first steps in creating a public health surveillance system for vision loss prevention and eye health promotion.  The system provides an ongoing systematic collection, analysis, interpretation, and dissemination of vision health data. This data is essential to the planning, implementation, and evaluation of public health practice in prevention and control of vision loss and eye diseases.

The contents of the website are geared toward all individuals. In the Basic Information section, consumers can find information regarding common eye conditions and treatments. This section of the website also offers brief descriptions and videos in lay language enabling easy comprehension by a large audience.

National and state data regarding vision health are available for use in research reports or presentations. For example, the interactive map on the front page of the website allows users to access such data as prevalence rates of common eye disorders and information regarding access to care. In the Data and Statistics section, pertinent vision-related national and state data are summarized and detailed descriptions of the large data sources available to VHI are provided.

Additionally, links to other relevant vision loss prevention and eye health promotion resources are provided, including a section on the national vision health goals set forth in Healthy People 2010.

For more information, contact 800–CDC–INFO or cdcinfo@cdc.gov.

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Healthy Vision Community Awards Spotlight: Prairie Band Potawatomi Health Center

The Prairie Band Potawatomi Health Center (PBPHC) is a tribally operated primary care clinic in Kansas that is contracted with the Indian Health Service (IHS). The clinic provides ambulatory services to American Indians and Alaska Natives of all ages. Services are provided by one full-time family physician, two part-time family physicians, and one part-time nurse practitioner. PBPHC has approximately 2,700 active patients. The clinic’s diabetes registry currently contains information on 286 type 1 and type 2 patients.

In May 2008, the Diabetes Program at PBPHC implemented the IHS/Joslin Vision Network (IHS/JVN) Teleophthalmology Program in Indian Country. The program provides a diabetic retinopathy imaging machine to PBPHC that uses telemedicine technology. Imaging staff members at PBPHC collect retinal images of the eyes of people with diabetes who visit the clinic, and transfer the images to IHS ophthalmologists in Phoenix, Arizona. The ophthalmologists then evaluate the images for diabetic retinopathy and report the results back to PBHPC. The IHS/JVN program should allow PBPHC to image the retinas of virtually every patient with diabetes in the registry over the course of a year.

In August 2008, when PBPHC applied for a 2009 Healthy Vision Community Award (HVCA), the component missing from this new initiative was patient education on diabetic retinopathy. The objectives of the Prairie Band Potawatomi Healthy Oshkishkwen (Eyes) Project are to:

• Provide education on diabetic retinopathy to all patients on the PBPHC diabetes registry.
• Provide education on diabetic retinopathy to all patients identified as pre-diabetic or insulin resistant.
• Increase community awareness of diabetic retinopathy and provide general information on diabetic retinopathy and its impact on the community.
• Increase the number of diabetic patients receiving exams for diabetic retinopathy.

As people with diabetes visit the clinic for their retinal imaging appointments, they receive one-on-one education. These sessions occur directly after the patients’ retinas are imaged. At that time, the cause, results, and prevention of vision loss from diabetic retinopathy are explained in detail. The imager is able to show the patients their retinal images. Without context, however, it is difficult for the patients to understand what they are looking at. Using HVCA funds, the project purchased oversized eye models that allow PBPHC staff members to show patients the retinal anatomy relative to the entire eye. Staff members also use special goggles with patients to demonstrate simulated vision changes due to diabetic retinopathy. Additionally, the clinic’s diabetes prevention program provides information to people with pre-diabetes on diabetic retinopathy. Information about the risk of eye damage due to diabetic retinopathy helps to motivate these patients to actively work to prevent diabetes.

Instead of developing new curriculum materials, the program uses already existing educational materials. Specifically, the project uses the National Eye Institute’s Diabetic Eye Disease: An Educator’s Guide, Diabetic Retinopathy: What You Should Know, and Don’t Lose Sight of Diabetic Eye Disease. The project also distributes booklets from the IHS Division of Diabetes Treatment and Prevention to patients and to people attending community events.

For the purpose of community outreach, PBPHC partnered with the Fire Keeper’s Elder Center, a local facility that provides meals and other services to the elders of the tribal community. The Elder Center assists in disseminating educational materials to their patrons and served as the location for a group presentation. PBPHC is also planning community education programs and events designed to increase community awareness of diabetic retinopathy at an annual diabetes educational conference for patients. The conference has been jointly developed by four tribes located in northeast Kansas and will be held in the last quarter of 2009.

For more information, contact Sebe Masquat, RN, by phone at 785–966–8273 or by email at sebem@pbpnation.org.

To learn more about the HVCA Program, visit www.healthyvision2010.org/news/hvca.

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On the Road With NEI

NEI regularly exhibits at national meetings across the country. Exhibits provide an opportunity to share information and publications, promote NEI messages and resources, and strengthen links with partner organizations. Upcoming NEI exhibits are listed below. If you plan to attend this meeting, please stop by and say “hello”!

American Academy of Optometry
Annual Conference
Orlando World Center Marriott
Orlando, Florida
November 11-14, 2009
Booth Number 629

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