Educational Resource Spotlight: Healthy Eyes Toolkit

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Healthy Vision Community Programs Database

Health Vision Community Programs Database

This easy-to-search resource can help you learn about new ways to address eye health issues and replicate eye health-related projects in your community. Visit the Healthy Vision Community Programs Database at /nehep//.

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The National Eye Health Education Program is coordinated by the National Eye Institute, National Institutes of Health, U.S. Department of Health and Human Services. This administrative document may be reprinted without permission.

Anne Louise Coleman, M.D., Ph.D.

Letter from the Chair of the NEHEP Planning Committee

More than 11 million Americans have uncorrected refractive error, the most common cause of visual impairment in the United States. Fortunately, refractive error is usually correctable, with strong research evidence and wide-ranging clinical experience connecting appropriate prescriptive eyewear such as eyeglasses and contact lenses to substantial improvement in quality of life.

May is Healthy Vision Month. Held each year since 2003, Healthy Vision Month was established by the National Eye Institute (NEI) to elevate vision as a health priority and to advance vision-related objectives in the Healthy People 2010 public health framework. The focus for 2009 is on reducing uncorrected refractive errors by raising awareness about the importance of eye exams to detect common vision problems.

We encourage you to support Healthy Vision Month 2009 by participating in activities to educate your community about the importance of eye exams in detecting and correcting refractive errors. Promoting vision care at the community level is a key component of the broader effort to achieve healthy vision for everyone.

In this issue of Outlook, you will find information about attitudes toward eye examinations based on findings from the joint NEI and Lions Clubs International Foundation Survey on Public Knowledge, Attitudes, and Practices Related to Eye Health and Disease. In addition, you will be introduced to some of the many materials and resources that NEI has developed as part of its new Healthy Eyes Toolkit, which can be used to educate people in your community about the critical role of eye exams.

Because both refractive errors and other eye problems can be detected, getting individuals to have a comprehensive dilated eye exam is fundamental to improving the nation's eye health. The National Eye Health Education Program (NEHEP) works to educate the public with evidence-based information about eye health and the importance of early detection and timely treatment in minimizing vision loss.

We all have an important role to play in making vision a health priority, and every effort makes a difference. We encourage you to use NEHEP materials in your community to spread the word about the importance of eye health. Contact us, as we want to help, and we would appreciate any and all feedback on how you have used NEHEP materials and how those materials could be enhanced. We look forward to hearing from you.

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
Professor of Epidemiology
UCLA School of Public Health

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KAP Highlight: Eye Examinations

doctor giving an eye exam.The Knowledge, Attitudes, and Practices Related to Eye Health and Disease (KAP) Survey is a national survey conducted in English and Spanish by the National Eye Institute (NEI) and the Lions Clubs International Foundation. KAP provides information about adults' experiences and attitudes related to eye examinations.

Ninety-one percent (91%) of KAP Survey respondents report having had their eyes examined sometime in the past by a healthcare provider (HCP).1 The information that follows provides more detail about the eye examination practices of this specific group of adults.

More women (94%) report having had their eyes examined than men (88%). Adults aged 65 and older (94%) most often report having their eyes examined, followed by adults aged 40 to 64 (93%) and adults aged 18 to 39 (89%).

Seventy-six percent (76%) of adults who report having had their eyes examined sometime in the past by an HCP have had a dilated eye examination. Of these, 81 percent of women and 71 percent of men report having had their eyes dilated during an exam. Ninety-four percent (94%) of adults aged 65 and older report having had their eyes dilated compared with 84 percent of adults aged 40 to 64 and 60 percent of adults aged 18 to 39.

Of the 74 percent of adults who report having had their eyes examined sometime in the past by an HCP, the main reason reported for doing so was for a regular checkup (52%). This was followed by a need for new glasses or contact lenses (17%) and by trouble seeing (13%). Results from the KAP Survey found that recommendations from primary care providers, family members, and coworkers had the greatest influence among adults for having their eyes examined.

Of the 9 percent of adults who report never having had their eyes examined by an HCP, 60 percent report that it is because they did not have any vision problems and therefore did not feel the need for an eye exam. When analyzed by age group, this explanation was true for 38 percent of adults aged 65 and older, 61 percent of adults aged 40 to 64, and 63 percent of adults aged 18 to 39. This rationale supports the importance of educating all adults about the crucial role of eye examinations, especially in identifying eye diseases that usually have no warning signs.

The National Eye Health Education Program is using the survey information to continue to develop and implement targeted efforts to raise awareness about the importance of regular eye exams. Other organizations can use these findings in developing their own eye health education outreach.

For more information about the KAP Survey and to download a full copy of the report, visit


1 An HCP can be a primary care provider (PCP) or an eye care provider (ECP).

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Join Us in May for Healthy Vision Month 2009

image of an ecardDid you know that more than 11 million Americans have uncorrected vision problems due to refractive errors such as nearsightedness, farsightedness, astigmatism, and/or presbyopia? The good news is that these problems can be detected through a simple eye exam and are easily corrected with the use of prescriptive eyewear such as glasses or contact lenses.

Uncorrected Refractive Error Facts

Approximately half of all American adults don't have the 20/20 vision that eye care professionals consider optimal due to refractive errors.1

Eighty-three percent of visually impaired individuals can benefit from the use of refractive correction such as glasses or contact lenses.2

Women experience refractive error more frequently than men:

  • Twenty-six percent more women aged 12 and older have uncorrected visual impairment due to refractive error compared with men aged 12 and older.
  • Fourteen percent more women aged 40 and older have refractive errors compared with men aged 40 and older.3

May is Healthy Vision Month! Please join the National Eye Institute (NEI) in raising awareness about the importance of eye exams in detecting common vision problems.

To spread the word, NEI has developed a Healthy Eyes Toolkit to help you educate the public about the role of regular eye exams in maintaining good eye health. It includes a variety of resources such as e-cards, print and radio public service announcements, sample text messages, drop-in articles, fact sheets, downloadable posters, bookmarks, and stickers that can be used to promote the importance of eye exams.

There is a lot you can do to encourage people in your community to schedule an eye exam. Here are a few resources and ideas for using them.

Drop-In Articles: Get the word out! See What You've Been Missing is a general article that you can send to local newspapers or use in newsletters, publications, or on websites. Your Eyes Your Health is an article targeted to women about how important it is for them to take care of their vision. Place it in newsletters, local magazines, or on websites that are popular with women. You can also print out hard copies and ask local beauty salons and day spas if you can leave some for their patrons in a reading rack or on a counter. Both articles are available in English and Spanish.

Electronic Messages: Start a chain reaction! Send an e-card or use one of the text messages to remind friends, family, and colleagues about the importance of having an eye exam. Encourage each contact to send the message to their family and friends and they should encourage others to do the same. You get the idea!

Downloadable Bookmarks and Stickers: Give it away! Make presentations at health fairs and other community events. Bring a supply of bookmarks to give out to participants to remind them to schedule an eye exam or drop some off at your local library or bookstore. Try organizing an eye health event or screenings in your community and give a sticker to each person who has his or her eyes examined.

NEI Healthy Eyes Webpage: This site provides information on keeping eyes healthy and the importance of eye exams. Visit and encourage others to do the same.

For these and other resources, visit the Healthy Vision Month Website at


1 Vitale, S., Ellwein, L., Cotch, M. F., Ferris, L. F., & Sperduto, R. (2008). Prevalence of refractive error in the United States, 1999-2004. Archives of Ophthalmology, 126(8), 1111-1119.

2 Vitale, S., Cotch, M.F., & Sperduto, R.D. (2006). Prevalence of visual impairment in the United States. The Journal of the American Medical Association, 95(18), 2158-2163.

3 National Health and Nutrition Examination Survey (NHANES), National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), 2002.

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Early Action Saves Sight: The Vision Advocacy Project

Early Action Saves Sight (EASS), a pilot project, has heightened awareness among older adults and providers about the importance of taking quick action when there is a change in vision. The project was designed to improve outcomes for people who have or may develop age-related macular degeneration (AMD) or other serious eye diseases (glaucoma, diabetic retinopathy). It has been implemented with funding from Genentech and Alcon at sites with significant numbers of community-dwelling older adults (e.g., Naturally Occurring Retirement Communities, senior centers, assisted-living facilities). A staff training component helped staff members identify seniors at risk for vision loss.

This pilot program consists of an upbeat, 40-minute talk featuring AMD, glaucoma, diabetic retinopathy, nutrition, and vision rehabilitation. A site-specific flyer is available in advance to sites. Presenters discuss warning signs of eye diseases, what older adults can do to minimize risk and how to use the Amsler grid to monitor vision changes. Free gifts, a door prize, and refreshments encourage attendance and attention. Take-home materials include the NEI publication, "Age-Related Macular Degeneration: What you should know," an Amsler grid, and a nutrition fact sheet. The emphasis is on seeing an eye doctor regularly and contacting an eye doctor quickly if there is a change in vision. In total, 907 individuals attended EASS pilot programs (860 older adults; 47 staff members) surpassing the project's original target of 400.

Participants complete the Functional Vision Screening Questionnaire (FVSQ), a validated, 15-question instrument, and answer seven short lifestyle questions. Follow-up identifies older adults who have not seen an eye doctor in more than 1 year, and those who are having significant difficulty with daily activities. Contact with those 'at risk' encourages seeing an eye doctor and gathers feedback about action taken. EASS appears to have been successful in encouraging participants to obtain primary eye care or a low vision evaluation. Of the 579 older adults who completed the screening, 43 percent or 249 were in need of eye care. Of the older adults subsequently contacted, 94 percent reported they had either received or made an eye appointment as a result of the program, a higher success rate than other education programs using similar methodology.

Another important finding, consistent with published studies, was that race and ethnicity are significant variables. EASS evaluation results show that 54 percent of Latinos needed follow-up, compared to 51 percent of African Americans, 47 percent of Asians, and 40 percent of Caucasians.

For more information contact Karen R. Seidman at 212-821-9465 or

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POB Partners with Georgetown University Hospital to Provide Free Eyeglasses

photo of an RV The Prevention of Blindness Society of Metropolitan Washington® (POB) is pleased to announce that it has partnered with Georgetown University Hospital's KIDS Mobile Medical Clinic/Ronald McDonald Care Mobile® (KMMC) to provide free eyeglasses to children. KMMC provides comprehensive pediatric health care services, and once a month, a volunteer ophthalmologist provides free eye exams for children ages 3 to 21 years old on the pediatric mobile unit.

"We're delighted to partner with KMMC to provide this much needed service," said Michele Hartlove, executive director of POB. "Providing free eyeglasses to children who need them is the first step in preventing the needless loss of sight."

Children are eligible for the program whether or not they have medical insurance. Additionally, KMMC also treats patients with Medicaid coverage but who do not have a regular doctor or pediatric clinic. There is no out-of-pocket expense to patients or their families. POB's Children's Vision Screening Team will screen children to identify whether or not they need an eye exam. POB will also provide new eyeglasses free of charge to children with a prescription from KMMC.

For more information contact Jennifer Heilman at 202-234-1010 or

About the Prevention of Blindness Society of Metropolitan Washington:
Founded in 1936, POB, the largest local prevention of blindness agency in the United States, is dedicated to the improvement and preservation of sight by providing services, education, advocacy and innovation. POB screens more than 7,500 children annually for vision loss and strabismus and 5,000 adults for glaucoma. POB also serves nearly 8,000 low-income and homeless persons at its eyeglasses clinic. POB sponsors the Aging Eye Network, the Macular Degeneration Network, and the Stargardt's Network. For more information on programs and services, please call 202-234-1010, or visit

About the KIDS Mobile Medical Clinic:
The KIDS Mobile Medical Clinic is under the direction of the Community Pediatrics Program, which is part of the Department of Pediatrics at Georgetown University Hospital, a MedStar Health Partner. KMMC is a not-for-profit 501(c)(3) program. The KMMC staff is a dynamic team of healthcare professionals dedicated to providing quality services to children, adolescents and families. It includes doctors, nurses, social service providers and an administrative support team.

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Older Treatment May Be More Effective in Preserving Sight

DRCR LogoA promising new drug therapy used to treat abnormal swelling in the eye-a condition called diabetic macular edema-proved less effective than traditional laser treatments in a study funded by the National Eye Institute (NEI), part of the National Institutes of Health. The study, published in the September 2008 issue of the journal Ophthalmology, demonstrates that laser therapy is not only more effective than corticosteroids in the long-term treatment of diabetic macular edema, but also has far fewer side effects.

Between 40 and 45 percent of the 18 million Americans diagnosed with diabetes have vision problems, such as diabetic macular edema. This condition occurs when the center part of the eye's retina (called the macula) swells-possibly leading to blindness. Ophthalmologists traditionally use lasers to reduce the swelling in areas of the macula. Early reports of success in treating diabetic macular edema with injections of a corticosteroid called triamcinolone led to the rise in popularity of this alternative treatment. However, this is the first study to compare the long-term benefits of both treatments and evaluate their potential side effects.

The study was conducted by the Diabetic Retinopathy Clinical Research Network ( involving 693 participants at 88 clinical centers across the United States. is a collaborative network, supported by NEI, dedicated to multicenter clinical research of diabetic retinopathy, including diabetic macular edema. Only diabetic macular edema was examined as part of this study. Macular edema from conditions other than diabetes may respond to corticosteroid and laser treatment differently.

Researchers defined substantial vision loss as reading at least two less lines on a standard eye chart two years after entering the study. In the corticosteroid-treated group, 28 percent experienced substantial vision loss as compared to 19 percent in the laser-treated group. The corticosteroid-treated group was also far more likely to experience increased eye pressure and cataract surgery.

In addition, about one-third of the eyes treated with laser therapy showed substantial improvement in vision. Laser treatment had previously been thought to prevent further vision loss, but not to improve vision. These findings confirm the importance of laser treatment in the management of diabetic macular edema.

Researchers found that, while not as effective as the laser treatment, corticosteroid treatment did provide some benefit, raising the possibility that combining laser with corticosteroids might produce greater benefit. The DRCR Network ( is conducting a study that is comparing a combination of corticosteroids and laser with laser alone.

For more information contact Neil M. Bressler, M.D., at

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AMD LogoIn January, the Macular Degeneration Partnership announced the completely redesigned for people with age-related macular degeneration (AMD), their families and friends. With enhanced accessibility and features, visitors to can set the font size with an easy click, switch to a high-contrast version, or use accessible technology like Jaws® and ZoomText.

Family Caregivers will find a new home that addresses their concerns and provides practical information- what it's like to have macular degeneration, how to know when your loved one is ready for help, and more. "Living With AMD" offers tips, tools, and resources to make the most of your vision including low vision rehabilitation and what to expect at the doctor's office.

A free subscription to AMD Update is available on the homepage. This monthly e-newsletter covers breaking news and in-depth articles about research, treatment, and lifestyle. Visitors can also order the AMD Toolkit with comprehensive information, magnetic Amsler Grid, and other tools. Since 1998, over 55,000 people have registered at

The Macular Degeneration Partnership and are programs of the non-profit Discovery Eye Foundation (DEF). Since 1970, DEF has conducted research into the causes and cures for eye diseases, including macular degeneration, diabetic retinopathy, keratoconus and, currently at the University of California, Irvine, DEF collaborates with scientists worldwide on stem cell and regenerative retinal projects. In addition to the Macular Degeneration Partnership, DEF supports the National Keratoconus Foundation, an outreach program for people with keratoconus.

For more information, contact Judith Delgado, Executive Program Director, by phone at 310-623-4466, 888-430-9898, or by e-mail at

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NDEP Provides Free Resources To Help People Prevent Type 2 Diabetes

NDEP small steps logoType 2 diabetes can lead to complications that affect many parts of the body, including the eyes. Research shows that people with pre-diabetes, a condition in which your blood glucose (blood sugar) levels are higher than normal but not high enough for a diabetes diagnoses, can develop diabetic eye disease (retinopathy). Research also shows that people who are at risk for developing type 2 diabetes who make healthy lifestyle changes can prevent or delay the onset of the disease and its complications. The National Diabetes Education Program (NDEP), a joint program of the National Institutes of Health and the Centers for Disease Control and Prevention, promotes the importance of preventing type 2 diabetes and managing diabetes to prevent or delay complications, including diabetic retinopathy.

NDEP provides a wide range of information and resources for people with diabetes, those at risk for type 2 diabetes, and healthcare professionals. A centerpiece of NDEP's Small Steps. Big Rewards. Prevent Type 2 Diabetes. campaign is the patient education booklet, Your GAME PLAN to Prevent Type 2 Diabetes: Information for Patients. This easy-to-read booklet uses evidence-based science from the Diabetes Prevention Program (DPP) clinical trial. The DPP proved that type 2 diabetes could be prevented or delayed in people at risk for diabetes by losing a small amount of weight and getting at least 30 minutes of moderate-intensity physical activity 5 days a week. Risk factors for diabetes include having a family history of diabetes, being age 45 years or older, or being overweight or obese. Diabetes disproportionately affects African Americans, Hispanics/Latinos, American Indians and Alaska Natives, Asian Americans, and Pacific Islanders.

photo of Your Game Plan bookletThe Your GAME PLAN booklet provides patients with information about their risk for developing type 2 diabetes and how to implement a program to prevent or delay the onset of the disease.

The NDEP encourages people at risk for diabetes to work with their healthcare team to find out if they have pre-diabetes.

To order a free copy of NDEP's GAME PLAN booklet, please visit or call 1-888-693-NDEP (6337), TTY: 1-866-569-1162. Materials are also available in Spanish and copyrightfree. Many are available on printer-ready CDs, making it convenient for organizations to add their logo and print desired quantities.

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Healthy Vision Community Awards Spotlight: Chinese American Service League

CASL LogoThe Chinese American Service League (CASL) in Chicago, Illinois, is the largest and most comprehensive social service agency in the Midwest dedicated to serving the needs of Chinese Americans. It serves more than 17,000 clients annually. As a Healthy Vision Community Awards (HVCA) recipient in 2007, the objective of CASL's Healthy Eyes Program was to increase awareness within the Chinese community of the importance of eye health and vision and eye care practices that are currently available. This was accomplished through three workshops on age-related eye health issues, children's eye health issues, and age-related macular degeneration. A total of 236 people were reached through these workshops and CASL referred 87 people for dilated eye exams.

CASL was also a 2008 HVCA recipient. The objective for CASL's Healthy Eyes 2008 Program is teaching the importance of eye health within the Chinese community with a focus on identifying and correcting refractive errors and preventing glaucoma.

Through this project, CASL encourages people young and old, to go for an annual eye exam. The overriding objective is to provide current and accurate information to the Chinese community in its native language. In 2008, three workshops were conducted by Dr. David Lee, Professor of Optometry and Physiological Optics from Illinois College of Optometry. The workshops were publicized in Chinese, via the six community newspapers, internal and community flyers as well as by word-of-mouth.

One workshop was held for 26 young participants in CASL's Workforce Initiative Act Youth Program on eye health issues such as nearsightedness, farsightedness, and refractive errors. Information on the impact of prolonged viewing of computers and television was also addressed. Another workshop, held for 80 elderly clients at CASL Senior Housing, addressed the age-related eye health conditions: glaucoma, cataracts, vitreous degeneration and macular degeneration. The third workshop was held for 25 elementary school-aged youth. The same topics were covered with the elementary school students as the high school students from the youth program, with emphasis on the negative effects of prolonged TV and computer viewing. In each of the workshops, participants were given brief pre- and post-tests to measure increase in knowledge.

In addition to providing education about eye health, CASL promotes access to eye care through referral services to the Illinois Eye Institute (IEI) for eye exams. As part of the exam, clients are screened for glaucoma, refractive errors, and other eye health issues. Of the 131 people who attended the workshops, a total of 84 clients were referred for a comprehensive dilated eye exam. All referred received the comprehensive dilated eye exam and it was agreed that IEI would perform any needed follow-up.

IEI has many Chinese students who are being trained to work with Chinese-speaking patients. Working with CASL clients provides experience for them in serving patients in the Chinese languages while providing patients with low-cost eye exams. Several of the CASL clients who were referred to IEI were able to take part in the Vision of Hope Health Alliance (VOHHA) program that provides free eye exams to Illinois residents who are low-income and do not have insurance. Clients not meeting the eligibility requirements for the VOHHA took part in the regular clinic at IEI.

To maximize the number of people receiving eye exams and minimize wasted resources, CASL calls clients ahead of time to remind them of their appointment. If they are unable to attend, CASL schedules someone else to take their place. These efforts have resulted in an attendance rate exceeding 90 percent for scheduled appointments. This track record has helped to solidify CASL's collaboration with IEI.

For more information, contact Esther Wong, Executive Director, by phone at 312-791-0418 or by e-mail at

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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 any of these meetings, please stop by and say "hello"!

American Academy of Physician Assistants
37th Annual Conference
San Diego Convention Center
San Diego, CA
May 26-27, 2009
Booth Number 141

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