Increasing Access to Vision Rehabilitation

[摘要]

The American Public Health Association,

Noting that visual impairment is a significant public health problem with an estimated 13.5 million visually impaired persons over the age of 45 in the United States and one in six reporting adults with some form of visual impairment;¹ and

Realizing that visual impairment is a significant public health problem in many other countries,^2,3 and recognizing that APHA has adopted resolutions supporting screening and examination for causes of visual impairment;^4-7 and

Noting that the World Health Organization has defined vision impairment as corresponding to visual acuity measurements of 20/70 to 20/1000 (or corresponding visual field loss) in the better eye with the best possible correction;⁴ and

Understanding that the incidence of visual impairment is expected to increase as the population ages and, therefore, as the prevalence of macular degeneration and glaucoma increases,^5,6 with the number of Americans with visual impairment expected to double within the next three decades;⁷ and

Recognizing that the incidence of visual impairment is expected to increase as the incidence of diabetes continues to increase,⁸ due to increasing rates of diabetic retinopathy, diabetic cataracts, neovascular glaucoma, and other ocular complications from diabetes; and

Observing that visual impairment has been linked with many significant public health problems such as increased length of stay for hospitalizations,⁹ greater utilization of health care services,¹⁰ increased risk of falls¹¹ and hip fracture,¹² restrictions in activities of daily living,¹³ increased reliance on community support services,¹⁴ depressive symptoms¹⁵ and increased mortality rates;^16,17 and

Noting that comprehensive vision rehabilitation services include evaluating the functional status of the eyes and visual system, assessing ocular health and related systemic health conditions and the impact of disease on visual functioning, providing appropriate intervention to improve visual functioning including the prescription of assistive aids and devices and provision of instruction and education in their use, counseling regarding visual impairment including recommendations for treatment, management and future care, and appropriate referral for services to ensure maximum performance and participation in life activities;¹⁸ and

Recognizing that vision rehabilitation services have been shown to improve quality of life,^19,20 improve functional capacity,²¹ and to enable individuals with visual impairment to return to the workforce;²² and

Noting that public knowledge about vision rehabilitation is lacking,²³ and people with visual impairment often do not receive visual rehabilitation services,24 are delayed in receiving rehabilitation services,²⁵ or do not use optical devices, adaptive aids, and rehabilitation services;²⁶ and

Noting that increasing the use of rehabilitation services, visual devices, and adaptive devices by people with visual impairments is an objective in Healthy People 2010.²⁷ 

Therefore:

1. Urges third-party payers, insurance companies, managed care organizations, and health plans to include and implement coverage with reimbursement for vision rehabilitation examinations, social services, and prescribed assistive devices including vision enhancement devices, adaptive technology, and education in their use;
2. Urges all health care providers to make appropriate and prompt referrals for vision rehabilitation services for people with visual impairments meeting the WHO guidelines;
3. Supports educational campaigns to increase the public’s awareness of the need for and benefits of vision rehabilitation services, such as the National Eye Health Education Program of the National Eye Institutes;
4. Encourages educational programs for all eye care professionals to emphasize the importance of vision rehabilitation; and
5. Supports collaboration between relevant professional organizations such as the American Optometric Association, the American Medical Association, the American Academy of Ophthalmology, the American Academy of Optometry, and Prevent Blindness America to accomplish the goals of the resolution.

References

1. The Lighthouse, Inc. The Lighthouse National Survey on Vision Loss: the experience, attitudes, and knowledge of middle-aged and older Americans. New York: The Lighthouse, Inc., 1995:11-3.
2. Dandona R, Dandona L, Srinivas M, Giridhar P, Nutheti R, Rao GN. Planning low vision services in India: a population-based perspective. Ophthalmology 2002 Oct;109(10):1871-8.
3. Liu JH, Cheng CY, Chen SJ, Lee FL. Visual impairment in a Taiwanese population: prevalence, causes, and socioeconomic factors. Ophthalmic Epidemiol 2001 Dec;8(5):339-50.
4. APHA Resolution "Reducing the Incidence of Blindness, Lower Extremity Amputation, and Oral Health Complications in Minority Populations," 2000.
5. APHA Resolution "Improving Early Childhood Eye Care," 2001.
6. APHA Resolution "Prevention of Visual Loss from Glaucoma," 2002.
7. APHA Resolution "Ensuring Optimal Vision Performance in Visually At-Risk Drivers," 2000.
8. United States Department of Health and Human Services. The international classification of diseases, 9th revision, clinical modification (OCD-9-CM), 4th ed, vol 1. U.S. DHHS (PHS-HCFA). Washington, DC, 1996.
9. Mukesh BN, McCarty CA, Rait JL, Taylor HR. Five-year incidence of open-angle glaucoma: the visual impairment project. Ophthalmology 2002 Jun; 109(6):1047-51.
10. VanNewkirk MR., Nanjan MB, Wang JJ, Mitchell P, Taylor HR, McCary CA. The prevalence of age-related maculopathy: the visual impairment project. Ophthalmology 2000 Aug; 107(8):1593-600.
11. Prevent Blindness America. Vision Problems in the U.S. Schaumburg, Illinois, 2002:1.
12. Miki E, Lu M, Lee ET, Keen H, Bennett PH, Russell D. The incidence of visual impairment and its determinants in the WHO Multinational Study of Vascular Disease in Diabetes. Diabetologia 2001 Sep; 44 Suppl 2:S31-6.
13. Morse AR, Yatzkan E, Berberich B, Arons RR. Acute care hospital utilization by patients with visual impairment. Arch Ophthalmol 1999 Jul; 117(7):943-9.
14. Horowitz A, Brennan M, Su YP. Dual sensory impairment among the elderly. New York: The Lighthouse, Inc., 2001.
15. McCarty CA, Fu CL, Taylor HR. Predictors of falls in the Melbourne visual impairment project. Aust N Z J Public Health 2002 Apr;26(2):116-9.
16. Ivers RQ, Norton R, Cumming RG, Butler M, Campbell AJ. Am J Epidemiol 2000 Oct 1, 152(7):633-9.
17. Rubin GS, Bandeen-Roche K, Huang GH, Munoz B, Schein OD, Fried LP, West SK. The association of multiple visual impairments with self-reported visual disability: SEE project. Invest Ophthalmol Vis Sci 2001 Jan; 42(1):64-72.
18. Wang JJ, Mitchell P, Smith W, Coming RG, Attebo K. Impact of visual impairment on use of community support services by elderly persons: the Blue Mountains Eye Study. Invest Ophthalmol Vis Sci 1999 Jan;40(10):12-9.
19. Lupsakko T, Mantyjarvi M, Kautianinen H, Sulkava R. Combined hearing and visual impairment and depression in a population aged 75 years and older. Int J Geriatr Psychiatry 2002 Sep; 17(9):808-13.
20. Wang JJ, Mitchell P, Simpson JM, Cumming RG, Smith W. Visual impairment, age-related cataract, and mortality. Arch Ophthalmol 2001 Aug;119(8):1186-90.
21. Rajala U, Pajunpaa H, Koskela P, Keinanen-Kiukaanniemi S. High cardiovascular disease mortality in subjects with visual impairment caused by diabetic retinopathy. Diabetes Care 2000 Jul;23(7):957-61.
22. American Optometric Association. Care of the patient with low vision. Optometric Clinical Practice Guideline. St. Louis: American Optometric Association, 1997:41.
23. Nilsson UL. Visual rehabilitation of patients with advanced stages of glaucoma, optic atrophy, myopia or retinitis pigmentosa. Doc Ophthalmol 1988 Dec;70(4):363-83.
24. Brody BL, Williams RA, Thomas RG, Kaplan RM, Chu RM, Brown SI. Age-related macular degeneration: a randomized clinical trial of a self-management intervention. Ann Behav Med 1999 Fall;21(4):322-9.
25. Watson GR, De l’Aune W, Stelmack J, Maino J, Long S. National survey of the impact of low vision device use among veterans. Optom Vis Sci 1997 May;74(5):249-59.
26. Nilsson UL. Visual rehabilitation of patients with advanced diabetic retinopathy. A follow-up study at the Low Vision Clinic, Department of Ophthalmology, University of Linkoping. Doc Ophthalmol 1986 May 15;62(4):369-82.
27. Rosenthal B, Thompson B. Awareness of age-related macular degeneration in adults: the results of a large-scale international survey. Optometry 2003;74:16-24.
28. Gresset J, Baumgarten M. Prevalence of visual impairment and utilization of rehabilitation services in the visually impaired elderly population of Quebec. Optom Vis Sci 2002 Jul;79(7):416-23.
29. Keeffe JE, Lovie-Kitchin Je, Taylor HR. Referral to low vision services by ophthalmologists. Aust N Z J Ophthalmol 1996 Aug;24(3):207-14.
30. Elliott AJ. Poor vision and the elderly. Eye 1989;3(pt 3):365-9.
31. Bowyer NK, Kleinstein RN. Healthy People 2010—vision objectives for the nation. Optometry 2000 Sep;71(9):569-78.

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[发布日期] 2003-11-18

[学科分类] 医学（综合）