CDC ‘s Role in Vision & Eye Health

1. CDC ‘s Role in Vision & Eye Health John E. Crews, DPA Vision Health Initiative Division of Diabetes Translation Centers for Disease Control and Prevention

2. CDC’s Scope of Work • Population perspective • Monitor health • Conduct research to enhance prevention • Implement prevention strategies • Promote healthy behaviors

3. Risk Factors Who is most Affected? Surveillance How big is the problem? A Public Health Approach Implementation How do you do it? Intervention Evaluation What works? Problem Response

4. Three Initiatives • Surveillance: State level vision surveillance using the Behavioral Risk Factor Surveillance System (BRFSS) • Translation: Improving access to eye care for people at high risk for glaucoma • Multiple Chronic Conditions: Their relation to vision impairment

5. Vision Surveillance at the State Level • BRFSS samples over 350,000 people annually • Core questions & modules • Vision module in 23 states since 2005 • Questions about function, eye diseases , and access to eye care

6. Behavioral Risk Factors Surveillance System - BRFSS

7. Access to Eye Care, age ≥ 65 years

8. Reasons for Not Seeking Eye Care by Age Group Cost & Perception of “no need for care” are barriers to eye care.

9. Develop, Test, and Implement Cost-effective Intervention to Improve Eye Care Access for People at High Risk of Glaucoma • In the US, >2 million people have glaucoma • 7.3 million by 2050 • Half don’t know they have the disease • African Americans and Hispanics are at higher risk • Early detection and appropriate management can slow the progression and save remaining vision Vajaranant, Wu ,Torres ,Varma 2012

10. Glaucoma Program Community-based interventions Will Eye Institute in Philadelphia, PA • Aggressive community outreach University of Alabama-Birmingham, Birmingham, AL • Innovative collaboration with Wal-Mart Rigorous evaluation of the effectiveness of the community intervention

11. University of Alabama-Birmingham Glaucoma Screening at Wal-Mart vision centers Located in Community Establish/trusted eye care provider Optometrist works with patient and UAB Ophthalmology When glaucoma suspected, fundus photo taken and transmitted to UAB

13. Fundus Photography Photo of fundus taken of suspected cases of glaucoma Photo transmitted to UAB Ophthalmology Read by Glaucoma Specialist Results communicated back to patient through Wal-Mart Vision Services

14. Innovative Collaboration Private-Public partnership Employs existing infrastructure Fundus Photography Technology Telemedicine Community based follow-up

15. Multiple Chronic Conditions • Chronic conditions are common among older people • Chronic conditions do not exist in isolation • Managing multiple chronic conditions is challenge for providers and consumers

16. Percent of People ≥65 Years with Chronic Conditions Reporting Vision Impairment, 2002 & 2008 National Health Interview Survey National Health Interview Survey, 2002 & 2008

17. Self-reported Worse Health in Past Year Among People ≥ 65 years With & Without Diabetes & Vision Impairment,1997-2004 National Health Interview Survey Crews, Jones, & Kim, 2006

18. Thank You! For More Information www.cdc.gov/visionhealth/ www.cdc.gov/diabetes www.cdc.gov/washington CDC Washington Office: 202-245-0600