The findings and conclusions in this presentation are those of the author and do not necessarily represent the views of the CDC.

CDC ‘s Role in Vision & Eye Health

John E. Crews, DPAVision Health Initiative

Division of Diabetes TranslationCenters for Disease Control and Prevention

CDC’s Scope of Work

Population perspective Monitor health Conduct research to enhance

prevention Implement prevention strategies Promote healthy behaviors

A Public Health Approach

Problem Response

SurveillanceHow big is

the problem?

Risk FactorsWho is most

Affected?

InterventionEvaluation

Whatworks?

ImplementationHow do you

do it?

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

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

Behavioral Risk Factors Surveillance System - BRFSS

Access to Eye Care, age ≥ 65 years

No Visio

n Loss

Little

Difficul

ty

Modera

te/Se

vere

VI0

20

40

60

80

100

Health care cov-eragePersonal doctorEye Examined last yearDilated eye exam last year

Reasons for Not Seeking Eye Care by Age Group

Cost or lack of insurance No need

39.834.6

42.8

32.9

23.3

43.8Total Age 40-64 Aged ≥65

Cost & Perception of “no need for care” are barriers to eye care.

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

Glaucoma Program

Community-based interventions Will Eye Institute in Philadelphia, PA

o Aggressive community outreachUniversity of Alabama-Birmingham, Birmingham, AL

o Innovative collaboration with Wal-Mart

Rigorous evaluation of the effectiveness of the community intervention

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

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

Innovative Collaboration Private-Public

partnership Employs

existing infrastructure

Fundus Photography Technology

Telemedicine Community

based follow-up

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

Percent of People ≥65 Years with Chronic Conditions Reporting Vision

Impairment, 2002 & 2008 National Health Interview Survey

Arthritis Cancer Stroke Diabetes0

5

10

15

20

25

30

35

22.119.7

30.9

23.6

National Health Interview Survey, 2002 & 2008

Self-reported Worse Health in Past Year Among People ≥ 65 years With & Without Diabetes & Vision Impairment,

1997-2004 National Health Interview Survey

No VI/ No DiabetesDiabetes Only VI only Both VI & Diabetes0

5

10

15

20

25

30

35

10.3

19.9

25

31.7

Crews, Jones, & Kim, 2006

Thank You!

For More Informationwww.cdc.gov/visionhealth/

www.cdc.gov/diabeteswww.cdc.gov/washington

 CDC Washington Office: 202-245-0600