Need for surgery and laser treatments to rise
The number of blind or visually impaired people in the United States is expected to double in 30 years, to 6.8 million, as the baby boomer generation ages, according to Vision Problems in the U.S., a report issued by the National Eye Institute in Bethesda, MD. Visual impairment is defined as having 20/40 vision or worse in the better eye, even with glasses.
Outpatient surgery managers can use the report to plan for the future and evaluate whether they need to add or expand ophthalmology services. "The report also takes a look at the various vision disorders that contribute to loss of vision and the treatments available to slow or stop vision loss," says Frederick L. Ferris, MD, clinical director of the National Eye Institute.
The significance of this report is not only that it confirms what many in the epidemiology field suspected, but uses data from a review of major epidemiological studies using standard case definitions for the eye conditions in this report, Ferris points out. "This is important for planning purposes because it gives you the best numbers to evaluate the extent of each condition," he adds.
The importance of the study to same-day surgery managers who have ophthalmic programs is that it identifies prevalence of conditions — including those that are typically treated by surgery — by state, gender, and race. "These numbers can help managers put together a proposal to justify a new program because they do give you an accurate picture of the population in your state," he adds.
Refractive errors are the most significant vision problem in the United States, with myopia, or nearsightedness, affecting more than 30.5 million Americans, Ferris says. While eyeglasses or contact lenses can correct myopia, hyperopia or farsightedness, astigmatism, or uneven focus, the field of refractive surgery is growing, he says.
"We are seeing twice the number of LASIK [laser-assisted in situ keratomileusis] patients that we saw during the same time last year," points out Kris Kilgore, RN, BSN, administrative director of Surgical Care Center of Michigan in Grand Rapids. "Now that we can offer the procedure to people with a wider range of refractive error, including astigmatism, we are seeing a continued increase in the number of people in their 40s and 50s scheduling the surgery." And that’s not the only procedure that’s seen an increase. "We’ve noticed an increase in all of our surgeries, but especially in cataract," Kilgore says.
Cataract, a clouding of the eye’s naturally clear lens, affects almost 20.5 million Americans who are older than 40, Ferris says. By age 80, more than half of Americans will have cataracts, he adds. An aging population that experiences more cataracts, however, can’t completely explain this increase, Ferris points out.
"October is usually our busy month for cataract surgery, but we’ve experienced milder than normal winters in Michigan during the past couple of years, so the snowbirds have not been traveling south," Kilgore says. This has meant that the surgeons are doing much more cataract surgery during January, February, and March than normal since the patients are staying in town, she adds.
Other eye disorders included in the report are:
• Diabetic retinopathy. Just fewer than 5.4 million Americans are diagnosed with diabetic retinopathy, but any one of the 10.3 million Americans with diabetes are at risk for the disease. Laser photocoagulation has been shown to reduce the risk of sight loss in retinopathy, Ferris says.
• Glaucoma. "While we found the prevalence of most vision disorders consistent across diverse populations and genders, we discovered that glaucoma prevalence is related to age and race," Ferris says. "It affects [more than] 2.2 million Americans but is more common in African-Americans and Hispanics," he says. While treatments such as laser peripheral iridotomy and argon laser trabeculoplasty are used to relieve the intraocular pressure and slow down the loss of vision, the number of surgeries to treat glaucoma is decreasing because there are many effective medications for the condition, Ferris points out.
• Age-related macular degeneration. Laser photocoagulation can destroy leaking blood vessels and slow the loss of vision in age-related macular degeneration (AMD), he says. More than 1.6 million people are diagnosed with AMD, Ferris adds.
In addition to the large group of baby boomers reaching their 60s, he points out that the fact we are living longer contributes to the study authors’ prediction that the number of blind or visually impaired Americans will double in 30 years. "Because all of these vision disorders are age-related and because people are living into their 80s, it is not surprising that we will continue to see increases in diagnoses of vision problems," he says.
To order a free copy of Vision Problems in the U.S., Prevalence of Adult Vision Impairment and Age-Related Diseases in America, contact:
• National Eye Institute, 2020 Vision Place, Bethesda, MD 20892-3655. Telephone: (301) 496-5248. Web: www.nei.nih.gov.