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, DPA Vision Health Initiative Division of Diabetes Translation Centers 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 ProblemResponse Surveillance How big is the problem? Risk Factors Who is most Affected? Intervention Evaluation What works? Implementation How 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

Reasons for Not Seeking Eye Care by Age Group 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 outreach University 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 National Health Interview Survey, 2002 & 2008

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

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