1. Working to eliminate preventable blindness in Native communities Casey Eye Outreach January 20, 2016Joan Randall, MPH, Research Associate Verian Wedeking, Outreach Program Administrator

2. What is preventable blindness? “Blindness which could be either treated or prevented by known, cost-effective means” – International Agency for the Prevention of Blindness 3 main conditions in United States

3. Diabetic Retinopathy Excess sugar in blood causes damage to blood vessels in the eye In United States, 12% of new cases of blindness 1 In early stages, there are no warning signs Images from "Eye disease simulation, diabetic retinopathy" by National Eye Institute, National Institutes of Health

4. Glaucoma Optic nerve damage, usually due to high pressure inside the eye Called the “thief of sight” Images from "Eye disease simulation, glaucoma" by National Eye Institute, National Institutes of Health

5. Macular Degeneration Mostly affects older adults Loss of vision in center of visual field- the macula Exacerbated by lifestyle factors – Smoking & hypertension Images from "Eye disease simulation, age related macular degeneration" by National Eye Institute, National Institutes of Health

6. Why are people in the US still going blind?! Knowledge that care is needed/education Lack of trust in system or providers Access to healthcare – Cost/insurance – Transportation – Maldistribution of physicians

7. Solution: Bring the Care to Those Who Need It!

8. In 2010, Casey Eye Institute built a van

9. Why Native communities? Disease prevalence – 2.3 times higher risk of diabetes than Whites – Higher prevalence of visual impairment and low- tension glaucoma compared with other racial and ethnic groups High rates of smoking High rates of poverty Geographic location

10. How Native Communities We are learning! – Very much guided and supported by our friends at the Paiute, Klamath, Cow Creek, Coos tribes Work with tribal leadership – are there unmet needs? Listen to each tribe about individual needs; how can we help for the long haul Collaborate with local providers whenever possible

11. Casey Eye Outreach Van Medical Director, Mitchell Brinks, MD, MPH – Burns Paiute Tribe – Dr. Miles Rudd, Deputy Director Portland Area HIS – Dr. Tom Becker, OHSU Public Health – Dr. Steve Mansberger, Legacy Devers Eye Institute – Michelle Singer, OHSU NAERG – Kerry Lopez, Director, NW Tribal Cancer and Western Tribal Diabetes Projects

12. Establish partner sites within the communities Partner sites identify and invite participants to screening Partner sites assist with any follow up that needs to be done based on the screening Use the existing van model

13. The Leap Cow Creek Klamath Coquille

14. Cow Creek at Canyonville

17. Klamath at Chiloquin

21. Coquille at Coos Bay

23. 795 miles 133 people screened 75 glasses Rxs 36 referrals Increased awareness of eye health issues Trip Details

24. Other Native Screenings NARA – twice/year Burns Paiute yearly

25. NARA July 2015

27. NARA December 2015

28. Burns Paiute October 2015

30. Next Steps Partner with other tribes Continue/expand outreach of educational opportunities in health careers to Native youth Expand eye health services to the aging Work with tribes to integrate educational components

31. Contact Verian Wedeking caseyoutreach@ohsu.edu, or at wedeking@ohsu.edu (503) 418 - 1698

32. Thank You

33. References 1. Engelgau, M. M., Geiss, L. S., Saaddine, J. B., Boyle, J. P., Benjamin, S. M., Gregg, E. W., Venkat Narayan, K. M. (2004). The evolving diabetes burden in the United States doi:10.7326/0003-4819-140-11-200406010-00035 2. Indian Health Service. (2012). Facts at-a-glance. 3. Centers for Disease Control and Prevention. (2014). Morbidity and mortality weekly report: Cigarette smoking in the united states. ( No. 63 (47)). Atlanta, Georgia