Healthy Aging Month is almost here, and with it comes calls for those over 65 years old to get a thorough eye exam. As people age, several vision health concerns begin to emerge such as macular degeneration, diabetic retinopathy, glaucoma and cataracts. Not only can these vision problems lead to loss of sight, but they can also make day-to-day activities more difficult.

According to the BrightFocus Foundation, macular degeneration is a leading cause of vision loss in Americans 60 years of age and older. Advanced age-related macular degeneration is also the leading cause of irreversible blindness and visual impairment in the world. The Foundation noted that nearly 20 million adults in the U.S. have some form of age-related macular degeneration. As of 2019, 18 million people aged 40 and older were living with early-stage macular degeneration and 1.49 million people had late-stage macular degeneration.

As the senior population continues to grow, the number of older patients requiring vision care for common ailments will also begin to rise. The American Society on Aging noted that there is a “woeful lack of funding and specialized services available for older adults experiencing vision loss, and the preponderance of existing programs and services are mostly focused on employment.”

The Society believes many state agencies are aware of the serious gaps in education and training related to vision loss for service providers and agencies across the aging network. These include a lack of information about access points for available support and services for older Americans experiencing vision loss.

At the Alliance on Aging and Vision Loss, a special-interest affiliate of the American Council for the Blind, efforts to promote advocacy and access to better care are at the forefront of the organization’s operations.

Doug Powell, president of AAVL, noted that there are many parallels between access to general health care among seniors and those who are blind or visually impaired. He said transportation barriers, lack of information available in accessible formats and ill-equipped vision care personnel continue to make access to adequate vision care a challenge.

“We believe that the biggest challenge will continue to be the lack of information that eyecare personnel have about vision rehabilitation, thus preventing them from referring their patients to services in the community which could address their functional limitations posed by vision loss,” he said.

Powell noted a recent study by VisionServe Alliance’s Big Data Project, which found that seniors who are blind or have low vision are much more likely to be poor than their sighted counterparts. He added this may be due to existing barriers to employment, combined with the fact that this population is more likely to experience other health issues, resulting in higher out-of-pocket expenses and lower income levels.

The data also showed that vision loss exacerbates other health conditions or increases the risk of negative outcomes in seniors. For example, nearly 17 percent of people with blindness or low vision reported having a stroke, compared to just 7.3 percent of those without vision loss. People with vision loss were also more likely to report having a heart attack compared with those without vision loss. The authors of the report believe these higher rates of health issues among those with vision loss are due to less access to adequate care and resources.


“Aging network organizations, such as Area Agencies on Aging (AAAs) must acknowledge the increasing numbers of seniors with visual impairments and ensure that their programs and services are accessible for that population, by providing information about their services in accessible formats,” Powell said. He added that Area Agencies on Aging must begin to fund vision rehabilitation interventions, at least on a basic level, to ensure their constituents with visual impairments can access and utilize their services, such as activities at senior centers.

He noted this can only be achieved if vision rehabilitation services are acknowledged and supported by programs such as Medicaid, Medicare and other advantage care plans.

Powell said the Alliance on Aging and Vision Loss (AAVL) is an active member of the Aging and Vision Loss National Coalition (AVLNC), a consortium of organizations and professionals that come together to advocate for the expansion and strengthening of services for older people experiencing blindness or low vision. Through its advocacy committees, he said the organization develops talking points and encourages its members to advocate with their congressional representatives around issues of importance to its constituents.

“Specifically, AAVL has been advocating for inclusion of new language in the Older Americans Act (OAA) around blindness, visual impairment and dual sensory disabilities as part of the ongoing process of reauthorization of the Act,” Powell said. “We believe that, by having this language added to the OAA, it will generate increased awareness of and potential for more services available to the many millions of older people expected to develop severe vision loss in the next decades.”

The Gr8 Eye Movement provides resources and support to caregivers. In collaboration with Prevent Blindness, the program also helps raise awareness and educate the public about retinal diseases and offers extensive educational materials, learning tools and helpful resources online.

New data from Gr8 Eye Movement found that 37 percent of caregivers believe that people with diabetes will eventually lose their sight. Meanwhile, 75 percent of current caregivers for at-risk individuals find it challenging to care for someone with significant vision loss. Additionally, 79 percent of caregivers perceive vision loss as an inevitable part of aging.

 
 Jeff Todd.
Jeff Todd, president and CEO of Prevent Blindness noted that an aging population, particularly Baby Boomers and the oldest Gen Xers, is creating higher rates of age-related health issues, including vision loss and eye disease. He believes this will put a significant strain on the health care system as many caregivers in the system are a part of this cohort.

“This will lead to increased demand for eyecare services while the number of available eyecare providers is shrinking,” Todd said. “Access to eyecare is further complicated by disparities in insurance coverage, the uneven distribution of providers between urban and rural areas, and individual financial capacities to cover treatment costs,” Todd said, adding that variations in health literacy also impact the identification and management of eye conditions.

Improving the financing of eyecare in the U.S. is essential, according to Todd, who noted this must be accompanied by enhanced prevention strategies and patient-centered care approaches to reduce the incidence of vision loss and eye disease.

“Unfortunately, current funding for vision and eyecare services in the United States is insufficient to meet the population's needs. Prevent Blindness is advocating for funding for the Vision Health Initiative at the CDC to ensure that necessary resources are available for public health interventions and community-level strategies to control eye disease,” he said.

Todd said that ongoing inadequate access to eyecare is a significant issue affecting all groups, particularly seniors who often struggle to afford Medicare Advantage Plans, where most vision benefits are available. He said while some health insurance plans, including Medicare, offer coverage for certain vision services, they do not cover all expenses.

“This can be confusing for patients and caregivers, particularly when dealing with out-of-pocket costs for medical treatments such as diabetic macular edema, age-related macular degeneration and cataract removal,” he said. “Additionally, navigating insurance policies and terms can be especially challenging for individuals with vision impairments, as many brochures and websites are inaccessible for those with low vision.”

He said caregivers face difficulties managing these complexities, and the Prevent Blindness Living Well with Low Vision program provides a free resource designed to help them navigate these challenges including service directories and downloadable handbooks.

Ongoing improvements to access to vision care are also critical to providing the right support for seniors with vision loss, according to Todd.

He said Prevent Blindness is working with government representatives and public health organizations like the National Health Council to educate policymakers on the need for funding and support for expanded access to vision care, including providing data that demonstrates how prevention programs benefit the U.S. economy by saving money on health care expenditures in the future.

“Among the strategies that would improve access to vision care include expanding vision services within Medicare and Medicaid, increasing the availability of vision services at Federally Qualified Health Centers, enhancing public and patient education about eye health, and improving early detection and care coordination as part of public health programs,” Todd said. “Prevent Blindness will continue to push the message to lawmakers that vision loss is not inevitable as Americans age, and that public policies should reflect this notion.”