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Planning Continues
NEHEP Low Vision Program
In the fall, 20 representatives comprising nearly half of the National Eye Health Education Program (NEHEP) Partnership met to review initial plans for the forthcoming NEHEP effort targeting people with low vision.
The program, which has been in the planning stage for months and is slated to begin in 1999, will address a vision problem that is "most difficult and complex," according to National Eye Institute Director Carl Kupfer, M.D., in opening remarks to the group. Meeting participants discussed their ongoing low vision programs, reviewed draft plans, and provided recommendations for the proposed NEHEP program. Anthony Adams, O.D., Ph.D., chairman of the Ad Hoc Working Group on Low Vision and a member of the NEHEP Planning Committee, chaired the meeting.
 Low vision, defined as "reduced vision that interferes with activities of daily living," affects, in particular, older people--a large and increasing segment of the U.S. population. Efforts to improve the quality of life for people with low vision face a number of impediments, including a lack of communication and understanding about low vision and a lack of reimbursement for low vision aids and services.
Robert Kalina, M.D., who chaired a session on low vision at the Fourth National Eye Health Education Conference in March 1997, discussed how low vision issues raised at the conference are being addressed in the proposed program plan. Dr. Kalina, a member of the NEHEP Planning Committee, stated that the low vision campaign will target the public, the media, and health care providers.
Review of NEHEP Partnership
Low Vision Efforts
NEHEP Partnership representatives offered insights based on their own current and past efforts relating to low vision and outreach.
Carol Sussman-Skalka noted that The Lighthouse Inc. employs a strategy of using consumers as spokespersons for public service announcements and as volunteers to bring information to people with low vision. Carmel Kang of the American Association of Retired Persons reported that her organization has been targeting workers to help them with vision problems.
Egon Werthamer, O.D., of the American Academy of Optometry, reported that his organization has a low vision section that meets regularly and focuses on supporting research. Dr. Werthamer said he considers the general unfamiliarity with low vision--with both the term and the problem--to be a major obstacle to rehabilitating people. Other participants discussed the need for a term other than "low vision." Bob Cywinski said that the Lions Clubs International works through partnerships to provide assistance to people with low vision and other vision problems. He added that the Lions use the phrase "limited vision" rather than "low vision." Lorraine Marchi, who created the National Association for Visually Handicapped in 1954, said that the group recently adopted the term "hard of seeing" to describe those with low vision.
Many NEHEP Partners provide information on low vision to the public. Prevent Blindness America representative John Shoemaker said his organization supports vision screening and disseminates information about low vision services through 20 state offices. The American Foundation for the Blind creates and disseminates printed materials and educational curricula on low vision for the elderly and families, said spokesperson Alberta Orr.
Donald Fletcher, M.D., and Jane Aguirre presented a view from the American Academy of Ophthalmology, which publishes a low vision guide for ophthalmologists. Dr. Fletcher suggested that greater demand could become an important driving force for increasing low vision services. He noted that insurance coverage for low vision services varies widely from state to state, and low vision rehabilitation devices are never covered.
Larry Spitzberg, Ph.D., of the American Optometric Association (AOA), emphasized that the AOA has the manpower to support a national low vision program. About 46 percent of optometrists recently reported providing low vision services, and this year, the AOA will publish low vision clinical care guidelines. AOA currently administers, in partnership with the Xerox Corporation, a program of low vision education and outreach.
The Plan
Victor Sierra of Prospect Associates, the NEI support contractor, presented the proposed plan for a public education program to heighten awareness of low vision rehabilitation. A key aspect of the plan is its recognition that, because of the public's general lack of awareness about low vision and its services, the campaign will be long term and address a variety of audiences. The primary target audience is people age 65 and older with visual impairment that interferes with their activities of daily living. Additional audiences are managed care organizations, health care professionals, professionals in the area of aging, and family and friends of those in the target audience.
Mr. Sierra described proposed strategies for getting messages out to the public. These include creating a broad-based consumer media campaign; developing an educational kit to distribute to health care professionals and service organizations; and conducting a multifaceted awareness campaign employing exhibits, print advertisements, journal articles, and a speakers bureau.
The meeting participants gave a vote of confidence to the draft plan and offered suggestions for enhancing it. Recommendations included partnering with national organizations on aging and various local organizations, which in many cases can effectively disseminate information to the public.
In discussing messages and messengers, the participants emphasized the power of having people present their own stories about reduced vision. Themes may include an increase in independence; a focus on function rather than vision loss; and a focus on ability rather than disability. And, as Dr. Kalina said, "There should be an emphasis on hope rather than despair."
To obtain more information about the upcoming NEHEP low vision program, call Rosemary Janiszewski at (301) 496-5248 or write to the National Eye Health Education Program, 2020 Vision Place, Bethesda, MD 20892-3655.
Eye Health Professionals Work Together to Educate the Public
Dan Bintz, O.D., was in the right place at the right time.
As a member of the board of directors for the Oklahoma Association of Optometric Physicians while simultaneously serving as president of the Oklahoma affiliate of the American Diabetes Association, Dr. Bintz was in a unique position. He realized he could use his connections with both groups to encourage people with diabetes to have annual dilated eye exams.
So he took the challenge.
The result is a statewide community program called the Mission for Vision Project. This program drives home the message to people with diabetes that they need annual dilated eye exams to detect diabetic eye disease and receive proper medical care.
 "The major thrust of the program is education," said Dr. Bintz, who co-chairs the program with colleague Kirk Hoster, O.D. "This education centers around three major areas. The first area is educating the public about the relationship between diabetes and eye disease. The second area is educating people with diabetes about the importance of annual dilated eye exams. The third is educating family doctors about the relationship between diabetes and vision problems. Through recent research, we know that nearly 70 percent of all blindness due to diabetes could be delayed or prevented with better control of the disease and early detection of complications."
Under the Mission for Vision Project, people with diabetes who have not had a dilated eye exam in the previous 12 months receive a free exam by optometrists and ophthalmologists who volunteer their time. "It's not an exam for glasses; it is a thorough dilated eye exam," Dr. Bintz said. "The exam is done in the doctor's office, not a mall or other setting.
This gives doctors access to the proper instruments and lighting. And the program is not limited by income. It's for people of all income brackets with diabetes who have not had their eyes dilated in the past year."
The eye exam also includes visual acuity and tonometry testing. In addition to the eye exam, blood pressure is measured. Dr. Bintz said the program does not test people for diabetes, but instead is aimed at those who have developed the disease.
Dr. Bintz said that typically, in a town of 10,000, about four optometrists will participate in the program. "Most of the optometrists in a small town will work together and share the cost on a project like this," Dr. Bintz said. "The optometrists conducting the program will set up a phone line where people can call for appointments and information. Each optometrist will see between five and 10 people." So far, Dr. Bintz said, the Mission for Vision Project has reached out to about half of the state; doctors have examined between 300 and 500 people with diabetes for diabetic retinopathy. "Some people have been referred to retinal specialists because we discovered advanced retinopathy that required treatment," he said.
Dr. Bintz said copies of patients' exam results are sent to their family doctors to be included in their medical histories. The program also provides the Oklahoma State Department of Health (OSDH) with copies of patients' results, as well as information on how many people with diabetes have health insurance coverage. This allows OSDH to monitor the fairness factor in ensuring that people with diabetes receive health insurance coverage. "In the past, it has been difficult for people with diabetes to get health insurance," Dr. Bintz said. "On the form that patients complete when they arrive for their exam, we ask questions about their health insurance. If they have financial limitations and need further eye care, we will refer them to a medical center affiliated with a college of medicine that will treat them at little or no cost." Dr. Bintz said that only a small number of people screened--between five and 10 in each quarter of the state--need low-cost medical eye care.
Educational materials from the National Eye Health Education Program (NEHEP) are an important part of the Mission for Vision Project. "When we go into an area, we blanket the optometrists, ophthalmologists, and family doctors in that area with information on the program and give them a project packet," Dr. Bintz said. "This packet includes the Educating People with Diabetes Kit. We also give patients the brochure Don't Lose Sight of Diabetic Eye Disease. As doctors wait for patients' eyes to dilate, the patients watch a videotape on diabetic eye disease. The NEHEP materials help a great deal because they are of such high quality."
Dr. Bintz, who also serves as chairman of the Oklahoma Coalition to Reduce the Burden of Diabetes, credits the Oklahoma Association of Optometric Physicians (OAOP) and the Oklahoma affiliate of the American Diabetes Association (ADA) for their roles in the success of the program. "The member doctors in OAOP are the nucleus of the Mission for Vision Project," Dr. Bintz said. "The ADA assembles the project packets and uses its extensive database to mail the packets to family doctors. The ADA also provides brochures and information, such as dietary guidelines, to people with diabetes. The program tries to give people with diabetes the resources they need to better manage their disease." Dr. Bintz pointed out that optometrists who are not members of OAOP, as well as ophthalmologists, are encouraged to participate in the program.
Dr. Bintz began the program in the fall of 1993, getting the idea from the Lions Clubs Fight for Sight Program in Georgia. Initially, the Mission for Vision Project had some false starts and stops. However, the program has maintained a level of consistency since the Oklahoma State Department of Health stepped in to help with public awareness efforts. Although the doctors conducting the Mission for Vision Project in their local communities are responsible for complementing OSDH's efforts with local awareness campaigns, this is proving to be a challenge. "The doctors are willing to do the eye exams, but are having difficulty scheduling time to do the proper publicity that a program like this requires," Dr. Bintz said.
Dr. Bintz said the program "is focusing on the smaller to middle-sized towns and holding off on the big cities until we get a system down and reach a stride." He also said it was decided to do a quadrant of the state each year so that the program is not repeated to the same people each year. "The program would lose its effectiveness if the same thing was done over and over again instead of once every four years," Dr. Bintz said. "Instead, we are trying to educate the family doctor, the public, and people with diabetes on one simple message. People with diabetes need to have a dilated eye exam every year."
For more information on the Mission for Vision Project, contact Dr. Bintz at (405) 243-1121 or write Dr. Bintz at P.O. Box 9, Elk City, OK 73648. His e-mail address is bintz@itlnet.net.
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