In this issue:
Spring always brings with it feelings of rejuvenation, growth, and excitement. Here in D.C., it’s not just the cherry blossoms that have us feeling invigorated, it’s also because it’s time to celebrate Healthy Vision Month (HVM).
Each May, the National Eye Institute (NEI) sponsors HVM, an annual observance dedicated to encouraging Americans to take care of their eyes and make their vision a health priority. In addition to having regular comprehensive dilated eye exams, we promote how important it is for people to know their family’s eye health history, live a healthy lifestyle that includes exercising and eating right, avoid smoking, protect their eyes from the sun, and use eye safety gear while engaging in sports and other recreational activities. These are all things people should do year-round to help protect their eyes from disease and injury. We’ve been busy at NEI preparing for this important time of year and have developed a variety of resources in English and Spanish to help make it easy for you—our partner organizations, friends, and colleagues around the country—to join us in promoting eye health and safety. You can find resources, including our new HVM Toolkit, on our Healthy Vision Month website.
We are also excited about some new resources available and some currently in development. Among these is a new animated video for kids that explains how the eyes work. This video is part of a larger website for kids that NEI will launch early this summer. Also in development is a completely redesigned National Eye Health Education Program (NEHEP) website, which we hope to launch later this summer. NEHEP is putting the final touches on the Spanish version of our popular See Well for a Lifetime Toolkit that is part of our Vision and Aging Program. I want to thank all of the professionals and organizations, who serve Hispanics/Latinos, for helping to review and test these new materials.
NEHEP Partnership and other intermediary organizations play such an important role in helping us develop our materials and also in sharing our eye health information in ways that are meaningful and relevant to our target populations. It is through your efforts that we are able to reach millions of people all over the country where they live, work, and play. Your efforts—from simple activities like helping social media messages go viral, sharing and posting infocards and infographics, writing blog posts and other content on your website, and simply distributing materials at health fairs and other community settings—help make a big difference in people’s access to eye health information. We at NEI view you as an extension of our team and just as excited as we are about it being spring, we’re excited about the energy and commitment to eye health education we’ve seen from so many of you! This particular issue of Outlook contains great information about activities and resources from various NEHEP partners and I hope they spark new ideas for outreach and collaboration.
Happy spring and happy reading!
Teleophthalmology in the Community Setting Serving Latinos
Judy E. Kim, M.D. and Velinka Medic, M.S.
Medical College of Wisconsin
NEHEP Planning Committee Member
To get our eyes examined we need to find the nearest eye clinic, may need to take time off from work, adjust our schedules based on the doctor’s availability, travel to the clinic, or ask someone for a ride. Additionally, the first available opening for an appointment could be days to weeks. If one does not speak English, does not have insurance or has high deductibles, or needs a subspecialist, there could be other difficulties in getting an eye examination. This traditional model of health care delivery can require us to spend considerable amount of time, money, and effort. Certain populations, especially Latinos, have an increased risk for eye diseases from diabetes, and these issues may keep people from getting an annual eye exam as recommended. With the rise of the number Latinos with diabetes in the United States and relative shortage of eye care providers in the future, the problem of access and barriers accompanying the current delivery of care may require a paradigm shift to preserve the vision of our patients. One such shift may be the use of teleophthalmology.
What is teleophthalmology? Teleophthalmology is a branch of telemedicine, which is delivery of health care (medicine) at a distance (tele-), focusing on eye diseases. Teleophthalmology is commonly used as a “store and forward” method where pictures of the eyes are taken and then forwarded to trained personnel to interpret at a later time.
How can teleophthalmology be used to improve eye health? The pictures of the retina can be taken with a nonmydriatic camera, which does not require dilation of the pupil in most cases. There is software for storing and reviewing the photos and graders to interpret the images. An array of nonmydriatic cameras are currently available, offering anywhere from a 25 degree view of the fundus to 200 degrees of ultra-wide field view. Teleophthalmology has been successfully used to screen for diabetic retinopathy at venues ranging from mobile screenings in rural areas to health clinics of major hospitals. People who use it range from those without insurance to those who need other services. Participants indicate high satisfaction with the service, and a number of studies have shown acceptable sensitivity and specificity for detection of diabetic retinopathy.
What is Teleophthalmology to Improve Eye Health among Latinos (TIEHL)? Latinos are at increased risk for developing diabetes and diabetic retinopathy. We wanted to provide eye screening in their community, rather than having them go to physicians as in traditional medicine. The Medical College of Wisconsin partnered with the United Community Center (UCC), a nonprofit organization serving more than 20,000 Latinos in Milwaukee, of which more than 40% are at or below the poverty level, to address the eye health needs of Latinos. In the pilot program, our expertise in diabetic retinopathy, telemedicine, technology, and community engagement was taken to the community center to screen participants by taking images of their retinas. The images were then forwarded to a retina specialist via a Health Insurance Portability and Accountability Act (HIPAA) compliant cloud server. Our technology collaborators at Marquette University developed and deployed a HIPAA compliant database to collect the demographics and surveys.
The primary goals of TIEHL were to assess acceptance of such a modality for eye screening by the Latino community and to assess the feasibility of implementing teleophthalmology in a community setting to increase eye screening and improve access to care for the Latino community in Milwaukee. The pilot program also educated participants about eye diseases and strived to empower them to take ownership of their health. We found that participants favorably accepted the technology, and they liked viewing their own retina images, which served as an important way to educate the participants. To make this a sustainable model for the community, we trained bilingual community staff to take photographs and screen participants for diabetic retinopathy. This resulted in high-quality images that retina specialists could interpret, as well as high-satisfaction of the participants due to the staff’s bilingual skills, knowledge of the culture, and presence in the community.
The pilot program showed that teleophthalmology is possible in the community setting and may serve as a model to improve access to care for other communities at high risk for diabetic eye disease. As imaging technologies improve and become more affordable, teleophthalmology may be a cost-effective, reliable, and patient-centered way to screen for other eye diseases in higher risk communities.
The National Eye Institute (NEI) is preparing activities for Healthy Vision Month, a month-long health observance that kicks off every year in May. The goal during the month is to educate Americans about the steps they can take to protect their vision and keep their eyes healthy and seeing their best. These include:
- Getting regular comprehensive dilated eye exams
- Living a healthy lifestyle
- Knowing your family’s eye health history
- Wearing sunglasses that block 99–100% of UVA and UVB rays
- Protecting your eyes when playing sports or doing recreational activities
The Healthy Vision Month website has many resources and materials available in both English and Spanish to help spread the word during May and throughout the year. Some include:
- Web buttons to post to your website or blog
- Videos with tips on keeping your eyes healthy
- An animation of a dilated eye exam from an eye care professional’s point of view
- Infocards and infographics to share through social media
- Posters to download and hang in your local library, grocery store, doctor’s office, and other community settings
We look forward to celebrating Healthy Vision Month with you!
The National Eye Institute (NEI) recently released a new animated video that walks kids through the visual system. Using plain language and engaging graphics, it explains how the different parts of our eyes work together so that we can see and make sense of the world around us. The video was kid-tested and kid-approved!
Watch the video now and share it on your website or with your networks. The video is part of a larger project that NEI is working on for kids. This summer, NEI will launch an eye health and safety website, with the same fun look and feel, for upper elementary and middle school kids. Stay tuned for more updates.
To find additional educational resources NEI currently offers for kids, visit https://nei.nih.gov/kids.
We are sad to share that National Eye Health Education Program (NEHEP) Planning Committee member Dr. Robert A. Copeland, Jr., M.D., passed away unexpectedly on April 11.
Dr. Copeland was a professor and chairman of the Department of Ophthalmology at Howard University Hospital, specializing in ophthalmology, corneal and external diseases, and uveitis. He was an active participant in national and international glaucoma awareness and screening programs and served on the boards of various eye organizations, including the Prevention of Blindness Society of Metropolitan Washington, the Minority Organ Tissue Transplant Education Program, and the American Academy of Ophthalmology (AAO).
Dr. Copeland received numerous professional accolades and awards for his work, including an AAO Achievement Award and was named in Super Doctors and Washingtonian Magazine’s Top Doctors. Additionally, he served as an editorial advisor for the AAO EyeNet Magazine and editor forAdvances in Ophthalmology & Visual System.
He was a valued member of the NEHEP Planning Committee since 2012, where he became a prolific spokesperson. In January, he was interviewed on the nationally-syndicated radio program, the Tom Joyner Morning Show, answering questions on glaucoma.
“Dr. Copeland was a staunch advocate for quality patient care and eye health education, especially among underserved populations,” said Neyal Ammary-Risch, NEHEP Director. “As a NEHEP Planning Committee member, he devoted much of his time to helping us reach African Americans through media and community-based events. His passing is a tremendous loss for everyone who knew him and he will be sorely missed.”
More information on Dr. Copeland can be found on AAO’s website: http://www.aao.org/member-services/obituaries/member-obituaries.
AFB Offers New Tech Content
The American Foundation for the Blind (AFB) has expanded its content on technology use for those with visual impairments and made it easy for everyone―from people who are new to vision loss and technology to seasoned tech gurus―to get the information they need. The “Using Technology” sidebar features the following links that take visitors to new AFB content for further learning and exploration:
- Using a Computer
- Cell Phones, Tablets, and Other Mobile Technology
- Using Social Media
- Online Shopping and Banking
- Using Technology for Reading
- Prescription, Health, and Fitness Management Tools
- Smartphone GPS Navigation
- Accessible Identification Systems
And for the latest news on accessible technology, look to AccessWorld, AFB’s online magazine offering updates every month.
Aging and Vision Loss Statistics
Are you interested in statistics related to aging and vision loss? Check out the latest installment of Research Navigator for a discussion on the essential indicators related to older Americans with vision loss, as well as answers to questions such as:
- How many older adults in the United States are blind or visually impaired?
- How does vision loss change with age? What can be expected in the future?
- What are key policy and advocacy concerns of older Americans with vision loss?
Low Vision Devices
VisionAware, a program of AFB focused on adults with vision loss, has a new Web page dedicated to low vision devices. The page provides an overview of the various types of low vision devices, tips on obtaining a low-vision device, and resources for finding a low vision specialist.
For more information, visit http://www.afb.org.
Only 12% of adults in the United States have the health literacy skills needed to manage the demands of our complex healthcare system, and even these individuals' ability to absorb and use health information can be compromised by stress or illness. Experts recommend working under the assumption that everyone may have difficulty understanding, and thus, creating an environment in which all patients can thrive. Like with blood safety, universal precautions should be taken to address health literacy, because we can't know which patients are challenged by healthcare information and tasks at any given time.
The Agency for Healthcare Research and Quality (AHRQ) Health Literacy Universal Precautions Toolkit – 2nd edition can help reduce the complexity of health care, increase patient understanding of health information, and enhance support for patients of all health literacy levels. New with the second edition are:
- An enhanced assessment and quality-improvement planning tool
- A companion implementation guide
- Tool 21: Make Referrals Easy
- A crosswalk showing how implementing health literacy tools can help meet standards for patient-centered medical home certification
To download a copy of the AHRQ Health Literacy Universal Precautions Toolkit, 2nd edition, go to http://www.ahrq.gov/literacy.
Learn more about how to improve primary care by visiting AHRQ’s National Center for Excellence in Primary Care at http://www.ahrq.gov/professionals/systems/primary-care/index.html.
Find out about more AHRQ health literacy resources at: http://www.ahrq.gov/health-care-information/topics/topic-health-literacy.html.
The American Optometric Foundation (AOF) is a philanthropic organization devoted to the advancement of optometric education and research in vision and eye health to improve patient clinical care. Founded in 1947, AOF is proud to be an affiliate of the American Academy of Optometry. Sources of support for AOF include optometrists, corporations, other foundations, state associations, and private citizens interested in vision care. AOF has a strong history of dedication to the improved visual welfare of the public.
The flagship program of AOF is the William C. Ezell Fellowship, which is awarded to graduate students studying in the United States and internationally. To date, this elite program has produced more than 300 fellows. Among the list of former Ezell fellows are more than 20 deans and presidents of optometric schools and colleges; more than 130 faculty members; and more than 160 fellows of the American Academy of Optometry, including three of its presidents. In addition to the Ezell Fellowship, more than $400,000 in fellowships, scholarships, grants, and residency educational awards was awarded last year.
For more information about AOF and its programs, please visit http://www.aaopt.org/AOF.
Researchers, state health department officials, and the general public can now access the latest and most relevant state vision health data using the Centers for Disease Control and Prevention’s (CDC) Vision Health Initiative (VHI) interactive data site. State data inform and guide partners in developing vision loss prevention and eye health promotion strategies.
Data are from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing, annual telephone survey of the noninstitutionalized adult population in each state. The vision question added to the core module in 2013 was “Are you blind or do you have serious difficulty seeing, even when wearing glasses?” BRFSS questions provide data on health-related risk behaviors, chronic health conditions, and the use of preventive services—all data that can now be found on the VHI website.
Feel free to explore these data by location or topic. Data can be displayed in both tabular and colorful graphic formats. Are you interested in the prevalence of those who report blindness or serious difficulty seeing? As a result of the new BRFSS core question on vision status, those accessing VHI’s data page will see that in 2014, the percentage of adults 18 years and older who reported blindness or severe difficulty seeing ranged from 2.7% to 8.6%. Data on blindness and difficulty seeing can also be stratified by age, gender, race, education level, smoking status, comorbid conditions, and other important risk factors for every state. The findings provide opportunities to highlight disparities and identify gaps occurring within states that can be filled with targeted and collaborative programs. As many of these public health issues disproportionately affect those from lower income communities, these data have the potential to inform state-level efforts to address the needs of people with vision impairment.
Additionally, a nine-question BRFSS vision module was used from 2005–2011 in 23 states and provides state-level data on specific eye diseases, as well as access and use of eye care services, all also available on VHI’s interactive data site. CDC’s VHI looks forward to seeing how this new and engaging data site will be used and to finding opportunities to grow and develop it in the coming years.
The American Academy of Ophthalmology recently launched a new and improved eye health information website for the public on a mobile-first platform. The new version of the Academy’s EyeSmart website makes it simpler than ever for people around the globe to get anytime, anywhere access to timely and accurate sight-saving advice.
The EyeSmart website was first launched by the Academy in 2007 and has since become a leading source of eye care guidance for the public. It attracts 3 million page views a month and one million unique visitors. The site provides users with a vast library of important news and information on how people can protect and preserve their vision.
EyeSmart features 4,000 pages of content, including articles, graphics, and animated videos. All are reviewed by Academy member ophthalmologists. EyeSmart’s revamped interface improves the organization of this content. It also provides a more modern look and feel, easier navigation, and several other enhancements, including:
- A new interface for Ask an Eye M.D. This popular feature of the website enables members of the public to ask questions and receive answers from Academy member ophthalmologists. The new version also allows visitors to more easily find existing answers to questions like theirs. Hundreds of questions and answers are already available on the site.
- An improved Find an Eye M.D. tool. This ophthalmologist-locater feature enables users to search for Academy member ophthalmologists worldwide. It now provides a more intuitive interface and has improved mapping functions.
- Links to Spanish versions of most EyeSmart content in the OjosSanos section, which is located at aao.org/salud-ocular. EyeSmart also integrates with Google translate for readers of dozens of other languages.
- Feeds from the EyeSmart Facebook and Twitter channels. This allows users to engage with the many thousands of people following EyeSmart and share their experiences on social media.
- A revamped section for health professionals. This improved section is filled with resources health professionals can use to educate their own local communities about eye health.
The launch of the new EyeSmart website is part of the Academy’s strategic rebranding, which was announced in October.
Health professionals are encouraged to link to EyeSmart. It is now located at a new Web address on the Academy's AAO.org website. Those who link to EyeSmart at its old geteyesmart.org address will be redirected to the new Eye Health section of AAO.org. However, updating the link is highly recommended. Learn more at Instructions: Web Links and Buttons for Connecting to EyeSmart.
The National Diabetes Education Program (NDEP) at the Centers for Disease Control and Prevention recently launched its redesigned website. Now, it’s easier for community-based organizations, healthcare providers, and others working with people who have or are at risk for diabetes to find evidence-based, tested, and culturally appropriate diabetes education resources and tools.
NDEP also provides educational resources for American Indians/Alaska Natives, Hispanics/Latinos, African Americans, Asian Americans, Native Hawaiians, and Pacific Islanders—groups at risk or with high prevalence of type 2 diabetes. Visit NDEP at http://www.cdc.gov/diabetes/ndep to learn more.
As our population ages, the incidence of age-related vision loss is increasing. According to the National Eye Institute (NEI), the number of Americans with low vision will continue to grow dramatically, from 2.9 million in 2010, to 5 million in 2030, and to 8.9 million in 2050.
The Low Vision Focus at Hadley Institute for the Blind and Visually Impaired is pleased to present these sample tips for people experiencing low vision:
Use tactile markers. Mark stove-top control settings with small dots of glue or clear nail polish that you can feel when dry. Put one dot on low, two dots on medium, and three dots on high for easy-to-remember temperature settings by touch. Tactile marks are also handy for identifying food items. Canned goods, for instance, may be identified by using a system of rubber bands: one band around canned peas, two bands around canned corn, and so forth.
Apply contrasting colors. Use a dark table cloth with white plates to make dining easier. A dark cutting board for light-colored foods or vice versa will help with food preparation. Door frames, trim, and light switches make navigation safer if painted in a contrasting color from the walls around them. Also, add a strip of contrasting colored paint or tape to the edge of stairway step treads.
Adjust lighting. Design lighting appropriately for low vision; for example, reduce overall ambient light, while increasing task-specific lighting. Reduce glare by ensuring that lamp shades are opaque and extend below eye level, and cover shiny table surfaces with a cloth.
Practice safety first. While reaching down to pick up dropped objects, keep your hand, palm out, approximately 12 inches in front your face. This way, you don’t hit your forehead on the edges of tables or countertops. Consistently close kitchen and bathroom cabinets, especially those above countertops, and make sure doors around the house are either completely open or shut. Practicing these safety techniques can greatly reduce the risk of head injury. Area rugs can pose a hazard for persons with visual field loss.
Tips, information, and support can reduce the impact of vision loss. For more information, please visit http://www.lowvisionfocus.org or call 855–830–5355 to receive free audio materials designed to assist older adults with low vision.
The Joint Commission on Allied Health Personnel in Ophthalmology (JCAHPO) and the Association of Technical Personnel in Ophthalmology (ATPO) are pleased to announce that U.S. News and World Report has ranked “ophthalmic medical technician” as one of the best jobs of 2016. This ranking is based on a metric that U.S. News uses that prioritizes median salary, employment rate, and job prospects, while also factoring in other measures, such as 10-year growth projections, stress level, and work–life balance.
Ophthalmic medical technicians, also known as allied ophthalmic personnel (AOP), are ranked 12th out of all health care support careers and 61st out of the 100 Best Jobs. The U.S. Bureau of Labor Statistics predicts this profession will grow at a rate of 25% from 2014 to 2024, creating an estimated 9,100 new positions in this field, as the population ages and incidence of vision problems increases.
In her interview with U.S. News and World Report, ATPO President Christine McDonald, COE, COA, ROUB, OSC, recommends that jobseekers interested in entering the allied ophthalmic health field start by researching ophthalmology practices in their area and drafting a resume that communicates the skills that make them suited for medical professions.
Most ophthalmic technicians receive on-the-job training, but entry into the field can be aided by completing an independent study course or attending one of the 30 formal academic programs in which students can earn a degree or diploma in ophthalmic assisting.
JCAHPO certifies AOP and provides independent study and continuing education materials.
According to the U.S. Bureau of Labor Statistics, ophthalmic technicians stay in their careers and positions significantly longer than average American workers, who stay in their jobs for approximately 4.6 years. In comparison, the ATPO 2015 Salary and Compensation Report shows that uncertified AOP remain in their jobs for an average of 8 years and certified AOP spend an average 10.7 years with their employer.
People who are interested in learning more about becoming an ophthalmic technician can visit http://www.discovereyecareers.org.
New Resources Available from the National Center for Children’s Vision and Eye Health at Prevent Blindness
The National Center for Children’s Vision and Eye Health at Prevent Blindness has released a new report titled “Children’s Vision and Eye Health: A Snapshot of Current National Issues.” A compilation of current research, survey data, and best-practices, this report outlines the current landscape for children’s vision and eye health in the United States. It also includes the national prevalence rates for vision conditions (amblyopia, strabismus, etc.), including breakdown by ethnic group, and provides a summary of school vision screening requirements by state. The report includes information and examples that may translate into effective community-level health promotion strategies leading to improved vision systems for children.
The Children’s Vision and Eye Health: A Snapshot of Current National Issues report can be downloaded in PDF form or viewed online at: http://nationalcenter.preventblindness.org.
In addition, The National Association of School Nurses (NASN), in partnership with the National Center for Children’s Vision and Eye Health at Prevent Blindness, has launched a new Vision Resource Page on its website to support school nurses in the implementation of stronger vision health programs for the students they serve.
The free resource promotes a standardized approach to vision and eye health, facilitates follow-up to eye care for children who do not pass vision screening, and provides family-friendly educational information. The new materials at can be found at https://www.nasn.org/ToolsResources/VisionandEyeHealth.
For more information on the Children’s Vision and Eye Health: A Snapshot of Current National Issues report, the NASN Vision Resource Page, or general children’s vision topics, please call 800–331–2020 or visit http://nationalcenter.preventblindness.org.
The National Association of Community Health Centers (NACHC) is a nonprofit organization whose mission is to enhance and expand access to quality, community-responsive health care for America’s medically underserved and uninsured. And NACHC uses National Eye Health Education Program (NEHEP) resources to do it.
NACHC represents the nation’s network of more than 1,200 federally qualified health centers, which serve more than 24 million people (or 1 in 14 Americans) through more than 9,200 sites located in all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. It is the national advocacy voice for health centers. It also provides technical assistance, trainings, and program assistance.
NACHC promotes prevention of illness through bold, innovative solutions that not only improve poor health outcomes but address factors that may cause them. Vision services are part of the range of primary care services that a health center can provide, depending on the populations it serves. Low-income and minority populations that health centers typically serve are often at greater risk for undiagnosed and uncorrected eye and vision disorders and diseases than the general population for a variety of reasons. These may include lack of access to an eye care professional, lack of insurance coverage, or the high cost of treatments (such as corrective lenses).
NACHC provides links to NEHEP resources on its website, promotes eye health social media messages on Facebook and Twitter during health observance months like National Diabetes Month, and posts and distributes NEHEP resources to its member health centers.
For more information on NACHC, visit http://www.nachc.com.
The National Eye Health Education Program (NEHEP) wants to know what you think about Outlook. Let us know what you find beneficial, ideas for content you would like to see in upcoming issues, or suggestions for improvement. We’re always interested in hearing about your eye health education efforts and especially how you have used NEHEP resources and materials.
Please contact us. We look forward to hearing from you!