8 Access to Eye Health Services
Bailie Featherston
Eye health continues to be an important aspect of the maintenance of holistic health. Eye health is when eye function, ocular health, and vision are improved to increase people’s overall wellbeing (Ramke et al., 2021). Recent studies have shown that greater than 11 million U.S. individuals, 12 years and older, require some sort of vision or ocular health service (CDC, 2020). However, regular visits to the optometrist are typically not one of people’s priorities regarding health care. On a global scale, a study indicates that over 440 million people across the world struggle with eye health conditions (Barman & Mishra, 2020). Despite these large numbers, a gap remains between need for vision care services and number of people who have the means and the motivation to obtain quality eye care.
In the United States, many men and women in the general population do not visit the eye doctor. Specifically, only 50% of the 93 million U.S. adults have accessed eye care in the last year (CDC, 2020). Furthermore, only 39% of U.S. children have participated in vision screenings (CDC, 2020). Eye conditions often go undetected because of decreased screening and lack of regular eye exams. This is concerning because some overarching conditions can be recognized during a routine eye exam, including diabetes, hypertension, and cancer (Stepko, 2021). Some other examples of common eye issues that can be found at regular eye exams include amblyopia, cataracts, glaucoma, and retinal detachments . Without regular eye exams that assess vision prescription and look at retina health, men and women may experience a decreased quality of life that can be prevented. By accessing eye health services, quality of life is increased through the preventative screenings and exams that create a decreased risk for disease by catching problems early and by allowing patients to achieve a better sense of sight through corrected vision.
Importantly, men are less likely to access eye health services. For example, a study was conducted to see if patients diagnosed with sarcoidosis were attending their recommended eye exams and found men were less likely to complete the appointments than women (Fidler et al., 2021). This finding of men not utilizing eye health services is due to multiple factors, including income and underlying barriers that come with increasing age. Often, vision insurance is separate from general insurance coverage and is usually not offered as a benefit within individuals’ general health insurance. This gap between vision insurance and health insurance can also enhance economic barriers to accessing eye care services because of added costs.
Due to men’s limited receipt of vision care services, preventions must be implemented to improve men’s overall health and quality of life. One of these interventions could be fostering increased doctor and patient collaboration to encourage men to be more involved in their eye health care plan (Rosu et al., 2017). Another intervention is to expand insurance status and transportation efforts to increase access to care for low-income men and elderly men (Barman & Mishra, 2020).
Intersectionality Within Men’s Eye Health
As a population group, men are less likely to utilize eye care services, such as routine eye exams (Fidler et al., 2021). As a result, men are at a greater risk of declining sight, rising incidence of ocular conditions, and having systemic issues that go unnoticed. Continued eye health is also crucial to better quality of life for men, as stated in a study that tracked men’s uptake of eye services (Fidler et al., 2021).
Income and age play major roles in men’s need and use of eye care. For example, a study conducted in Spain states that sight problems are largely associated with decreased income (Latorre-Arteaga et al., 2018). Although this study focused on Spain, the information can also be applied to trends in the United States. For instance, a study based in the U.S. found that vision insurance and its affordability affected men’s access to care (Varadaraj et al., 2019). Age is also a factor in determining access to eye care. A Canadian study, that can also be translated to the U.S., states that men have increased issues with getting to the doctor due to older age (Aljied et al., 2018).
How Does Low Income Impact Men’s Eye Health?
As a determinant of men’s health, income has a large effect on ability to access eye care. In general, ocular health services are expensive. This high-cost places a burden on men that can be too great to overcome. Insurance status facilitates access to eye care. For example, in a U.S. study of surveyed men, records indicate that if men could not afford coverage, this prevented them from engaging in vision services (Varadaraj et al., 2019). Also, regarding insurance, a participant in a study discussed how his vision insurance plan only covered two optical visits per year, and as a result, he was less likely to go to the optometrist when he needed care (Spafford et al., 2019). Therefore, even men who are insured struggle to use eye care services because their plans may not provide complete coverage due to high costs. Overall, the burden of income is a deterrent in some men’s willingness and ability to obtain eye health services. As previously mentioned, a Spanish study notes that 10% of the population related their poor eye health to lack of money to pay for services (Latorre-Arteaga et al., 2018). Again, this similar to U.S. trends that show lack of income as a barrier to accessing eye care.
“No money and poverty graphic design” by Mohamed Hassan is licensed under Pixabay License
How Does Increasing Age Impact Men’s Eye Health?
As a general trend, men’s eye health decreases with increasing age. The prevalence of ocular conditions, such as the development of cataracts, increases as men get older (Tham et al., 2014). Because of this, using eye health services is important to track conditions, such as cataract progression, to determine if the condition is impairing vision. Furthermore, as men age, they often feel less motivated to go to the eye doctor due to decreased mobility. Specifically, a study including men in the U.S., states that men are less likely to obtain vision services as their age increases (Barman & Mishra, 2020). Another study indicates that 41% of men, 60 years and older, who had vision problems did not go to the eye doctor in the past year (Aljied et al., 2018). As men age, getting to the doctor’s office becomes a greater challenge, and they may need to obtain assistance to fulfill this task. This lowers men’s sense of independence, which can hinder them from accessing care since they cannot be self-reliant (Barman & Mishra, 2020).
“Mature Cataract” by Community Eye Health is licensed under CC BY-NC 2.0
Despite the studies regarding how socioeconomic status and age-associated barriers affect men’s access to health care services, there is a lack of research regarding the quality of eye care services for men. There are many studies that pertain to quality of health care in general, but not cases specifically pertaining to the quality of eye care for men.
Recommendations to Improve Men’s Access to Eye Care
To improve access to eye care services, the World Health Organization is working with governments at the United Nations General Assembly to increase initiatives to integrate eye care plans into universal health insurance (World Health Organization, 2021). However, not much progress has been made regarding these efforts. To achieve this goal, communities and policy makers must work together to ensure eye care services are accessible for all people.
One policy intervention to increase men’s access of eye health services is to expand insurance policies to include vision services. Often, general health insurance plans do not include coverage for routine eye exams or vision screenings. By expanding these insurance policies to include eye care services, men will be more equipped to access services, despite having a lower income. A recent study found that 32% of low-income individuals were more likely to use eye health services under states who expanded their Medicaid coverage to include vision plans (Lipton & Decker, 2015). Due to these lower out-of-pocket costs, individuals, including low-income men, were able to access the eye doctor.
As men age, they are less likely to access eye care services due to less mobility and not wanting to ask others for help to reach healthcare facilities. One way to address this barrier could be to focus on implementing more accommodation services for groups of the population, specifically elderly men. Communities could offer eye care screening days at senior centers. In doing this, the services would be brought to the individual and allow elderly men to still feel in control of their health without the need to ask for help getting to the doctor (Barman & Mishra, 2020). Additionally, community eye centers can implement a transportation shuttle service. This shuttle service would further maintain men’s sense of independence by eliminating the need for them to ask for assistance to access eye services (Barman & Mishra, 2020).
Due to men’s limited use of eye care services, more studies on how to further improve access to care and to assess the quality of men’s eye care should be conducted. To know exactly what factors are hindering and putting men in a position of marginalization when accessing eye health services, these studies would help in designing targeted interventions that could benefit men’s eye health and their overall quality of sight.
Key Takeaways
- Eye health is not a main concern for most people, and services in eye care are drastically under-utilized.
- Low income can place a burden on men due to high out-of-pocket costs and lack of vision insurance, thus hindering them from accessing care.
- Age-associated barriers, such as decreased mobility and decreased sense of independence, can deter older men from accessing the eye doctor.
Chapter Review Questions
- How many people, 12 years and older, require some sort of vision or ocular health service?
- A. 11 million
- B. 2 million
- C. 1 billion
- D. 3 million
- Regular visits to the _________ are not one of people’s priorities regarding health care.
- A. Optometrist
- B. Dentist
- C. Oral Surgeon
- D. Primary Care Physician
- Eye conditions often go undetected because…
- A. People don’t need to worry about their eyes.
- B. There are too many people trying to access services
- C. Lack of screenings and regular eye exams
- D. None of the above
- The two intersectionality identities highlighted in this chapter include:
- A. Race and ethnicity
- B. Rural and urban
- C. Age and race
- D. Income and age
References
Aljied, R., Aubin, M.J., Buhrmann, R., Sabeti, S., &. Freeman, E. (2018). Eye care utilization and its determinants in Canada. Canadian Journal of Ophthalmology, 53(3), 298-304. https://doi.org/10.1016/j.jcjo.2018.01.021
Barman, D. & Mishra, M. (2020). How does eye care seeking behavior change with increasing age and visual impairment? Intersectional analysis of older adults in the Indian Sundarbans. BMC Geriatrics, 20(71). https://doi.org/10.1186/s12877-020-1438-y
CDC. (2020, October 1). Keep an eye on your vision health. U.S. Department of Health & Human Services. Retrieved from https://www.cdc.gov/visionhealth/resources/features/keep-eye-on-vision-health.html
Fidler, L.M., Balter, M., Fisher, J.H., Stanbrook, M.B., To, T., Kohly, R., Gershon, A.S. (2021). Ophthalmologic assessments in patients with newly diagnosed sarcoidosis: an observational study. From a universal healthcare system. Respiratory Medicine, 187. https://doi.org/10.1016/j.rmed.2021.106575
Latorre-Arteaga, S., Fernandez-Saez, J., & Gil-Gonzalez, D. (2018). Inequities in visual health and health services use in a rural region in Spain. Graceta Sanitaria, 32(5), 439-446. https://doi.org/10.1016/j.gaceta.2017.03.009
Lipton, B.J. & Decker, S.L. (2015). The effect of health insurance coverage on medical care utilization and health outcomes: Evidence from medicaid adult vision benefits. Journal of Health Economics, 44, 320-332. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767617/
Ramke, J., AM Ah Tong, B., Stern, J., Swenor, B.K., Faal, H.B, & Burton, M.J. (2021). Defining eye health for everyone. Ophthalmic and Physiological Optics, 42(1), 1-3. https://onlinelibrary.wiley.com/doi/10.1111/opo.12922#:~:text=Eye%20health%20is%20the%20state,of%20life%20(Figure%201).
Rosu, M.B., Oliffe, J.L., Kelly, M.T. (2017). Nurse practitioners and men’s primary health care. American Journal of Men’s Health, 11(5), 1501-1511. 10.1177/1557988315617721
Spafford, M.M., Sivak, A.M., Lillakas, L., & Irving, E.L. (2019). Motivators and deterrents for seeking eye care in a Canadian region. Clinical and Experimental Optometry, 103(2), 224-229. https://doi.org/10.1111/cxo.12917
Stepko, B. (2021, November 15). 8 health problems that can be detected through an eye exam. AARP. Retrieved from https://www.aarp.org/health/conditions-treatments/info-2021/eye-exam-health.html
Tham, Y.C., Li, X., Wong, T.Y., Quigley, H.A., Aung, T., & Cheng, C.Y. (2014). Global prevalence of glaucoma and projections of glaucoma burden through 2040. Ophthalmology, 122(11), 2081-2090. 10.1016/j.ophtha.2014.05.013
Varadaraj, V., Frick, K.D., Saaddine, J., Friedman, D.S., & Swenor, B.K. (2019). Trends in eye care use and eyeglasses affordability: The US national health interview survey, 2008-2016. JAMA Ophthalmology, 137(4), 391-398. 10.1001/jamaophthalmol.2018.6799
WHO. (2021, July 23). Governments commit to accelerate action to improve access to eye care services. World Health Organization. Retrieved from https://www.who.int/news/item/23-07-2021-governments-commit-to-accelerate-action-to-improve-access-to-eye-care-services
Ocular means something of or relating to the eye.
Amblyopia is a condition of reduced vision in one eye that results from poor development of the part of the brain which serves the affected eye.
A cataract is a clouding of the lens of the eye or of its surrounding transparent membrane that obstructs the passage of light.
Glaucoma is a disease of the eye marked by increased pressure within the eyeball that can result in damage to the optic disc and gradual loss of vision.
A retinal detachment is a condition in which the retina of the eye is no longer connected to the eye as it should be.
Sarcoidosis is a chronic disease of unknown cause that is characterized by the formation of nodules especially in the lymph nodes, lungs, bone, and skin.
Medicaid is a program of medical aid designed for those unable to afford regular medical service and financed by the state and federal governments.