Vision Plans A Perspective On Eye Care: The Affect Of Healthcare Reform
by Karen M. Gustin, LLIF

Some people readily embrace new ideas; others critically analyze things and resolve all concerns before making a decision; and still others vehemently oppose anything new.

We have seen all three reactions to reforming America’s healthcare system and the possibility of universal care or public health programs. There has been a lot of attention on how the proposed change would affect on medical care, but very little focus on how reform would affect ancillary health services, such as eye care. In this article, we will compare eye care in the United States to eye care the United Kingdom, which has a nationalized healthcare system. Consider the following statistics in the United States:

A child’s eyes should be checked immediately after birth, with a comprehensive exam by age three and again at age five when entering school, and thereafter every one to two years. (National Eye Institute)

A Valued Sense

Americans rate sight as the one sense they value the most and do not want to lose, according to the National Eye Institute. Americans with eye care insurance tend to schedule regular appointments with their eye care physicians for wellness examinations. Unfortunately, only 40% have access to eye care insurance plans through their employers. People without insurance often wait until they have a vision problem before contacting their eye doctor. By that time, the disease may be advanced and difficult to reverse or cure.

Prevent Blindness America reveals that vision problems cost the U.S. $51.4 billion, primarily due to reduced employee productivity and performance; medical costs associated with treatment; or sick days taken for illness, treatment, or follow up care for vision issues.
U.S. eye care professionals say that sight loss prevention begins with early detection of potential problems. They recommend the following comprehensive examination schedules:
Every two years for ages 20 to 30. A baseline status exam at 40 and a comprehensive eye exam every year thereafter. (National Eye Institute). It is important to note that the quality of vision care in the U.S. is excellent and many insurance plans place few restrictions on the frequency of visits. If most U.S. employers offered vision benefits, a large number of Americans would get the regular comprehensive eye exams and treatment they need to protect their eyesight.

Eye Care Issues in the U.K

The United Kingdom’s nationalized health-care plan provides basic or sick coverage only; citizens can purchase supplemental insurance for additional coverage of health needs.
Nearly 93% of Britons fear going blind more than they fear getting a heart attack or dying prematurely, according to a recent survey by Transitions Optical. Yet, at least 25% say they only need to see an eye doctor when they have a noticeable vision problem.
Adult eyesight statistics – Every day, 100 Britons begin to lose their sight, reports the Royal National Institute of Blind people (RNIB). More than 2 million have significant sight loss. Since the majority of older citizens are not in regular contact with eye care services, records are not available on the severity of sight problems in the U.K. Health officials say that many more people have treatable eye concerns that are not being addressed. As a result, Britons are losing their vision needlessly.

Here is a list of eye health issues:

• More than 50% of all sight problems may be due to untreated refractive issues or cataracts. The RNIB projects that nearly 40 million Britons will have sight loss by 2050.
• Glaucoma – The RNIB estimates that 500,000 Britons are at risk of losing their sight due to this health concern.
• Diabetes retinopathy – Approximately one-half million people in the U.K. have diabetes. Nearly 20% of this group does not get retinal screenings for retinopathy. (Diabetes U.K.)
• Macular degeneration – At least 500,000 people in the U.K. have macular degeneration; another 250,000 are registered as partially blind or completely blind due to this disease.
• Blindness or vision impairment – Nearly 400,000 Britons are registered with this problem (2006); 82% are 50 years and older.
The RNIB says eye disease and sight loss costs the U.K. at least $10.6 billion due to lost productivity and sick days for illness associated with eye diseases. These costs are having a dramatically negative affect on the economy.

Kids at Risk

• Vision professionals say that at least 25,000 kids in the U.K. have sight problems.
• U.K. preschoolers routinely get vision screening, but there are no specific recommendations for testing school-age children. Some areas of the country offer visual -acuity and color vision tests in older children and teenagers. Eye examination tests are free to kids ages 16 and younger.

Concerns About Healthcare Rationing

In recent years, the U.K. has seen -considerable controversy over healthcare rationing. There are reports of limited access to drugs for medical care, with availability sometimes determined by a postage code lottery.

There are also media reports of the National Health System (NHS) refusing sight-saving drugs to people with -macular degeneration and other serious eye diseases until their vision is gone in one eye. Since drug treatment options are expensive, the NHS says it must limit the number of people who get care. Even a person who does get approved may wait several months before getting appropriate treatment.

In response to medical professionals’ concerns, the NHS is emphasizing the importance of wellness lifestyles to eliminate sight-damaging habits, such as smoking and excessive alcohol consumption. NHS recently introduced a screening program to evaluate residents health concerns, including sight problems, and provide a report on treatment options.
Forewarned is Forearmed

There are many perplexing healthcare -delivery and education issues and not everyone has -access to the quality of care or services they need. It is important to analyze healthcare -reform options carefully to determine whether the proposed changes will result in the quality of care, access to services and treatments, and freedom of choice we need and expect. These questions deserve an investment of time to ensure thoughtfully crafted plans that are in the best interests of Americans.
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Karen M. Gustin, LLIF, is senior vice president - group marketing, managed care and national accounts for Ameritas Group, a division of Ameritas Life Insurance Corp. (a UNIFI Company), with headquarters in Lincoln, Neb. A leading provider of dental and eye care products and services, Ameritas Group added hearing care to its product portfolio in 2008. Gustin joined Ameritas Group in 1983. She is vice chair of the National Association of Dental Plans’ board of directors and its statistical task force, and also serves on NADP’s executive committee.

Adults – Every day, 23 people experience the
early stages of sight loss:

• 4.6 million of those over 40 are visually impaired or blind.
• 2 million of those 50 or older have been diagnosed with macular degeneration.
• 22 million of those 40 or older have cataracts.
• 4.5 million of those over 40 have diabetic retinopathy.
• 2.3 million of those over 40 have glaucoma.
• 44 million of those over age 40 have myopia or hyperopia.

Children – These vision problems create attention and performance issues for kids at school and home:
• 25% of school-age children have vision impairment. Five percent of preschool kids have vision problems that could result in permanent sight loss if left untreated.
• The most common types of eye problems are myopia (nearsightedness), strabismus (crossed eyes), or amblyopia (lazy eye).
• Common causes of blindness among children are congenital cataracts, retinopathy of prematurity, and other complications due to premature birth.