Vision Loss & Blindness: Neglected Public Health Problems

Eye chartPublic health tends to focus on a few big problems: obesity, cancer, smoking, vaccination. These are all crucial issues to address in order to improve population health in the United States. However, there are other health concerns that affect millions of Americans that don’t get the same attention but cause significant suffering. This week, driving back to Maryland, I listened to the new podcast Invisibilia. In the episode “How to Become Batman,” hosts Lulu Miller and Alix Spiegler talk with a man who, based on his own experience, argues that it is not blindness in itself that keeps blind people from being independent, but cultural expectations are to blame. Listening to this show, which I cannot recommend enough, I realized that I knew next to nothing about visual impairment and its public health impact. So, as is my M.O., I decided to find out!

What are the major sources of visual impairment and blindness in the United States? How prevalent are they?

  • Cataracts (20.5 million people). Despite the cost-effective and vision-restoring surgery available, cataracts are a major cause of blindness among African-Americans.
  • Diabetes-related retinopathy (5.3 million people). This is the leading cause of blindness among Americans age 20-74.
  • Glaucoma (2.2 million people). Glaucoma can be controlled if detected early. However, half of cases are not diagnosed and glaucoma is the leading cause of blindness in African-Americans.
  • Age-related macular degeneration (1.6 million people). In people over age 50, treatment with zinc and antioxidants have been shown to reduce risk and progression to advanced age-related macular degeneration.

What is the annual cost in the United States?

  • Direct and indirect costs equal $139 billion per year.
    • Direct costs such as medical care, vision aids/adaptations/devices, and direct care: $66.8 billion
    • Indirect costs such as productivity losses, long-term care, and entitlement programs: $72.2 billion
  • Disability-adjusted life years (DALYs): 283,000 DALYs per year; at $50,000 loss per year, this would add an additional $14 billion to the total cost per year.
  • Quality-adjusted life years (QALYs): 600,520 QALYs per year; at $50,000 loss per year, this would add an additional $30 billion to the total cost per year. (Learn more about DALYs and QALYs).
  • Total annual cost, including DALYs and QALYs: $183 billion

What can be done to prevent visual impairment and blindness?

  • Some problems, such as Leber congenital amaurosis and Stargardt disease, are due to alterations in the genome and therefore cannot yet be prevented.
  • However, about half of visual impairment and blindness could be prevented through early diagnosis and treatment.
  • The most important ways to avoid vision loss and blindness is to have regular eye exams and take proper precautions to avoid eye injury.

I had no idea so many Americans experience visual impairment or blindness. I plan to keep learning about these issues, and I encourage you to do the same. The links in this post lead to reputable sources of information and data. WHO has great resources about these issues on a global scale. And remember next time you find yourself bemoaning our inability to prevent cancer or teenage smoking—sometimes, a simple win like a trip to the eye doctor can be all a person needs to prevent debilitating vision loss.