On July 17, 2012
Advocacy has often been described as a key component for the achievement of health promotion strategies. By advocacy, I am referring to the act of intervening for individuals or groups of people so that their voices are heard and their interests are taken into account.[i]
As a patient advocate and practicing nurse for more than 35 years, I have seen many instances in which patients who are diagnosed with an overall health issue are also having vision problems. Unfortunately, many patients who have a disease that involves both visual and systemic side effects – like diabetes – aren’t taking the right steps to care for themselves. In many cases, the vision problems are identified late – whether it’s because the patient has too many other health problems going on or doesn’t realize the importance of regular eye exams – and vision loss has already progressed. Considering the close link between eye and overall health, I believe that the eyecare professional can be an effective conduit for overall health promotion for their patients. This level of advocacy can be especially important for ethnic minority populations, who have been found to be at higher risk for many eye and overall health issues.
We know that the eyecare professional is already in the driver’s seat when it comes to diagnosing certain overall health conditions – like diabetes and hypertension – and treating their ocular side effects. To take this concept a step further, eyecare professionals can identify how their patients are managing their overall chronic conditions by examining them holistically within their own practices. While a hospital or doctor’s office setting can sometimes be overwhelming for a patient, the eyecare professional’s office can serve as a therapeutic milieu for patients to discuss and disclose their concerns with their overall health.
It is important for eyecare professionals to become investigators, or probers, of health issues that can impact their patients’ vision and larger scope of health. In addition to considering factors such as a patient’s age, gender and ethnic background, eyecare professionals should also take into account a patient’s history of overall health issues and ask questions as to how the individual views his or her health, illness and whether or not he or she participates in wellness exams.
At this time, I would like to focus on a few health considerations and examine how eyecare professionals can serve as a health advocate for patients with these conditions.
Many times the eyecare professional may be the initial assessor and will be the first to refer a mild- to moderate-stage Alzheimer’s patient to the proper specialist since the earliest symptoms of Alzheimer’s disease may be visual. For example, an Alzheimer’s patient may experience symptoms such as visual confusion or disorientation; having trouble reading or recognizing faces; misjudging distances; clumsiness or bumping into things; trouble finding things; worsened handwriting and difficulty driving.
When eyecare professionals are able to recognize some of the earlier signs of Alzheimer’s disease, they can advocate for their patients to see a geriatrician for further assessment and to possibly gain the advantage of the medications that can possibly slow down the progression of symptoms. Without this advocacy on behalf of the eyecare professional, these patients may have delayed treatment.
At the same time, eyecare professionals should take extra steps to ensure overall health when treating a patient with Alzheimer’s disease. Some suggestions from Dr. Leonid Skorin Jr. and Patricia Minor-Tolar, president of the International Opticians Association, include: [ii]
• Obtaining an accurate visual acuity to help with identifying numbers and letters by using the tumbling E chart
• Considering separate glasses for distance and reading because ocular motility through a bifocal or trifocal lens may be difficult
• Keeping the environment visually rich as a tool to assist cognition (pictures, flowers, paintings, etc.)
• Correcting any underlying pathology, such as removing cataracts and assessing for macular degeneration.
By helping to provide good intermediate vision, eyecare professionals may keep their patients safe by preventing falls or misjudging steps.
It is important to note that while most people in the United States living with Alzheimer’s are non-Hispanic whites, older African Americans and Hispanics are proportionately more likely to have Alzheimer’s disease – with African American’s about twice as likely and Hispanics about one one-half times as likely to have it.[iii]
Have you ever had a patient who arrives with symptoms of headaches or blurred vision and does not even know he or she is hypertensive?
While signs of high blood pressure can be seen in the eye, often at this point it is too late and the hypertension is out of control. Unfortunately, sometimes the eyecare professional is the first to detect signs of hypertension because the patient does not know he or she has the disease and has not seen a general health physician. By taking the simple step of checking a patient’s arterial blood pressure during an eye exam, eyecare professionals can help to diagnose more cases of hypertension and speed up access to medical treatment before irreparable damage to other organ systems is done. It is estimated that an eyecare professional who uses a sphygmomanometer could detect one in 14 patients with undiagnosed hypertension.[iv]
Hypertension is especially prevalent among African Americans, who are 40 percent more likely to have it and 10 percent less likely to have it under control.[v]
Nutrition and Other Concerns
The American Optometric Association encourages eyecare professionals to take a new approach in caring for patients by incorporating counseling on the benefits of proper nutrition into routine patient visits.[vi] Taking this step is important, considering that studies have shown that taking steps to improve one’s nutrition can help to improve both eye- and overall-health.
For example, the National Eye Institute (NEI) projects that the number of Americans with age-related macular degeneration will increase to nearly 3 million by the year 2020. The NEI also provides evidence that several antioxidant vitamins and minerals can reduce the risk of progression to advanced AMD by 25 percent and the risk of moderate vision loss by 19 percent over a five-year period. Further research suggests that the nutrients lutein and Zeaanthin, as well as the omega-3 fatty acids DHA and EPA, might also be beneficial in preserving the integrity of the macula.
Another important health factor to bring up during an eye exam is whether or not a patient smokes. Smoking has long been known to cause heart disease and lung cancer; however, many people don’t realize that smoking can also lead to vision loss. Studies have shown that smoking increases the risk of age-related macular degeneration, cataract development, glaucoma and retinopathy. The eyecare professional is in a great position to encourage individuals to stop smoking, because the fear of blindness is a great motivator. In late 2011, Prevent Blindness Georgia launched a “Smoking Causes Blindness” campaign in which graphic ads and billboards directed smokers to a toll-free number they could call for information about quitting. If a patient is interested in quitting, eyecare professionals can refer patients to these types of programs from their individual offices.
By making available brochures and other educational resources to establish the link between good nutrition and eye health, eyecare professionals can help to promote healthier lifestyles among their patients. At the same time, providing this type of overall health information can help to change the overall patient perspective of what an eyecare professional does – allowing patients to view the eye doctor as an all-encompassing health promotion type of practitioner rather than one who simply performs eye exams and offers recommendations for eyewear.[vii]
One platform that eyecare professionals can leverage in their own health promotion efforts is the Healthy People 2020 initiative. The program features more than 600 health objectives, including eight that address eye and visual health conditions, to be met by 2020. The overarching goal of these eye health objectives is to improve the visual health of the nation through prevention, early detection, appropriate and timely treatment and rehabilitation. With Healthy People 2020 in full swing, now is the time for eyecare professionals to establish partnerships and collaborate with individual states and communities to achieve the vision’s objectives.
Eyecare professionals – what are you doing to serve as an overall health advocate for your patients? Share your best practices below.
[i] Community Eye Health Journal: International Centre for Eye Health, Vision 2020, 2007.
[ii] Alter Your Vision Exam for Alzheimer’s Patients. Primary Care Optometry News, May 2006.
[iii] Alzheimer’s Association, 2012.
[iv] Hurcomb, Wolffson, 2005.
[v] Centers for Disease Control.
[vi] American Optometric Association, Practice Strategies, 2009.
[vii] American Optometric Association, Practice Strategies, 2009.