June 23, 2000 — Like the Joni Mitchell song says, “you don’t know what you’ve got ’til it’s gone.” This is particularly true of good vision. It’s easy to take seeing well for granted, but once your sight is lost, it cannot be restored to what it once was.

That National Institutes of Health (NIH) has included vision objectives in its “Healthy People 2010” initiative to look at ways to improve the eye health of Americans. This is the first time the Healthy People initiative, a public health awareness program begun in 1979, has included a comprehensive chapter on vision.

“The addition of vision objectives to Healthy People is a real milestone and gives vision a prominent place on the public health agenda,” says Carl Kupfer, MD, in an NIH news release. “Our long-term investment in clinical and basic vision research demonstrates that vision plays a significant role in the nation’s public health.” Kupfer is director of the National Eye Institute, which is part of the NIH.

The vision objectives aim to improve vision through prevention, early detection, treatment, and rehabilitation. These objectives include encouraging more early vision screening for children age 5 and younger and reducing uncorrected vision due to eyeglass prescription errors. Other goals include reducing visual impairment due to diabetic retinopathy (when blood vessels in the back of the eye begin to leak into the retina, the film-like layer in the back of the eye), glaucoma (an increase in pressure in the eye that can gradually destroy sight), or cataracts (a clouding of the lens of the eye). Increasing the use of visual rehabilitation devices for people who have reduced or no vision is also on the list of objectives.

The initiative calls visual impairment “one of the 10 most frequent causes of disability in America.”

“If the guidelines are to get people to go out into the community and give talks [and] screenings, those kinds of things would be very helpful,” George Pronesti, MD, tells WebMD. Pronesti is the national medical director of the Kremer Laser Eye Center headquartered in King of Prussia, Pa.

So exactly what are the National Eye Institute’s plans to implement these initiatives? Obviously, just publishing some great ideas on eye care will not improve the eye health of the nation.

Michael Davis, associate director for science, policy, and legislation at the National Eye Institute, tells WebMD that the program is in its organizational stage, since the Healthy People programs are forward-looking initiatives. Healthy People 2000 was implemented in 1990. So this current program is just beginning to organize national programs and campaigns to take effect in 2010, and it is still very much in the planning stages.

According to Pronesti, anything that can increase awareness and bring more people into the office to have their eyes checked is important. “You really don’t appreciate how important it can be to get things checked until you lose vision or until something goes wrong,” he says. However, with some eye problems, if you wait until there is a noticeable change in vision, it is often too late.

Take glaucoma, for instance. “Glaucoma is silent,” Pronesti says. “Once you begin to notice that you can’t see well, it’s way too late, and there’s almost nothing you can do at that point.”

Early vision loss from glaucoma, he explains, affects tiny pinpoint areas of peripheral vision. These are not usually noticeable to patients, but screening machines that map the side vision can pick up these early losses.

Another serious eye problem is diabetic retinopathy, a very serious disease that affects the retina in people with diabetes; left unchecked, it can lead to blindness. People who have diabetes for longer than 5 years have a more than 50% chance of developing diabetic retinopathy. People with diabetes need regular eye exams and if problems are detected, they need to step up the frequency of those office visits.

Prevention and early treatment are most important for everyone. Davis tells WebMD that one of the goals is a quality of life issue, since vision loss often has a direct effect on how people function day-to-day. People need to be aware of programs, screening, treatments, and devices that can help them see better. Low vision devices designed for people nearly blinded by age-related macular degeneration, a disease that affects the central part of the retina, can help these people read again. But, many people — including physicians — don’t know that these devices exist.

Public awareness campaigns and free community screenings are the types of programs that often grow out of the Healthy People initiative, Davis says. “What we’re hoping to do is to have the organizations that are already established come up with ideas on how to communicate with people better about treatment availability and the means to improve vision,” he says. “In many cases, once you’ve lost your vision, that’s it. It cannot be restored.”

Vital Information:

• The NIH now includes healthy vision as one of its objectives in the Healthy People 2010 initiative, calling visual impairment one of the 10 most frequent causes of disability.
• The Healthy People initiative seeks to establish national programs and campaigns to raise public awareness about important health issues.
• Screening is a crucial step in preserving vision, because once deterioration occurs, it often cannot be reversed.