Many patients might go for years without having their eyes checked. The lack the financial resources to adequately care for their vision, and an insurance system that treats vision care as a separate policy leads people to go without care. Like many of the other health challenges facing patients, a family medicine annual exam might be the first time a patient discusses vision loss or ocular health issues.
Many diseases that threaten sight do extreme early damage, and by the time an ocular disease affects an individual’s lifestyle in a meaningful way, there can be little done for prevention or corrective action.
Take for example, glaucoma: According to the CDC, about three million Americans have glaucoma, and it’s the second leading cause of blindness worldwide. Half the people with the condition don’t know they have it and might not experience symptoms until their peripheral vision is already lost. Earlier detection allows for treatment such as eye drops, oral medicine, or surgery to reduce eye pressure, all of which can prevent or delay permanent vision loss.
July is Healthy Vision Month and the perfect opportunity for family medicine physicians to consider their role in closing the gap on vision care.
Why family medicine is positioned to identify eye issues sooner
Family physicians see patients the most regularly and for many, especially those in rural areas; their family practitioner might be their only doctor. Part of an annual or bi-annual visit typically includes a brief look at the eyes for pupil response, eye pressure, and any abnormalities. This is a time to ask about vision changes.
Patients at-risk for eye disease and related ocular conditions
The highest-risk patients are probably already on the schedule, which is what makes this efficient rather than additive.
Consider patients with diabetes. The CDC estimates 12% of the U.S. population has diabetes; in 2023 that equaled about 40.1 million people with diagnosed or undiagnosed diabetes. When it comes to eye health, diabetic retinopathy is the leading cause of blindness in working-age adults, yet about 60% of people with diabetes skip an annual eye exam. This is striking when considering that in 2021, about 26.43% of people with diabetes in the United States had diabetic retinopathy. Early treatment can repair damage to the eye and even prevent blindness in most people.
Diabetes is just one common condition for which eye discomfort, decline in vision, or blindness is a risk factor. Others include hypertension, high cholesterol, rheumatoid arthritis, and thyroid diseases (Graves Eye Disease), among others.
Making time for eye health conversations
Screening for declines in vision does not need to add notably more time to a visit. One way to do this is to fold questions about symptoms into existing intake forms or staff questions; another is to delegate the visual acuity test (Snellen Eye Test Chart) during weight and blood pressure checks, especially for high-risk patients.
Referring patients to an eye specialist
Have a list of referrals, including low-cost, community resources. If screening reveals something concerning, actively encourage and refer patients to an optometrist or ophthalmologist. This is important because conditions like glaucoma can only be confirmed through a comprehensive dilated exam.
From the National Eye Institute: The American Glaucoma Society, Lions Clubs International, Operation Site and VSP Eyes of Hope are just a few resources that provide free and discounted access to vision care. Other options are community health centers and local colleges and universities.
Vision loss and blindness are scary prospects for those experiencing them. According to Lisa Ord, a licensed clinical social worker and patient support director at the Moran Eye Center, vision loss affects every aspect of life, including how the individual sees themselves and their engagement with others. Loss of vision can be overwhelming and without guidance, there is a greater potential for isolation, depression, and dependence.
Family medicine physicians are uniquely positioned to close the gap for patients who might otherwise ignore or be unable to pursue eye care on their own. Treating vision as part of whole-person health rather than a separate errand positions family physicians to catch problems early while something can still be done.
