Presentation on theme: "Women and Vision: Eye Care Disparities in the USA"— Presentation transcript:
1Women and Vision: Eye Care Disparities in the USA Lynn K Gordon, MD, PhDProfessor , OphthalmologyAssociate Dean, Diversity AffairsDavid Geffen School of Medicine at UCLA
2DisclosureThe presenter has no financial interest in the topics discussed
3British Columbia Centre for Epidemiologic & International Ophthalmology (BCEIO), 2000 Two-thirds of all blind individuals in the world are femaleMost are older than 50 years90% of blind people live in povertyGender bias is not limited to the developing world
4Healthy People 2010: The Numbers Speak US Department of Health and Human Services2000: vision objectives were initially included>80 million people have potentially blinding diseases>4 million individuals in the United Stateslow visionlegally blindsevere visual limitationsEconomic impact:>50 billion dollars in 2002 for health care for individuals with visual disorders (both direct and indirect costs)Estimate: by 2030 the number of visually impaired and legally blind individuals may double
5Visual Loss is Associated With……. Decreased quality of lifeChanges in independent livingIncreased injury and fallsIncreased depressionIncreased isolationUntreated poor vision is associated with cognitive decline and onset of dementiaRogers, MA, Langa KM. Untreated poor vision: a contributing factor to late-life dementia. Am. J. Epidemiol :728
6Visual Impairment and Falls Falls in older adultsOccur in 35-40% of individualsResponsible for 90% of fractures in the elderlyClinical risk factors include vision impairment, gait abnormality and muscle weaknessFractures associated withPoor visual acuity in older womenPoor contrast sensitivityDecreased depth perceptionBinocular visual field lossColeman AL, el al. J Am Geriatr Soc. 2009; 57: Patino CM el al. Ophthalmology. 2010; 117:199.
7Common Eye Diseases in the United States Associated with Vision Loss Treatable or preventable eye disease: the big 4Age-related macular degenerationDiabetic retinopathyGlaucomaCataractLess common, important causes for vision loss in womenTraumaImmune-related eye diseaseIdiopathic Intracranial Hypertension (IIH)
8British Columbia Centre for Epidemiologic & International Ophthalmology (BCEIO), 2000 What about gender?Female gender bias held true for many diseasesCataractGlaucomaTrachomaAge-Related Macular Degeneration (ARMD)Age-adjusted risk is about equal for men and womenPercentage of women in the at-risk population is larger than the percentage of men
9Women and Macular Degeneration ARMD: leading cause of legal blindness in the USA9 million people have some form of ARMD1.6 million have advanced diseaseAge is the greatest risk factor55-64: one percent are affected65-74: four percent are affected>75: thirty percent are affectedWomen tend to live longer than men, F:M lifetime risk 2:16% for females3% for malesWomen’s Eye HealthWomen’s Eye Health.org
10Women with DiabetesYounger women and those of reproductive age are less likely than older women to receive eye examinationsWomen > 75 years were twice as likely to have been examined as compared to women < 50 yearsBarriers for preventive careLow socioeconomic positionLack of insuranceLow levels of educationOwens, et al. Women with diagnosed diabetes across the life stages: Underuse of recommended preventive care services Journal of Women’s Health. 17: 1415
11Women and GlaucomaPrevalence of glaucoma is higher in women than in menRisk for angle closure glaucoma is higher in femalesNo gender bias in the incidence of open angle glaucomaBurden of blindness due to glaucoma is larger for womenRate of visual impairment is higher in womenWomen are 24% less likely to be treated for glaucomaVajaranant, TS, et. al. Gender and glaucoma: what we know and what we need to know. Curr. Opin. Ophthalmol :91.
12Women and GlaucomaVision loss from glaucoma can be slowed or prevented with adequate therapyAbout 50% of individuals with glaucoma are not diagnosed:Must identify affected individuals and provide adequate therapyHealth disparities in glaucoma require additional study and intervention
13Women and Cataract Cataract prevalence increases with increasing age Surgery for cataract accounts for 60% of Medicare expenses for visionNuclear sclerosis is the most common form of cataractGender association: more common in womenOther associations: diabetes, low education, myopia, smoking, BMI >35
14Women and cataractSignificant cataracts in the Los Angeles Latino Eye StudyFemales 20% more likely than malesPrevalence of cataract:2.6% in the age range 60-6917% in individuals > 801/3 of patients with cataract had an unmet need for surgeryRisk factors for unmet needLack of health insuranceIncome <$20,000 per yearSelf-reported barriers to careLast eye exam > 5 years agoRichter, CM et al. Ophthalmology. 2009; 116:2327.
15Women and Eye Trauma Massachusetts Eye and Ear Hospital experience 20% of open globe injuries are in patients > 65 years oldAverage age in this group = 79.8 years65% of these are caused by falls76% of these occur at home, mid-day and night-time peaksWomen as a percentage of the total58% of the geriatric patients14% of the non-geriatric patientsOpportunities for counseling and home preventive careAndreoli, MT, and Andreoli, CM. Geriatric Traumatic Open Globe Injuries. Ophthalmology in press
16Women and Eye Disease Inflammatory eye disease Many autoimmune diseases are gender-associatedOne million Sjögren’s patients in the USA, 90% are womenIdiopathic intracranial hypertensionOccurs primarily in womenSignificant risk for visual lossWomen’s Eye Health
17Women and Eye Disease: USA Gender issues and eye disease: increased eye disease in American womenIncreased incidenceAngle closure glaucoma, cataract, IIH, autoimmunityIncreased prevalenceAging population: glaucoma, ARMDBarriers to careAccessEducationCultural sensitivity
18Opportunities for the Future Increase research to understand disease pathophysiologyEnhance importance of prevention educationImprove access to careEnsure treatment equalityEliminate barriers and reduce co-morbidities!
19Together we can effect change Thank you for your attention
20Women with Diabetes2007 data: 24 million affected in the USA, half womenTotal cost $174 billion, 2/3 to direct medical expensesCost of disease increases with increasing ageCenters for Disease Control and Prevention (CDC) and the Agency of Healthcare Research and Quality AHRQ developed a report:Women and Diabetes: Quality of Health Care Report prepared inOwens, et al. Women with diagnosed diabetes across the life stages: Underuse of recommended preventive care services Journal of Women’s Health. 17: 1415
21Women with DiabetesWomen with diagnosed diabetes as compared to women without diabetesMore likely to be older and non-whiteMore likely to be socioeconomically disadvantaged40% poor or near-poorLess likely to have completed high school28-37%Accumulation of disadvantageOwens, et al. Women with diagnosed diabetes across the life stages: Underuse of recommended preventive care services Journal of Women’s Health. 17: 1415
22Women with DiabetesData obtained for women > 18 years of age from three national surveysSelf-reported dilated eye exam67% of all women with diabetes47.4% of women <45 years of ageHemoglobin A1CBlood test provides evidence for degree of metabolic controlGood control: 50.9% of all women, 37.4% <45 years of agePoor control: % of all women, 19.3% <45 years of ageOwens, et al. Women with diagnosed diabetes across the life stages: Underuse of recommended preventive care services Journal of Women’s Health. 17: 1415