Ophthalmologists are well aware of the human and financial costs of delayed care and progressed disease, said Eve J. Higginbotham, SM, MD, ML. “I am sure that we all agree with the statement that we all wish to optimize the quality of life of every patient who enters our office.”
She made her comments at the Opening Session (Sym64) during the 80th Jackson Memorial Lecture, named after Dr. Edward Jackson, whose professional career remained focused on retaining ophthalmology within the house of medicine.
Dr. Higginbotham urged clinicians to think beyond eye-specific metrics in assessing a patient’s health. “When one considers all factors contributing to eye health, genetics contributes only 20% to 30% to the health and well-being of an individual,” with the remainder composed of such factors as access to care, behavior, and social and environmental factors.
Given that imbalance, Dr. Higginbotham highlighted three challenges that need to be addressed:
- The need to document social determinants of health (SDOH). Understanding the impact of SDOH — the nonmedical conditions in which people are born, grow, live, and age—upon eye health is critical, Dr. Higginbotham said.
Nonetheless, despite our knowledge that SDOH and lifestyle behaviors contribute to the development and progression of various ophthalmic conditions, relevant research is lacking, Dr. Higginbotham said. For instance, between 2009 and 2023, 16 papers were published on SDOH and glaucoma. In contrast, during the same time period, 4,519 addressed genetics and glaucoma.
- The need to make the case that eye health is a public health imperative. According to the World Health Organization, multiple industrialized and developing countries have failed to prioritize the prevention or treatment of visual impairment, Dr. Higginbotham said. On a global basis, this lack of strategic public health planning and funding has been estimated to affect at least 3 billion individuals, with far-reaching impacts on those individuals’ education, social mobility, income, and other outcomes.
Closer to home, “Uncorrected refractive error is commonly seen among preschool children in the United States, and it is expected to increase, particularly among populations who are marginalized,” Dr. Higginbotham said. She added, “Consider the value of an investment of a pair of glasses provided to a child during their most developmental phase of life.”
- The need for more specific demographic descriptors. Overly broad, nonspecific, and imprecise categorization (such as “White” and “non-White”) hampers the ability of both investigators and clinicians to fully understand the demographic nuances of disease occurrence and progression.
Moreover, greater demographic specificity, especially when combined with increased research focus on patient-centered outcomes, can be expected to strengthen ophthalmologists’ argument that eye health is a public health issue, Dr. Higginbotham said.
What can individual clinicians do? In pursuit of these goals, Dr. Higginbotham recommended the following steps: 1) capture more specific patient demographics “beyond the five categories that have been used for centuries”; 2) document both SDOH and patient-centered outcomes; 3) consider using tools such as AI to educate and assist patients in tasks such as identifying local resources and translating health information into a patient’s preferred language; and 4) work strategically with other health care providers.
When it comes to advancing eye and vision health, “We must educate to activate,” Dr. Higginbotham said, and she closed with a quote from the American botanist Robin Wall Kimmerer: “Transformation is not created by tentative wading at the edge.”1 —Jean Shaw
1 Kimmerer RW. Braiding Sweetgrass. Milkweed Editions; 2015.
Financial disclosures: Dr. Higginbotham: None.
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