Into the Looking Glass: Factors and Opportunities to Reshape Eye Care in the Next 25 Years

Abstract

The profession of ophthalmology is on the cusp of a great challenge—and, thus, a great opportunity. Between 2000 and 2030, as the Baby Boomer generation in the United States reaches the age of 65 and beyond, the number of people 65 and older will more than double, from 35 million to over 71 million. This translates, absent major changes in disease prevalence, population demographics, and treatment paradigms, into a large increase in the number of people who will require health care for significant eye diseases and conditions, such as a 50% growth in the number of people with glaucoma by 2020. Indeed, as more and more survive into their 80s and longer, the number of those with chronic eye diseases will likely grow even more than the 50% we anticipate today, because rates of eye diseases today (based on claims data in the Medicare population) in those age groups exceed those in studies such as the Baltimore and Beaver Dam eye studies on which our projections are based. For example, of a representative cohort of Medicare beneficiaries in 1991, nearly half will be diagnosed with glaucoma, macular degeneration, or some form of diabetic retinopathy 8 years later. Beyond the numbers of people with eye conditions needing care to preserve their vision or enhance their functioning, we also have begun to learn that patients tend to underutilize eye care when they have conditions that may benefit from care. Nearly 30% of Medicare beneficiaries who survive 5 years will have no eye examination documented in claims data by either an optometrist or an ophthalmologist during that time. Yet, we know from analysis of a sample of nationally representative elders in the National Long-term Care Survey that patient reports of functioning show that more regular eye examinations over a 5-year period are associated with a lower likelihood of developing new limitations in activities of daily living or instrumental activities of daily living. Even among those with diagnosed eye conditions, the majority with macular degeneration, glaucoma, or diabetes (even those with diabetic retinopathy) will have at least one 15-month gap in care over a 5-year period, well beyond the recommended intervals in the American Academy of Ophthalmology’s preferred practice patterns for those with chronic eye diseases. At the same time, we also have learned that our health care system faces critical challenges besides a need to provide more regular examinations for many more people. Also at issue is the opportunity to improve the content of the care that patients receive during their visits with ophthalmologists and other providers. The Institute of Medicine has