The Future of Eye Care Is … Equitable Eye Health and Vision Care

Optometry is uniquely positioned to be a leading force in moving eye health equity efforts forward. According to the American Optometric Association, ODs practice in more than 10,000 communities and counties that cover 99% of the US population.¹ As a result of our collective professional presence in a wide range of communities, we are directly involved with patients navigating a broad spectrum of health issues and barriers to care.

A common challenge in moving into better alignment with health equity goals is identifying clear, achievable, and impactful efforts at the local practitioner and regional society levels. In this article, I present ways in which optometrists can take individual and small group approaches to tackling big problems together as we move toward achieving vision and eye health equity. Before we dive in, let’s make sure we have a mutual understanding of important terms often used in this conversation.

SPEAKING THE SAME LANGUAGE

Having a shared linguistic foundation allows us to better navigate this topic in more meaningful and productive ways. Acknowledging that language evolves with time, particularly in the context of people, it is important to make every attempt to choose words that accurately reflect the individuals and groups being discussed.²

Let’s review commonly used terminology in the context of health.

Diversity

This can be broadly defined as varying attributes and characteristics among people. Diversity within a health care setting emphasizes representation across all aspects of diversity, including ethnicity, race, gender, sexual orientation, religion and spirituality, neurodiversity, physical ability, and socioeconomic status. Varying backgrounds and beliefs contribute to the diversity of thought and experiences represented within and across cultures.

Health Equity

This is the state where everyone has fair and just opportunity to attain their highest level of health, without regard to ethnicity, race, ability, sexual orientation, gender identity, socioeconomic status, geographic location, primary language spoken, or other factors that affect access to care and health outcomes.³

Social Determinants of Health

Commonly referred to as SDOH, social determinants of health are nonmedical aspects of where someone lives, works, and plays that influence their health. Examples of SDOH include income, early childhood development and education, unemployment and job security, food insecurity, housing, and environment. The US Department of Health and Human Services groups SDOH into five domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community.⁴

Health Disparities

These disparities describe the quantitative differences that exist among different groups of people in various conditions and disease states.

Health Inequities

These inequities are disparities that exist as a direct result of racist and discriminatory policies, procedures, and actions that disproportionately affect people from marginalized groups, most consistently documented in Black, indigenous, and people of color (BIPOC), people with cognitive or mobility disabilities, and people who identify as lesbian, gay, bisexual, transgender, queer, intersexual, asexual, and all other identities (LGBTQIA+).

DOING YOUR PART

It cannot be overstated: There is no easy solution to addressing the systemic inequities within our society that have led to health disparities, inequities, and injustices. These problems are complex and widespread, affecting both big cities and rural communities. With our greatest area of influence being eye health and vision care, it’s valuable to understand the status of eye health and vision care across communities.

A 2022 report in the Journal of Ophthalmology offered a detailed review of health disparities in eye and vision health.⁵ Across the roughly 4.2 million individuals in the United States 40 years of age or older affected by visual impairment, disparities can be outlined by socioeconomic status and disease. The prevalence of eye disease and visual impairment increases with age and has statistical and actual variance across ethnicity and race, socioeconomic status, sex and gender, and geographic location. Social factors that have been identified to have an important role in vision loss include lower income, less educational attainment, lack of neighborhood safety, food insecurity, and limited access to care.^5,6 Difficult for many studies to distinguish between is natural disease history and sociopolitical influences, such as SDOH, racism, sexism, ablism, and global barriers to care.

As our profession evolves, adopting a broader scope of practice, offering a greater number of services, and establishing new practices in a variety of different neighborhoods, the number of patients walking through our doors is growing. These patients will represent greater diversity, particularly across ethnicity and race, according to population data and projections.⁷ Navigating toward equity in eye health and vision care on an individual level means being prepared to help address patients’ unique needs influenced by their cultural background, SDOH, and local health and economic policies and procedures.

The Rise to Health Coalition, a national coalition of organizations and individuals committed to equity in health care, offers a comprehensive resource that includes four steps to promote health equity that can be applied at the local and regional levels to enhance our individual and collective effect (see The Rise to Health Coalition’s 4 Steps to Promoting Health Equity).^9,10

LOOKING TOWARD THE FUTURE

Today, having the ability to practice optometry to the broadest scope of our level of education and training is a privilege—a direct result of tireless advocacy efforts of former, current, and future colleagues. It is also a testament to the strong and influential reach of this profession in moving an agenda forward, in the context of expanding access to quality eye health and vision care. It is along this established route of work that we can intensify our efforts to intentionally address societal challenges affecting the visual health of our patients.