Where is Utah succeeding, and where is it falling short in providing eye care to the state’s most underserved groups?
A recent survey of eye care providers and stakeholders identified screening and care for diabetes-related vision loss as the most urgent need for residents on the Navajo Nation, people experiencing homelessness, former refugees, and underinsured or uninsured Utahns. Vision screenings for children and access to eyeglasses came in a close second.
The insights are part of the ongoing Utah Assessment and Review of Community Health Eye Care Study (ARCHES), launched in 2020 by a team of John A. Moran Eye Center and University of Utah healthcare professionals.
While Moran’s Global Outreach Division provides donor-funded charitable care to thousands of Utahns each year at clinics around the state and on the Navajo Nation, the need for care outpaces capacity. Spearheaded by Outreach Division Medical Director Craig J. Chaya, MD, University of Utah Division of Public Health Associate Professor Sharon Talboys, PhD, and Moran resident Sean Collon, MD, ARCHES addresses the challenge by bringing more voices and providers to the table.
Preserving vision is an investment in our communities that allows our neighbors to fully participate in society, find or hold jobs, care for their loved ones, and engage in school,” says Chaya. “ARCHES is providing a roadmap for a coordinated, statewide response to providing eye care where it’s needed most.”
Top Priorities and Barriers to Eye Care
With 61 responses from ophthalmologists, optometrists, and vision heath stakeholders, the survey responses mirrored the state’s geographic population distribution. Respondents named screening and care for diabetic retinopathy as their top priority for underserved residents.
Diabetic retinopathy causes irreversible vision loss as it changes the blood vessels in the retina in the back of the eye. It is the most common diabetic eye disease and a leading cause of blindness in American adults, but many patients skip screenings and timely treatment due to the cost of care. Only one survey respondent reported more than 50% of their underserved diabetic patients were up to date on their annual eye screening—a necessary sight-saving precaution.
In 2021, Moran’s Global Outreach Division launched a monthly Hope in Sight Retina Clinic to address this dire need with ongoing monitoring and care, including laser treatments and injections. But it is only the first step, initially serving a small number of patients.
Vision screening for children and access to eyeglasses tied as the second most urgent eye care need, according to the survey.
The greatest perceived barrier to care among patients involved the cost of care or lack of insurance, according to the respondents. The cost of missing work and lack of transportation were the second most significant barriers, closely followed by a lack of awareness about eye disease and knowledge about resources.
Nearly 85% of survey respondents reported their institution is equipped to serve uninsured patients, non-English speakers, and people with disabilities. Fifty percent of ophthalmologists and 23% of optometrists reported having a funding stream for uninsured patients’ care. Yet, many commented that one of the most significant limiting factors in underserved groups receiving eye care was the lack of patient awareness about how or where they could receive care, coupled with a limited understanding of why they need to receive such care.
“The need for better collaboration among willing providers and communicating with patients are key takeaways,” says Collon. “We’re moving forward with new knowledge.”
Talboys says the findings “will help us advance a public health model for vision health in Utah, where screenings, health education, and linking people to needed services become an integral part of the overall approach.”
In response to the survey, the ARCHES group is making plans to:
- Create a referral network to connect patients with eye care providers and community clinics in an easy-to-access online format.
- Increase the number of optometrists in the referral network.
- Use teleophthalmology for remote patient consultations.
- Conduct community focus groups and interviews to refine the list of needs and priorities.
- Distribute educational materials to patients that explain the basics of eye diseases, eye care and safety, and the need for regular dilated eye exams.
- Create research projects to address priorities identified in the survey.