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Death (and Taxes) May be Certain. is Vision Loss?

Vision provides critical sensory input for many tasks that affect functional performance and quality of life. Although other senses and compensatory techniques can provide input for many of these tasks, it is vision that is central to knowledge of the environment. Consequently, the impact of any loss of vision cannot be overstated. "Even the earliest stages of vision loss harbinger significant changes in everyday activities such as reading or driving, vocational choice, or avocational activities and may also affect self-esteem and independence" (Morse, 2012, p. 235). Vision loss in the United States, including low vision and blindness, affects approximately 1 in 28 Americans who are older than 40 years of age. Although the cause-specific rates of vision loss vary for each cause by race, ethnicity, gender, and other personal characteristics, the overall prevalence of vision loss increases with aging. The probability of vision loss increases with age among all population segments, especially those older than 60 years (Morse, 2012), and among the oldest segment of our population, those over age 85, the prevalence of vision loss is rising most rapidly (Varma et al., 2016), underscoring the relationship between vision and aging. IMPORTANCE OF PREVENTION, IDENTIFICATION, AND TREATMENT Significantly, each of the four leading causes of blindness--cataracts, glaucoma, macular degeneration, and diabetic retinopathy--are not uniformly susceptible to treatment or vision restoration procedures. As a result, it is important to understand the differential potential for prevention, identification, and treatment of these and other eye disorders to minimize their deleterious effects. All providers of healthcare services should be engaged in this effort. Regardless of etiology, however, early identification will always yield the best result with the least impact on quality of life. It is also important to differentiate between age-related vision changes that are unavoidable from pathology that can be identified and addressed: Although both may result vision loss, pathology often can be addressed, but aging obviously cannot. For example, the lens of the eye yellows with aging, which causes distortion of color vision, but yellowing alone does not affect vision. The ultimate goal is not merely the promotion of eye health, but the actual improvement of eye health. The behavioral aspects and other barriers to adherence with eye health guidelines need careful attention. In addition, the causes of medication nonadherence, for example, as well as other issues need further study so that they may be effectively addressed. Each of the leading causes of vision loss has differential effects on the population--some groups are more at risk and suffer more loss of vision than others. Issues of disparity and cultural sensitivity are generally overlooked but adversely affect millions of Americans each year. Readers of this journal most often focus on helping people after they have lost vision, and this perspective needs to be changed. Prevention is better than cure; in many cases there is no cure, and vision loss is irreversible. Consequently, more attention needs to be paid to early identification and timely intervention to reduce preventable vision loss and, in other cases, reduce the severity of vision loss. Across the United States, there are hundreds of organizations whose mission is to help people with vision loss, but few of them contemplate prevention and virtually none consider surveillance. One reason for this disconnect is a mismatch between the needs of the population and the availability of government funding. The vast majority of federal and state funds are directed at vocational rehabilitation, while the vast majority of Americans who are at risk for or who are currently experiencing vision loss are on the upper edge of the workforce in terms of age or have already ceased working. There are also state-determined levels of vision that must be met for eligibility for services: some states require legal blindness while others accept vision loss or low vision as the threshold. …