World Sight Day 2015 Congressional Briefing Addresses Burden of Uncorrected Refractive Errors

Left to right: The Briefing participants included Kevin Frick, Ph.D. (Johns Hopkins Carey Business School), Jane Gwiazda, Ph.D. (New England College of Optometry), Cheri Wiggs, Ph.D. (National Eye Institute), and VISION 2020 USA Chair and moderator Sandra Block, O.D., M.Ed, MPH

In recognition of World Sight Day 2015 and with a theme of Universal Eye Health- Eye Care for All, on October 7and under the umbrella of VISION 2020 USA sixteen United States-based vision organizations (see box below) hosted a Congressional Briefing entitled Burden of Uncorrected Refractive Errors in Vision. Formatted as a panel discussion hosted by VISION 2020 USA Chair Sandra Block, O.D., M.Ed., MPH (Illinois College of Optometry), the participants included: Jane Gwiazda, Ph.D., a Professor of Vision Science and Director of Research at the New England College of Optometry; Cheri Wiggs, Ph.D., who manages three research portfolios at the National Eye Institute (NEI) within the National Institutes of Health (NIH), including Myopia and Refractive Error, Perception and Psychophysics, and Low Vision and Blindness Rehabilitation; and Kevin Frick, Ph.D., a Professor and Vice Dean for Education at the Johns Hopkins Carey Business School who has participated in vision research and is a health economist specializing in cost-effectiveness analysis.

In her introductory remarks, Dr. Block noted that 80 percent of vision impairment is avoidable, with cataract and uncorrected refractive errors (UREs) the leading causes of avoidable visual impairment and cataracts and glaucoma the leading causes of avoidable blindness. Worldwide, 285 million people are visually impaired, with 39 million blind and 246 million with low vision. Since UREs are one of the primary causes of preventable vision impairment and blindness, the World Health Organization (WHO) has the goal of reducing prevalence of avoidable visual impairment by 25 percent by year 2019.

Dr. Gwiazda described the common eye disorders in which the eye shape or length prevents light from focusing on the retina (the light-sensitive back of the eye): myopia (nearsightedness); hyperopia (farsightedness); astigmatism (distorted vision resulting from an irregularly curved cornea, the clear covering of the eye ball); and presbyopia (an age-related condition in which the ability to focus on near objects becomes difficult with age, starting around 40 years old). These UREs could lead to more serious visual conditions-for myopia, greater risk of retinal detachment, glaucoma, and early-onset cataracts, and for hyperopia, greater risk of amblyopia (lazy eye) and strabismus (eye turn) in children, as well as headaches and difficulty reading. Astigmatism presents a greater risk for meridional amblyopia (vision loss for specific orientations) and conditions associated with myopia or hyperopia, since astigmatism usually occurs with one of them), while presbyopia presents a greater risk of blurred near vision, headaches, and fatigue.

Although refractive errors cannot yet be prevented, they can be diagnosed, progression slowed, and corrected-and if done in a timely fashion, they do not impede good visual function. Different kinds of corrections are based on the magnitude of the error, and a person's age, visual demands, and personal preferences, with eyeglasses, contact lenses, and refractive surgery as treatment options that improve quality of life. If not treated, they can lead to vision impairment ranging from mild to severe, including blindness. Although UREs can impact quality of life at all ages, in the elderly they can especially lead to accidents, falls, social withdrawal and loss of independence.

Myopia, estimated to affect 34 million people in the United States in 2010, is increasing in prevalence, and in Asia it is reaching epidemic proportions. Although vision researchers are studying the mechanisms underlying refractive errors, it appears that spending extra time outdoors is important to preventing myopia-although clinical studies are needed to support that observation.

In that regard, Dr. Wiggs described the various routes through which NEI-funded research is investigating refractive errors at academic institutions throughout the U.S., which includes basic discovery science (such as biochemical pathways that regulate eye growth), the impact of genetics and environmental factors, clinical trials for treatments (including NEI's groundbreaking Correction of Myopia Evaluation Trial, or COMET, that evaluated whether progressive addition lenses slowed the rate of progression of juvenile-onset myopia when compared with single vision lenses), and technology development (such as advanced contact lenses, new imaging technologies to get clearer images inside the eye, and next-generation auto-refractors to diagnose UREs more effectively and economically, which have been developed through support by NEI's Small Business Innovation Research (SBIR) grant program).

Dr. Frick expanded on the economic impact of UREs as they relate to all stages of life, including: academic achievement, where he addressed issues relating to children’s vision screening and the prescribing, purchasing, wearing, and keeping of corrective eyeglasses; labor force issues, where individuals with vision problems are less likely to work and have lower wages when they do; quality of life issues, where various studies have documented a quality of life loss with worse visual acuity; medical care costs, emphasizing the excess expenditures associated with vision impairment and blindness that predominantly reflect paid home care; the types and numbers of eye care professionals needed in the future; and the cost of treatments and therapies once a URE is diagnosed.

AEVR was pleased to manage this Briefing for VISION 2020 USA, which drew a standing-room-only attendance reflecting Congressional staff and representatives from the sponsoring organizations. The attendance also included 21 Emerging Vision Scientists from across the U.S. who displayed posters of their research at a Congressional Reception that evening and visited with their Congressional delegations the next day.

Dr. Wiggs addressing questions from interested Congressional staff after the Briefing	Left to right: Dr. Block with Briefing sponsors Victoria Sheffield (International Eye Foundation and Maureen Cavanagh (Vision Impact Institute)
The packed room of attendees reflected Congressional staff, representatives from the sponsoring organizations, and AEVR’s 21 Emerging Vision Scientists	AEVR Executive Director James Jorkasky with Emerging Vision Scientists Eric Nudleman, M.D., Ph.D. (Shiley Eye Institute/University of California San Diego), Jack Whalen III, Ph.D. (USC Eye Institute/Keck School of Medicine, University of Southern California), and Heather Chandler, Ph.D. (Ohio State University College of Optometry)