Vision and Eye Health in Population Health
Public Health Systems of Care

Vision and Eye Health Surveillance

Surveillance is a core public health function that assesses and tracks population risk factors for vision loss and eye disease, establishes priorities and objectives for intervention, and evaluates the effectiveness of resources on meeting objectives. Surveillance can also be used to collect data around the attributes of vision loss and eye disease, such as means of access to care, education and income levels, racial and ethnic background, rural or urban location, age, gender, and other population-level factors.

A national surveillance system for vision and eye health—such as the Vision and Eye Health Surveillance System (VEHSS) at the Centers for Disease Control and Prevention—incorporates data from multiple sources and contributes to a national overview of the burden of vision impairment and eye disease. Currently, the VEHSS use data from such sources as:

  • National Surveys: American Community Survey (ACS), Behavioral Risk Factor Surveillance System, National Health Interview Survey, National Health and Examination Survey, and the National Survey of Children’s Health
  • Electronic Health Records and Registries: IRIS® Registry and AOA MORE
  • Examination-Based Studies
  • Administrative Claims Databases: Medicare, Medicaid, MarketScan, VSP Global, Military Health System Data Repository (MDR)

The VEHSS includes data that helps determine the burden and need across a number of social, economic, racial, age, and gender groups. Ultimately, this allows for the interdisciplinary use of information to create targeted approaches for the public and allows the vision and eye health community to be more responsive to shifting eye health needs.

Vision Health Data Using the National Health and Nutrition Examination Survey (NHANES)

Strong national surveillance is needed to develop a true understanding of how widespread both the risk and existence of vision loss and eye disease is in the U.S. population. The CDC needs national-level examination-based data that can determine who is at risk of vision loss and may not already be aware of it.

The Vision and Eye Health Surveillance System (VEHSS) incorporates new and existing data sources such as medical claims, self-reported surveys, registries, and electronic health records to provide health professionals, researchers, stakeholders, states and communities, and patients with critical data to drive program and policy decisions. This data includes an understanding of the scope and burden of vision loss, eye disease, eye disorders, and eye care services at the national, state, and county levels.  However, the nature of these data sources only provides an approximation—not a true illustration— of visual impairment, severe vision loss, or blindness because it only captures the scope and breadth of vision problems in people who already know that they have a vision disorder. This greatly limits efforts to prevent vision loss and eye disease and connect people at the highest risk of vison loss to eye care that can help save their eyesight and prevent unnecessary vision loss and blindness.

Data generated from the most reliable surveillance and epidemiological tool available —the National Health and Nutrition Examination Survey (NHANES)— is critical to the CDC’s efforts to prevent vision loss and eye disease for those most at risk. Unlike with self-reported survey instruments that are currently the only source of vision and eye health data, NHANES captures prevalence estimates of conditions that may not have previously been known to the patient. Current data sources only reflect the prevalence estimates of patients who have sought clinical eye care, which is especially problematic given that many eye conditions are asymptomatic or unknown to the patient until changes in vision are noticeable. Capturing examination-based data through use of NHANES helps identify patients who may have eye disease but may not yet know it, which can help people avoid preventable vision loss and contribute to public health messaging and interventions based on early detection and prevention.

A decades-long federal spending policy known as sequestration (enacted in the 2011 Budget Control Act and established deep agency-wide decreases in federal spending over an entire decade), the CDC has not had adequate resources to employ reliable surveillance activities using the NHANES since 2005 – 2008. Unfortunately, this means that our best-known estimates of our national vision loss and eye disease scope and prevalence is almost 15 years old with current state and community interventions based on data that dates as far back as 1999. With outdated data, public health messaging around preventable vision loss and eye disease is based on information that predates such trends as our rapidly aging population, skyrocketing rates of chronic diseases, new stresses to our eyes and vision from smart phone devices and technology, rising costs of health care, and disparities in access to eye care across diverse population groups that have been exacerbated by the COVID-19 pandemic.

Since the VHI’s last data collection using the NHANES, innovations in eye care treatment and methods of accessing care (such as telehealth and artificial intelligence) have changed the way patients access vision and eye care. With this data, states and communities can form partnerships that emphasize early detection and intervention, identify the biggest challenges to accessing eye care—whether it is cost of care, lack of eye care providers, inaccessible transportation, or unawareness of personal risk— and develop strategies that reflect the needs of their communities.

Continuing advocacy to equip the CDC’s Vision Health Initiative and the VEHSS is essential to meet the need for reliable surveillance data using NHANES, which measures rates of vision and eye examinations and measurements of visual acuity, screening tests, and visual functioning assessment to better determine where gaps in access and patient education exist. The CDC can use the data generated from NHANES to integrate into the existing VEHSS and develop collaborative partnerships with state and local public health departments and community leaders to improve vision and eye health in their communities.