PRACTICE STRATEGIES PRACTICE STRATEGIES

Healthy Eyes Healthy People� 2020

n December 2, 2010, the U.S. Department of Health

O& Human Services (HHS) unveiled Healthy People2020, the nation’s new 10-year goals and objectives

for health promotion and disease prevention. Under itsHealthy People program, the HHS provides evidence-based, national objectives for improving the health of allAmericansdeffectively setting the nation’s official publichealth agenda. The new Healthy People 2020 objectivesrepresent the fourth set of national health care priorities

The U.S. Department of Health & HumanServices (HHS) targets improvement in 8key areas of eye and vision health aspart of the nation’s official public healthagenda for the decade.

to be issued by the department. The original Healthy Peopleobjectives were released in 1979 with a second set of10-year objectives issued in 1990. At the behest of theAmerican Optometric Association (AOA) and other healthcare advocacy organizations, a set of ‘‘vision and hearing’’objectives were included in Healthy People 2010, thedepartment’s third set of objectives released in 2000. Atthe further urging of the AOA and other organizations,this year’s Healthy People 2020 objectives include a sectiondevoted exclusively to vision. All of the Healthy Peopleobjectives reflect health problems of national importancethat have been identified through government reportsfrom agencies such as the HHS’ Centers for DiseaseControl and Prevention (CDC). Specific measurable goalsfor improvement are set for each objective. The AOA sup-ports Healthy People vision-related objectives through itsHealthy Eyes Healthy People� (HEHP) program, whichwas developed under terms of a formal memorandum ofunderstanding with the HHS.Under the Healthy People 2020 program, the HHS calls

on the American health care system to place top priority onthe prevention of chronic conditions, such as heart disease,cancer, and diabetes, over the next 10 years. ‘‘The launch ofHealthy People 2020 comes at a critical time,’’ said HHS

Uzma A. Zumbrink, DHSc., MPH, is the associate director of public

health for the American Optometric Association’s Clinical and Practice

Advancement Group. Opinions expressed are those of the author and not

necessarily those of the American Optometric Association.

1529-1839/$ - see front matter � 2011 American Optometric Association. All r

doi:10.1016/j.optm.2011.01.002

Secretary Kathleen Sebelius. ‘‘Our challenge and opportu-nity is to avoid preventable diseases from occurring in thefirst place.’’ However, Healthy People 2020 also targets anumber of additional health priorities. New areas ofemphasis include adolescent health, early and middlechildhood, older adults, health-related quality of life, andwell-being. Attention is also paid to ongoing healthconcerns, such as accident prevention and substance abuse.Optometrists, as the nation’s primary eye care providers,

can play an important role in the fight against chronic con-ditions, such as diabetes, as well as in addressing many ofthe areas of emphasis set down in the Healthy People 2020document, notes AOA Community Grants Committee ChairFred Dubick, O.D. Those overall Healthy People 2020goals are reflected in the vision-related objectives setdown in the document, he adds. Expanding the program’spreviously established vision-related objectives, HealthyPeople 2020 includes a new objective to improve accessto vision care for patients in Federally Qualified HealthCenters (FQHCs), while maintaining previous provisionson the prevention and treatment of eye disease, preventionof eye injuries in both work and recreational settings, di-lated eye examinations, and rehabilitation and appropriatedevices for the severely visually impaired. Specifically,Healthy People 2020 sets down 8 vision-related objectives:

� Vision screening for children� Visual impairment in children and adolescents� Occupational eye injury� Dilated eye examinations� Visual impairment� Protective eyewear use� Vision rehabilitation� Comprehensive vision health services in FQHCs

Under Healthy People 2020, the HHS is targeting a 10%improvement in all but one of those areas over the decade.In several areas, the program specifies subobjectives (seeBox 1). The HHS emphasizes that it establishes benchmarksand monitors progress for each objective in an effort to:

� Encourage collaborations across sectors of health care� Guide individuals toward making informed health

decisions� Measure the impact of prevention activities

As with the setting of all the Healthy People priorities,progress toward the achievement of each objective will bemeasured using statistics from widely recognized

ights reserved.

Box 1

Healthy People 2020 summary of objectivesdvision

V–1: Increase the proportion of preschool children age 5 years and under who receive vision screening.Target: 44.1%Baseline: 40.1% of preschool children age 5 years and under received vision screening in 2008.Data sources: National Health Interview Survey (NHIS), NCHS, CDC.V–2: Reduce blindness and visual impairment in children and adolescents age 17 years and under.Target: 25.4 per 1,000.Baseline: 28.2 per 1,000 children and adolescents age 17 years and under were blind or visually impaired in 2008.Data sources: NHIS, NCHS, CDC.V–3: Reduce occupational eye injuries.

V–3.1: Reduce occupational eye injuries resulting in lost work days.Target: 2.6 per 10,000 full-time workers.Baseline: 2.9 per 10,000 full-time workers had occupational eye injuries resulting in lost work days in 2008.Data sources: Survey of Occupational Injuries and Illnesses, Bureau of Labor Statistics, U.S. Department of Labor.

V–3.2: Reduce occupational eye injuries treated in emergency departments.Target: 11.6 per 10,000 full-time workers.Baseline: 12.9 per 10,000 full-time workers were treated for occupational eye injuries in emergency departments in2008.Data sources: National Electronic Injury Surveillance System, Consumer Product Safety Commission, and NationalInstitute for Occupational Safety and Health, CDC, Annual Survey of Occupational Injuries and Illnesses, ED.V–4: Increase the proportion of adults who have had a comprehensive eye examination, including dilation,within the last 2 years.Target: 60.5%.Baseline: 55.0% of adults age 18 years and older had a comprehensive eye examination, including dilation, within thelast 2 years in 2008.Data sources: NHIS, NCHS, CDC.V–5: Reduce visual impairment.

V–5.1: Reduce visual impairment caused by uncorrected refractive error.Target: 122.5 per 1,000.Baseline: 136.1 per 1,000 population age 12 years and older had uncorrected refractive errors from 2005 through 2008.Data sources: National Health and Nutrition Examination Survey, CDC, NCHS.

V–5.2: Reduce visual impairment caused by diabetic retinopathy.Target: 30.7 per 1,000.Baseline: 34.1 per 1,000 population age 18 years and over with diabetes had visual impairment caused by diabeticretinopathy in 2008.Data sources: NHIS, CDC, NCHS.

V–5.3: Reduce visual impairment due to glaucoma.Target: 12.3 per 1,000.Baseline: 13.7 per 1,000 population age 45 years and over had visual impairment caused by glaucoma in 2008.Data sources: NHIS, CDC, NCHS.

V–5.4: Reduce visual impairment caused by cataract.Target: 98.6 per 1,000.Baseline: 109.6 per 1,000 population age 65 years and over had visual impairment caused by cataract in 2008.Data sources: NHIS, CDC, NCHS.

V–5.5: Reduce visual impairment due to age-related macular degeneration (AMD).Target: 14.0 per 1,000 population.Baseline: 15.6 per 1,000 population age 45 years and over had visual impairment caused by AMD in 2008.Data sources: NHIS, CDC, NCHS.

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V–6: Increase the use of personal protective eyewear in recreational activities and hazardous situations aroundthe home.

V–6.1: Increase the use of personal protective eyewear in recreational activities and hazardous situationsaround the home among children and adolescents age 6 to 17 years.Target: 18.2%.Baseline: 16.5% of children and adolescents age 6 to 17 years used personal protective eyewear in recreational activ-ities and hazardous situations around the home in 2008.Data sources: NHIS, CDC, NCHS.

V–6.2: Increase the use of protective eyewear in recreational activities and hazardous situations around thehome among adults age 18 years and over.Target: 43.7%.Baseline: 39.7% of adults age 18 years and over used protective eyewear in recreational activities and hazardoussituations around the home in 2008.Data sources: NHIS, NCHS, CDC.V–7: Increase vision rehabilitation.

V–7.1: Increase the use of vision rehabilitation services by persons with visual impairment.Target: 33.1 per 1,000.Baseline: 30.1 per 1,000 persons with visual impairment used vision rehabilitation services in 2008.Data sources: NHIS, CDC, NCHS.

V–7.2: Increase the use of assistive and adaptive devices by persons with visual impairment.Target: 12.3%.Baseline: 11.2% of persons with visual impairment used assistive and adaptive devices in 2008.Data sources: NHIS, NCHS, CDC.V–8: (Developmental) Increase the proportion of FQHCs that provide comprehensive vision health services.Potential data source: Health Center Management Information System, Bureau of Primary Health Care, HRSA.

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government agencies or programs such as the NationalElectronic Injury Surveillance System, Consumer ProductSafety Commission, National Institute for OccupationalSafety and Health, National Center for Health Statistics(NCHS) Annual Survey of Occupational Injuries andIllnesses, and the Health Resources and Services Admin-istration (HRSA).The AOA actively works to support the Healthy People

program through a number of association initiatives. TheAOA HEHP Community Grants program annually providesfunding through state optometric associations for innova-tive community eye care outreach and education efforts thatare conducted by practicing optometrists in conjunctionwith partner organizations in local communities to achieveHealthy People vision-related goals. In addition, the AOAAdvocacy Group, Communications Group, and Clinicaland Practice Advancement Group, as well as OptometryCares and other AOA-related entities, offer a number ofprograms, services, and materials that optometrists mayfind useful in addressing Healthy People vision objectives.A brief discussion of the Healthy People 2020 visionobjectives and relevant AOA programs follows.Vision screening for preschool childrendThe HHS

hopes to increase the percentage of children (age 5 yearsand younger) who undergo vision screening to 44.5%.The AOA continues to recommend preschool children un-dergo complete comprehensive eye examinations ratherthan screenings. Screenings can miss both eye health

conditions and developmental vision problems. However,this new Healthy People 2020 objective reflects growingacceptance among federal administrators of the importanceof preventive eye care for preschoolers and could facilitatenew opportunities for the providing of comprehensive ex-aminations to young children. The AOA HEHP CommunityGrants Program commonly funds pilot projects throughwhich preschool children can receive eye examinations.Patient information on eye care for children is availableon the AOA Web site Infant Vision page (www.aoa.org/x9420.xml) and Early Childhood Vision page (www.aoa.org/x9450.xml).Visual impairment in school-age children and adoles-

centsdReflecting growing acceptance of the importance ofgood vision care for school-age children, the HHS hopes toreduce the number of children and adolescents (age 17 andyounger) who are legally blind or have visual impairment to25.4 per 1,000 over the next 10 years. Like the previouslymentioned preschool vision screening provision, efforts toreach this new Healthy People objective will effectivelybe supported by school vision screening laws and AOA pro-grams such as VISION USA. Numerous eye care projectsfor school children are sponsored under the AOA HEHPCommunity Grants program. AOA Communications Grouppublic outreach programs such as the annual late-summer‘‘Ready for School’’ campaign have proven effective in in-creasing public awareness of the importance of good visionfor school children. Patient information is available on the

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AOA Web site School-age Vision Page (www.aoa.org/x9451.xml).Occupational eye injurydThis is a 2-fold objective; the

HHS hopes to reduce the number of occupational eye in-juries resulting in lost work days each year to around 2.6per 10,000 full-time workers and reduce the number of oc-cupational eye injuries treated in hospital emergency roomseach year to around 11.6 per 10,000 full-time workers.Many large employers now have eye safety programs,which have brought down eye-related accident rates. Prac-ticing optometrists can play a critical role in reaching bothof these goals by offering prescription and nonprescriptionprotective eyewear in their practices as well as educatingworkers and employers on its benefits. Optometrists mayalso wish to make employers and workers aware thatwhen accidents occur, emergency medical eye care canbe obtained through nearby optometric practicesdquicklyand often with less expense than through emergency rooms.Many larger employers now have eye health and safety pro-grams that have successfully brought down eye injury andemergency room treatment rates, according to the federalOccupational Safety and Health Administration. Theagency is now targeting small- to medium-sized employ-ersdparticularly in fields such as constructiondin effortsto encourage eye safety programs and is suggesting thatlocal eye care practitioners help. The AOA OccupationalVision Manual offers a comprehensive guide to optome-trists who wish to provide such services (www.aoa.org/x5358.xml). Patient education information is available onthe AOA Web site (see ‘‘Ensuring Eye Safety at WorkHealth or Play’’ on the AOA Adult Eye Care Page[www.aoa.org/x9452.xml] and AOA Protecting Your Eyesat Work Web page [www.aoa.org/eye-protection.xml]).Dilated eye examinationsdThe HHS hopes to

increase the proportion of adults (age 18 and over) whoundergo comprehensive, dilated eye examinations every2 years to 60.5%. This objective is in line with longstand-ing AOA recommendations. AOA surveys confirm thatefforts by the association and practicing optometristsover the last 4 decades have been highly successful in es-tablishing the periodic eye examination as an acceptedpart of routine preventive health care. However, manyAmericans still have not entered into a regimen of regulareye care. Think About Your Eyesdthe first unified na-tional eye care education campaign endorsed by a broadrange of eye care professional organizations withsubstantial industry funding targets increased awarenessof the importance of regular dilated eye examinations.Practicing optometrists will have opportunities to tie inwith the campaign at the local level. For additional infor-mation see the Think About Your Eyes Web page (http://thinkaboutyoureyes.com).Visual impairmentdCombining a number of objectives

outlined in previous Healthy People documents, the HHS ishoping to reduce visual impairment caused by a variety ofconditions:

� Uncorrected refractive error (122.5 cases per 1,000people)

� Diabetic retinopathy (30.7 cases per 1,000 people)� Glaucoma (12.3 cases per 1,000 people age 45 and

older)� Cataract (98.6 cases per 1,000 people age 65 years

and older)� Age-related macular degeneration (14 cases per 1,000

people age 45 and older)

Age-related macular degeneration is included for the firsttime in the Healthy People objectives. The AOA activelyparticipates in a number of outreach efforts (NationalGlaucoma Month, National Diabetes Month) designed toraise public awareness of such conditions and encourageparticipation by member optometrists. A variety of inno-vative eye care public outreach projects have been under-taken through the AOA HEHP Community GrantsProgram. Patient education materials are available on theAOA Web site (www.aoa.org.glaucoma.xml, www.aoa.org/diabetic-retinopathy.xml). Practitioners may wish toreview the AOA Optometric Clinical Care Guidelines(www.aoa.org/x4813.xml) on these areas of care.Protective eyewear (home and recreation)dFocusing

on the use of personal protective eyewear in recreational ac-tivities and hazardous situations around the home, the HHShopes to achieve the use of appropriate eye protectionamong 18.2% of children and adolescents (ages 6 to 17)as well as among 43.7% of adults. The AOA Sports VisionSection (SVS) offers a variety of materials on eye protec-tion for recreational activities and related topics includingits Junior Olympics Sports Vision Evaluation Protocols,Sports Vision Guidebook Series, Sports Vision UniversityEducation Program, and SVS Eye Emergency TriageCard (see the AOA Web site Sports Vision page[www.aoa.org/x4787.xml]). Patient information is availablethrough the Sports and Vision link on the AOA Web siteCaring for Your Vision page (www.aoa.org/x4724.xml).Vision rehabilitationdTheHHShopes to increase the uti-

lization rate of vision rehabilitation services among personswith visual impairment to 33.1 per 1,000. The departmentalso hopes to see just under an eighth (12.3%) of the visuallyimpaired population using assistive and adaptive devices.The inclusion of this objective in Healthy People 2020 repre-sents an important acknowledgement of the value of visionrehabilitation services by federal officials, according to theAOAVisionRehabilitation Section (VRS). TheAOAVRSof-fers a variety of resources for practitioners who wish to offerlow vision rehabilitation services, including an online re-source manual with advice on the daily operation of a visionrehabilitation practice, clinical practice guidelines, links tolow vision industry professionals, coding guidelines, andsample patient forms. For additional information, see theAOA RVS Web page (www.aoa.org).Comprehensive vision health services in FQHCsdThe

HHS supports some 1,200 FQHCs in an effort to ensure

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access to care for underserved populations. They includecommunity health centers, rural health centers, public hous-ing health centers, seasonal farm worker (migrant) healthcenters, and health centers for the homeless. The HRSA,which is housed within the HHS, recently announced a ma-jor initiative to expand the availability of primary care ser-vices through FQHCs. A new initiative provides fundingfor services expansion in primary care, including visioncare, which is currently available on-site at only about18% of health centers nationally. The AOA recently estab-lished a consulting arm, the Eye Care Technical AdvisoryCenter, designed to assist health centers that wish toadd a comprehensive vision service. For additional infor-mation, see www.aoa.org/community-health-centers orwww.aoa.org/eyetac.

Meeting the objectivesActive participation by optometrists in efforts to achievethe Healthy People 2020 objectives can benefit the nationas a whole, individual patients, optometric practices, andthe profession of optometry. It should be emphasized thatoptometrists can play a valuable role in meeting not onlythe Healthy People program’s vision-related objectivesbut those related to systemic conditions and care for tar-geted population groups. Practitioners may wish to reviewthe complete Healthy People 2020 document and considerall of the ways they may be able to assist. Participation byoptometrists in Healthy People 2020 can help to secureoptometry’s position as an important part of the nation’sprimary care system. Providing the full-scope-of-practice care necessary to meet the Healthy People 2020vision objectives as well as outreach activities to raisepublic awareness of the objectives can effectively helppromote a practice and open practice enhancement oppor-tunities.Optometrists should review the objectives and consider

participation in the AOA’s efforts to achieve them. A widerange of innovative eye and vision care community out-reach programs has been developed under the AOAHEHP Community Grants Program specifically to addressHealthy People objectives. AOA members may wish to par-ticipate in such programs or use them as models for similarefforts in their local communities. (For a list of this year’sHEHP projects, see the February edition of Optometry.)The new HEHP Launch Kit was introduced in Septemberof this year to help ensure both the success of AOAHEHP projects and the proper reporting of project results(see the following section). In addition to playing an impor-tant role shaping the Healthy People 2020 vision objectives,the AOA Advocacy Group is working on regulatory andlegislative issues, at both the state and federal levels, relatedto virtually all of the program’s eye care–related goals.(Particular attention is being paid to the coverage policesof new health plans being developed under the recent fed-eral health reform legislation.) The AOA Clinical and Prac-tice Advancement Group offers a variety of products and

services that can be helpful in addressing Healthy People2020 vision objectives. The AOA Communications Group(contact: publicrelations@aoa.org) and the AOA Order De-partment (www.aoa.org/x4795.xml) offer materials that canbe useful in either public outreach or patient education re-garding the Healthy People 2020 vision-related objectives.Additional information about Healthy People 2020 can befound on the HHS Healthy People Web site (www.healthy-people.gov) or the AOA Web site HEHP Web page(www.aoa.org/hehp).

Kit outlines communications plan forcommunity eye care projectsThe new HEHP Launch Kit, introduced last month by theAOA, is designed to help ensure the success of eye andvision outreach programs through effective communica-tions. Using the HEHP Launch Kit, project organizers candevelop comprehensive strategies not only to raise aware-ness of outreach efforts among target populations but alsoto attract businesses and organizations that may be inter-ested in cosponsoring such efforts and follow up witheffective reporting on the project results.The AOA HEHP program actively supports the vision-

related objectives of the HHS Healthy People 2010 publichealth agenda with grants for innovative community eye careoutreach and education efforts. Projectsmust be conducted bypracticing optometrists in conjunction with state optometricassociations and partner organizations in local communities.However, in some cases, peoplewhomight most benefit fromsuch eye care programs are not made aware of them. In manycases, that is the result of inadequate publicity in local mediaor because potentially valuable partner organizations in thecommunity are not effectively recruited to take part, the AOACommunity Grants Committee Chair, Fred Dubick, O.D.,believes.Complete with a manual and planning worksheet, the

HEHP Launch Kit provides an orderly process organizerscan use to formulate key messages and disseminate essen-tial information regarding their projects.Organizers can attract local project cosponsors using the

kit’s list of national organizations (e.g., American Associa-tion of Retired Persons, American Public Health Associa-tion, and Lions Clubs International) with local affiliatesthat might be interested in partnering on HEHP programs.A template introduction letter and script for follow-up callsis provided along with an outline for presentations to inter-ested organizations. A template partnership agreement isalso provided.Using the kit’s extensive guide to working with media,

organizers can then solicit publicity for their projects bydeveloping a contact list of local publications and broad-casters. Template fact sheets, press releases, and broadcastpublic service announcements are all provided with the kit.So are reproducible logos for print advertising and programmaterials as well as ‘‘banner’’ advertisements for practiceor partner Web sites.

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A limited supply of AOA brochures on specific eye andvision topics is provided for dissemination to patientsduring projects (along with order forms for additionalbrochures). Also provided is a template release for use inobtaining permission to use patients’ photos or commentsin follow-up press releases or media coverage of the event.A template for a follow-up press release is also provided

to inform the local community of the completion andresults of the project. Certificates of completion for par-ticipating practitioners and sponsors as well as ‘‘thank you’’cards for project partners are also included.Also included in the kit is a project report form to

facilitate quarterly reporting on the planning and

promotion of efforts, as required under the HEHP grantrules. In addition to a description of the project, theform requires objective measures (such as the number ofpatients seen or the number people attending presenta-tions) to be used in assessing the success of the project.As the program progresses, organizers must also rate thesuccess of various outreach measures and specificallystate ‘‘what has been working’’ and ‘‘what hasn’t beenworking.’’HEHP project coordinators can obtain the HEHP Launch

Kit by contacting Uzma Zumbrink, DHSc., MPH, AOAassociate director for Public Health, at (800) 365-2219, ext.4146 or UAZumbrink@aoa.org.