Vision census paints worrisome picture for eye care in Alabama

An eye care census in Alabama highlights the need for more eye care providers in rural areas and more minority providers.

A survey of eye care providers in Alabama conducted by researchers at the University of Alabama at Birmingham indicates that there are not enough eye care providers in rural Alabama, there aren’t enough minority eye care providers throughout the state and there is a looming shortage of eye care providers overall statewide.

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The census was done on behalf of the EyeSight Foundation of Alabama, as a follow up to a survey the foundation commissioned in 1999. The current study was conducted to provide updated information to the foundation and to serve as a resource to clinicians, researchers and policy-makers in Alabama.  The survey included responses from 438 ophthalmologists, optometrists and vision rehabilitation providers in Alabama, about 42 percent of the total of practicing eye care professionals in the state.

“We found that many Alabama communities are geographically isolated from eye care services,” said Paul MacLennan, Ph.D., an assistant professor of surgery at UAB and lead investigator of the study. “The overwhelming majority of eye care providers are located in urban counties. There are ten counties without an eye care provider at all.”

MacLennan identified the ten counties without eye care providers as Bullock, Clay, Coosa, Hale, Lawrence, Lowndes, Monroe, Randolph, Washington and Wilcox counties. He said 94 percent of ophthalmologists, 80 percent of optometrists and 85 percent of rehabilitation providers were located in urban counties.

Survey respondents frequently expressed the opinion that there is a need for more providers across the state, especially in light of the growing prevalence of diabetes in Alabama.

Survey respondents frequently expressed the opinion that there is a need for more providers across the state, especially in light of the growing prevalence of diabetes in Alabama. Diabetic retinopathy is the leading cause of blindness among working age adults in the United States. Those with diabetes are also at increased risk for glaucoma and cataracts. Survey participants report that approximately a quarter of their current patients have diabetes, and the number is expected to rise. Eye diseases are also more common in the elderly, the fastest growing segment of the United States population.

“Due to changing patient demographics, retirement, and a fixed number of ophthalmology residency slots nationwide, ophthalmology in Alabama and across the country will face substantial challenges in manpower by the year 2020,” said Cynthia Owsley, Ph.D., vice-chair for research in the UAB Department of Ophthalmology and a study co-author. “Vision problems associated with an aging population, coupled with increasing rates of diabetes, will place an additional strain on already limited eye care resources.”

Most respondents to the survey, 94 percent, identified themselves as of white, non-Hispanic origin. Eight-eight percent are male. MacLennan said previous research indicates that rates of vision impairment and eye disease among African Americans, who make up one-quarter of Alabama’s population, are two times higher than those of whites, especially uncorrected refractive error, cataract, glaucoma and diabetic retinopathy.

“Diversity among health care providers has been shown to help break down barriers to care, improve communication and increase the use of preventive eye care,” said MacLennan. “Enhanced racial diversity among eye care providers, particularly a larger number of African-American providers, could have positive benefits on eye health in the state.”

The study identified four priority focus areas that could deliver significant benefit to the eye health of Alabamians.

  • Identify strategies to increase the number of eye care providers, including more African American providers.
  • Develop and implement strategies in the eye care system for improved detection and follow-up management of the ocular complications of diabetes.
  • Develop and implement strategies to improve access to eye care, satellite eye care practices, telemedicine approaches and possibly transportation systems.
  • Scientifically evaluate these and any other public eye health interventions to improve the quality of and access to eye care in Alabama, in terms of their impact on both health outcomes and cost, so that eye health strategies in the state are evidence-based.

“The trends in vision impairment and blindness, particularly among people 40 and older, are alarming,” EyeSight Foundation Executive Director Torrey DeKeyser said. “The nation has seen an increase of 23 percent since 2000 in this age group and the predictions for that trend to continue are sobering, particularly in Alabama which has such a high incidence of diabetes, a leading cause of retinopathy and glaucoma.”

“While the EyeSight Foundation cannot address all of the strategies identified in the Census report, we will use the knowledge gained from it, combined with our past funding experiences, to help shape our ongoing grant making with the goal of reducing vision loss and blindness in Alabama and beyond,” she added.

Gerald McGwin, Ph.D., professor of epidemiology, ophthalmology and surgery and Karen Searcey, MSPH, manager of the UAB Ophthalmology Clinical Research Unit, are also co-authors of the report. The full report is available on the EyeSight Foundation website.

The report was funded by the EyeSight Foundation of Alabama, with supplementary support from UAB’s Comprehensive Diabetes Center; Department of Ophthalmology, School of Medicine; Minority Health and Health Disparities Research Center; School of Public Health; and Vision Science Research Center.

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