4 million individuals in the United States

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Lynn K Gordon, MD, PhD
Professor , Ophthalmology
Associate Dean, Diversity Affairs
David Geffen School of Medicine at UCLA
Disclosure
 The presenter has no financial interest in the topics
discussed
British Columbia Centre for Epidemiologic
& International Ophthalmology (BCEIO), 2000
 Two-thirds of all blind individuals in the world are female
 Most are older than 50 years
 90% of blind people live in poverty
 Gender bias is not limited to the developing world
Healthy People 2010: The Numbers Speak
 US Department of Health and Human Services
 2000: vision objectives were initially included
 >80 million people have potentially blinding diseases
 >4 million individuals in the United States
 low vision
 legally blind
 severe visual limitations
 Economic impact:
 >50 billion dollars in 2002 for health care for individuals
with visual disorders (both direct and indirect costs)
 Estimate: by 2030 the number of visually impaired and
legally blind individuals may double
http://www.healthypeople.gov/document/html/volume2/28vision.htm
Visual Loss is Associated With…….
 Decreased quality of life
 Changes in independent living
 Increased injury and falls
 Increased depression
 Increased isolation
 Untreated poor vision is associated with cognitive decline
and onset of dementia
Rogers, MA, Langa KM. Untreated poor vision: a contributing
factor to late-life dementia. Am. J. Epidemiol. 2010 171:728
Visual Impairment and Falls
 Falls in older adults
 Occur in 35-40% of individuals
 Responsible for 90% of fractures in the elderly
 Clinical risk factors include vision impairment, gait
abnormality and muscle weakness
 Fractures associated with
 Poor visual acuity in older women
 Poor contrast sensitivity
 Decreased depth perception
 Binocular visual field loss
Coleman AL, el al. J Am Geriatr Soc. 2009; 57:1825. Patino CM el al. Ophthalmology. 2010; 117:199.
Common Eye Diseases in the United States
Associated with Vision Loss
 Treatable or preventable eye disease: the big 4
 Age-related macular degeneration
 Diabetic retinopathy
 Glaucoma
 Cataract
 Less common, important causes for vision loss in women
 Trauma
 Immune-related eye disease
 Idiopathic Intracranial Hypertension (IIH)
British Columbia Centre for Epidemiologic
& International Ophthalmology (BCEIO), 2000
 What about gender?
 Female gender bias held true for many diseases
 Cataract
 Glaucoma
 Trachoma
 Age-Related Macular Degeneration (ARMD)
 Age-adjusted risk is about equal for men and women
 Percentage of women in the at-risk population is larger
than the percentage of men
Women and Macular Degeneration
• ARMD: leading cause of legal blindness in the USA
• 9 million people have some form of ARMD
• 1.6 million have advanced disease
• Age is the greatest risk factor
• 55-64: one percent are affected
• 65-74: four percent are affected
• >75: thirty percent are affected
• Women tend to live longer than men, F:M lifetime risk 2:1
• 6% for females
• 3% for males
Women’s Eye Health.org
Women with Diabetes
 Younger women and those of reproductive age are less
likely than older women to receive eye examinations
 Women > 75 years were twice as likely to have been
examined as compared to women < 50 years
 Barriers for preventive care
 Low socioeconomic position
 Lack of insurance
 Low levels of education
Owens, et al. Women with diagnosed diabetes across the life stages: Underuse of
recommended preventive care services. 2008. Journal of Women’s Health. 17: 1415
Women and Glaucoma
 Prevalence of glaucoma is higher in women than in men
 Risk for angle closure glaucoma is higher in females
 No gender bias in the incidence of open angle glaucoma
 Burden of blindness due to glaucoma is larger for women
 Rate of visual impairment is higher in women
 Women are 24% less likely to be treated for glaucoma
Vajaranant, TS, et. al. Gender and glaucoma: what we know and what we need to know.
Curr. Opin. Ophthalmol. 2010. 21:91.
Women and Glaucoma
 Vision loss from glaucoma can be slowed or prevented
with adequate therapy
 About 50% of individuals with glaucoma are not
diagnosed:
 Must identify affected individuals and provide adequate
therapy
 Health disparities in glaucoma require additional study
and intervention
Women and Cataract
 Cataract prevalence increases with increasing age
 Surgery for cataract accounts for 60% of Medicare
expenses for vision
 Nuclear sclerosis is the most common form of cataract
 Gender association: more common in women
 Other associations: diabetes, low education, myopia,
smoking, BMI >35
Women and cataract
 Significant cataracts in the Los Angeles Latino Eye Study
 Females 20% more likely than males
 Prevalence of cataract:
 2.6% in the age range 60-69
 17% in individuals > 80
 1/3 of patients with cataract had an unmet need for surgery
 Risk factors for unmet need




Lack of health insurance
Income <$20,000 per year
Self-reported barriers to care
Last eye exam > 5 years ago
Richter, CM et al. Ophthalmology. 2009; 116:2327.
Women and Eye Trauma
 Massachusetts Eye and Ear Hospital experience
 20% of open globe injuries are in patients > 65 years old



Average age in this group = 79.8 years
65% of these are caused by falls
76% of these occur at home, mid-day and night-time peaks
 Women as a percentage of the total


58% of the geriatric patients
14% of the non-geriatric patients
 Opportunities for counseling and home preventive care
Andreoli, MT, and Andreoli, CM. Geriatric Traumatic Open Globe Injuries.
Ophthalmology. 2010. in press
Women and Eye Disease
 Inflammatory eye disease
 Many autoimmune diseases are gender-associated
 One million Sjögren’s patients in the USA, 90% are women
 Idiopathic intracranial hypertension
 Occurs primarily in women
 Significant risk for visual loss
Women and Eye Disease: USA
 Gender issues and eye disease: increased eye disease in
American women
 Increased incidence

Angle closure glaucoma, cataract, IIH, autoimmunity
 Increased prevalence

Aging population: glaucoma, ARMD
 Barriers to care
 Access
 Education
 Cultural sensitivity
Opportunities for the Future
 Increase research to understand disease pathophysiology
 Enhance importance of prevention education
 Improve access to care
 Ensure treatment equality
 Eliminate barriers and reduce co-morbidities!
 Together we can effect change
 Thank you for your attention
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