GLOBAL EYE CARE
Global Perceptions and Vision Care Realities
Despite wide-ranging national and regional differences, rates of comprehensive eye exams are low worldwide.
By Colleen Riley, OD, MS, FAAO, Dipl CL
Dr. Riley is vice president of Professional Development for Vistakon, Division of Johnson & Johnson Vision Care, Inc. She also oversees The Vision Care Institute, LLC, a Johnson & Johnson Company.
Across cultures and national boundaries, people value sight as the most important of their five senses. Yet new research reveals that 44 percent of people around the world share the misguided belief that seeing well translates to good eye health.
“Global Attitudes and Perceptions About Vision Care,” a recent survey conducted on behalf of The Vision Care Institute, LLC, a Johnson & Johnson company, reveals that gaps between attitudes and behavior are common around the world. More than 6,500 adults ages 18 to 54 from 13 countries (Australia, Brazil, China, France, Hong Kong, Italy, Japan, Korea, Russia, Singapore, Taiwan, the United Kingdom, and the United States) were surveyed to better understand the frequency, practice, and perception of eye exams for adults and children.
Another survey of different ethnic groups in the United States, showed similar gaps between what people know they should do and what they actually do to maintain eye health.
Globally, survey respondents demonstrate a strong belief that good vision positively affects their quality of life. Nearly eight in 10 respondents (79 percent) believe that improving their vision will improve their enjoyment of life, helping them perform better in hobbies (73 percent), school/career (71 percent), and sports (65 percent). Even larger percentages believe better vision could have positive effects on their children's lives.
Frequency of Eye Exams
Despite these reported beliefs, however, only half (54 percent) of survey participants have ever had a comprehensive eye exam. This is in stark contrast to the relatively high numbers who report having general health and dental exams (82 percent and 91 percent, respectively). Even in developed countries that have good healthcare systems, such as France and the United States, there are still significant gaps between the respondents who have had comprehensive eye exams compared to those who have had general health and dental exams.
More than 90 percent of respondents in France, Italy, the United Kingdom, the United States, and Brazil report having had some type of eye or vision evaluation, which could include vision screenings, a brief vision test for a driver's license, or a comprehensive exam (see “Adult Eye Exam Incidence,” below). The number was lowest in China, where only 58 percent of respondents have ever had their eyes evaluated.
Certainly, lack of knowledge about eye exams and insufficient attention paid to eye health are driving these results. Nearly half of respondents globally say that they are not sure what a comprehensive eye exam involves, but a majority (62 percent), are willing to pay more for a more complete eye exam.
Cost does not appear to be a barrier to eye exams in most places. Globally, only 10 percent say they can't afford to have an eye exam. But in the United States, this number jumps to 27 percent—nearly triple the global average. U.S. adults, along with those in Hong Kong and China, are also more likely to cite lack of insurance or insufficient coverage for eye exams as a barrier to making an appointment.
Overall, the most common reasons cited for not having eye exams were “haven't really thought about it” (34 percent), “no perceived vision issues” (30 percent), and “vision isn't bad enough to warrant going for an exam” (26 percent).
A Global Snapshot
The Global Attitudes survey produced a wealth of data. Here are a few examples of country-by-country results.
Almost 90 percent of Australians report having a vision assessment, but initial eye exams typically don't take place until 20 to 21 years old, older than other countries in the study. About 60 percent of adults use vision correction aids, but only 11 percent of parents/caregivers report that children do—less than half the global average of 27 percent.
Brazil has a high frequency of comprehensive eye exams (80 percent of adults have had one and 61 percent intend to within 12 months), knowledge about exams, and a high level of concern about serious eye diseases. Parents and caregivers in Brazil also report a significantly higher frequency (52 percent) of comprehensive eye exams for their children.
Despite the fact that 95 percent of Chinese respondents report experiencing vision problems such as strain or lack of focus, only 19 percent plan to definitely have an eye exam in the next year. Rates of vision correction for adults and children are significantly below global averages.
Children's Eye Exams
To me, the most striking finding in this survey is the consistent lack of eye exams for children. Although discretionary income and access to care vary greatly by country, the almost universal lack of emphasis on children's eye care is very troubling.
More than one in three parents or caregivers has never taken their children for an eye exam or vision assessment. Even more troubling is that most of the exams children do receive aren't comprehensive. A school or pediatrician's office vision screening is usually just reading an eye chart and is often not performed by an eyecare practitioner. While these screenings do catch some problems, they aren't able to detect many conditions and may give parents a false sense of security. Many parents also believe that they will know if children have trouble seeing, but kids are conditioned to give the “right” answer and they are masters at compensating for visual deficits.
There is more than a decade gap between what respondents consider to be the ideal age for starting eye exams (5.6 years old) and the actual age that exams take place (17.4 years old). Even in families in which children receive regular eye exams, the typical age for beginning to visit an eye doctor is one to two years later than the perceived ideal age.
The American Optometric Association (AOA) recommends that children have their first eye assessment at 6 months, then comprehensive eye exams beginning at age 3, before a child enters school, and then at least every two years. Yet the AOA recently reported that its own surveys show that 58 percent of parents don't take their children for their first eye exam until age 3 or later. Optometrists who participate in InfantSEE, a public health program sponsored by the AOA Foundation and The Vision Care Institute, are helping parents recognize the importance of early eye exams by offering free and low-cost vision assessments for infants before their first birthday (www.infantsee.org).
Providing literature and posting notices in the office is another way to get the message to families that eye care is as important as routine dental and medical checkups. A glaucoma patient, for example, may see the materials and realize that her grandchildren should have a comprehensive eye exam. Free copies of the new brochure, “Healthy Eyes for Peak Performance,” which emphasizes the benefits of eye health and vision for families, are available from the AOA Sports Vision Section, Safe Kids Worldwide, and Vistakon (e-mail your name and complete mailing address to firstname.lastname@example.org to receive a set of 50 brochures).
Globally, 66 percent of adults use some form of vision correction aid, including prescription glasses, non-prescription glasses, or contact lenses, or they have undergone surgery to aid vision. About three in 10 parents or caregivers (28 percent) say their children use some form of vision correction.
Rates of spectacle versus contact lens wear were not analyzed for this survey. But respondents were asked whether they thought contact lens wear has or could have positive benefits for them or for their children. Large numbers of adults said that they could benefit from contact lens wear, and agreement on the benefits of contact lens wear for children was even more widespread. Most significantly, 76 percent cite children's self-image and confidence as an area that has improved or would likely improve with contact lens use. Approximately three-quarters of parents or caregivers also cited enjoyment of life and performance in school, sports, and hobbies as areas in which contact lenses would benefit their children.
This perception closely mirrors the actual benefits that children in two large multicenter studies in the United States derived from contact lens wear. In the Contact Lenses in Pediatrics (CLIP) study, both teens and younger children experienced improved quality of life with contact lenses compared to glasses (Walline et al, 2007). And in the Adolescent and Child Health Initiative to Encourage Vision Empowerment (ACHIEVE) study, children who wore contact lenses felt better about themselves compared to spectacle wearers in three specific areas: athletic competence, social acceptance, and physical appearance (Walline et al, 2009).
In the Global Attitudes survey, we do see differences by country in adults' beliefs about the impact of wearing contact lenses on children. For example, parents/caregivers in Asian countries (except China) believe that wearing contact lenses would have a greater impact on sport performance than on other aspects. In China, school performance is seen as a relative advantage of wearing contact lenses. Parents in the U.K. and Russia seem to be more resistant to contact lenses in general for children. Korean parents, more than those in any other country, are highly positive about contact lens use for their children.
Protecting eyes from the sun is another area in which perception colors action. Nearly nine out of 10 (88 percent) respondents agree that UV rays can damage their eyes, but only 57 percent wear sunglasses as protection and even fewer (41 percent) make sure that their children wear sunglasses when outdoors. Parents are more likely to apply sunblock on their children's skin than to insist that they wear sunglasses.
Again, we see significant differences across countries and regions. About three-quarters of the Australians and Europeans surveyed report sunglass use when outdoors, but only 36 percent of Koreans and just 17 percent of Japanese take this protective step.
Armed with this knowledge, clinicians have an opportunity to encourage patients to maintain ocular health with simple and inexpensive steps. Sunglasses and a wide-brimmed hat should be standard outdoor wear for everyone from infants to adults. And, for those who wear contact lenses, choosing lenses with UV-blocking can further help to protect the eyes from the sun's harmful rays.
Perceptions of Ocular Health
In general, respondents from Western countries rated both general physical health and their eye health higher than did those from Asian countries. For example, 80 percent of Brazilians, compared to 29 percent of Chinese believe their eye health is very good or excellent. This doesn't mean that Brazilians have healthier eyes. The Brazilians surveyed may be more optimistic about their health, have different expectations, or interpreted the question differently than did respondents in China.
The results of this study are fascinating for anyone interested in vision care. The diversity of perceptions and beliefs around the world presents significant challenges for vision care companies that operate globally. But despite the enormous differences in the countries we surveyed, one message is clear. Adults and children around the world are neglecting primary eye care.
This neglect hampers timely and effective correction of childhood amblyopia and refractive error, which can have a significant impact on school performance and delays intervention for serious conditions such as glaucoma, hypertension, and diabetes.
But there is some good news: eye care delivery is improving. With each successive generation, the first comprehensive eye exam is taking place at a younger age compared to the one before it. Moreover, the survey shows that people all over the world place tremendous value on their sight and are willing to pay for eye exams—they just don't realize that they need them. Eyecare practitioners can help to change that in their own communities, one practitioner and one patient at a time. CLS
To view the Executive Summary, including key findings by country, visit www.thevisioncareinstitute.com/globalsurvey.
For references, please visit www.clspectrum.com/references.asp and click on document #172.