Article Date: 2/1/2007

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Study reveals gap between vision care knowledge and behavior across ethnic groups and points to continued misunderstandings about contact lens wear.

How Much Do Your Patients Know About Eye care?

mericans see maintaining their vision as an important health priority, but new research suggests that you, the eyecare provider, need to do a better job of educating your patients about ocular health and common vision conditions.

More than 3,700 adults of various ethnic backgrounds (Hispanics, African-Americans, Asian-Americans and Cauca-sians) were asked about their attitudes toward, perceptions of and experiences with vision care in the nationwide "Americans' Attitudes and Perceptions About Vision Care" survey, conducted by Harris Interactive on behalf of The Vision Care Institute (TVCI) of Johnson & Johnson Vision Care, Inc. (Interviews were conducted online and by telephone. Online respondents were recruited from Harris Interactive's multimillion-member general panel. Telephone respondents were recruited from a mix of random-digit telephone samples and targeted samples. Telephone interviews were con ducted in English, Spanish or Mandarin, depending on the preference of the respondent.)

The good news: Nearly nine out of 10 respondents know that many serious health problems, such as diabetes, can be detected through eye exams. In fact, three-quarters of respondents said people should get their eyes examined at least once a year, and the same number of respondents agreed that eye exams are necessary even for people who aren't experiencing problems with their vision.

The bad news: When it comes to behavior, there is a gap between what people know they should do and what they actually do. Only about half the survey respondents said they'd visited an eyecare professional in the past year, while 25% reported not having an exam in more than two years. And, 14% said they did not have a regular eyecare provider.

Cultural competency
Most alarmingly, adults and children who are at greater risk for certain eye conditions and diseases are likely not receiving proper diagnosis and treatment. For example, African-Americans, who are five times more likely to have glaucoma, are less likely than other groups to report having a regular eyecare provider, according to the survey. Around 21% of African-Americans don't have a regular eyecare provider, compared with 14% of all respondents. Only 43% of Hispanics say they've seen an eyecare professional in the last year compared with 50% of all respondents.

"When we see such a disconnect between knowledge and behavior, we have to look at the barriers to care," says Edwin C. Marshall, O.D., M.S., M.P.H., an Indiana University professor of optometry and adjunct professor of public health. "[The barriers in care] include time con- straints, lack of insurance coverage and other financial barriers. In addition, some of the disparities in care for African-Americans and other ethnic groups may be due to cultural barriers," he says. "As eyecare professionals, we increasingly encounter patients from different cultural backgrounds than our own, and we need to do a better job of developing cultural competency, in order to be more sensitive to the needs and behaviors of people from diverse backgrounds."

Americans also display varying degrees of knowledge about vision conditions such as myopia, hyperopia, and astigmatism and treatments for these conditions, with Caucasians consistently demonstrating greater knowledge than Hispanics, African-Americans and Asian-Americans.

All groups surveyed lacked awareness of presbyopia, in particular. Consider: Only 38% of respondents age 40 and older say they know what presbyopia is, and only 53% of this group are aware that treatments for presbyopia are available.

This means you need to make sure your patients understand what's happening as their eyes age. And, you should ensure they know about monovision and the bifocal or multifocal products available to help them cope with presbyopic changes by taking the time to educate them.

In the dark on sunwear

Almost all survey respondents agree that ultraviolet (UV) rays can damage their eyes, but one-third believe that sunglasses alone provide enough protection from UV rays. In addition, 27% don't even wear sunglasses. The solution to this problem: Educate all your patients about protecting their eyes from UV exposure by wearing sunglasses and wide-brimmed hats and, when appropriate, UV-blocking contact lenses.

Practitioner patterns

Survey respondents overwhelmingly (79%) cite their eyecare professional as the source they most trust to provide reliable information about vision care products. Most respondents report regularly seeing an optometrist (42%) or an ophthalmologist (32%). Interestingly, half of Asian-American respondents say their eyecare provider is either of Asian or Pacific Islander decent, and one out of five Hispanics say they see an eyecare professional who's Hispanic. While most Hispanics say they communicate with their eye doctor in English, 8% say they communicate in Spanish, and 13% of Asian-Americans say they talk to their doctor in Chinese or Cantonese.

The bottom line: Doctors and staff should be trained in culturally competent eyecare due to the vast and growing diversity of our country. Many medical and optometry schools, along with continuing education (CE) sponsors, now offer such training.

Spectacle and CL wear

A majority of Americans wear prescription glasses or contact lenses, with one in 10 adults who say they wear both, according to the survey. Among these respondents, 62% say they wear their contact lenses more often than their glasses. The vast majority (87%) of contact lens wearers report using soft contact lenses.

When and where respondents wear their glasses or contact lens-es appears to be age-related.

Younger respondents, for instance, are much more likely to wear contact lenses and less like-ly to wear eyeglasses compared with respondents older than age 40. If this age group wears both, they generally prefer their contact lenses and are more likely to wear their glasses in solitary settings, such as "hanging around the house," while those age 40 and older are more likely to wear them all the time.

Younger people are also twice as likely as older people to say they would consider a surgical refractive procedure to correct their vision.

One group, in particular, is not even being offered the option of contact lenses. Fully one-quarter of respondents diagnosed with astigmatism say an eyecare provider has told them that they cannot wear contact lenses. This is unfortunate, given the availability of contacts that can provide astigmatic patients with consistent, all-day vision and comfort.

Something else to consider: Four out of 10 Americans who wear contact lenses not designed for overnight wear, report that they occasionally nap in their lenses, and 5% say they regular-ly sleep in their contact lenses over-night.

Moreover, only about half of all respondents say they always replace their contact lenses according to the recommended schedule. Further, people under age 30 are most likely to sleep in their lenses and least likely to adhere to recommended wear schedules.

These results reveal you need to emphasize the importance of compliance with lens care and replacement recommendations and make sure that young people, in particular, understand the potential consequences (corneal ulcers) of not complying with their contact lens care regiment.

Eye exam data

Nearly half (44%) of parents take their children at least once a year for an eye exam. The bad news: Among those with children, 35% report their child has never seen an eyecare professional. These results are similar to the AOA's 2006 American Eye-Q survey, which gave American adults a failing grade in several areas, including knowledge of how often adults should see their eye doctor and when children should have their first eye exam.

All these survey results can serve as a guide to the ongoing importance of patient education on a number of vision and eye health topics, including the aging eye, appropriate contact lens wear and care, protecting children's vision and the eyes as a window to systemic disease.

Dr. Marshall agrees, "I think the most important thing to come out of this study is that there is a pervasive belief that vision is the primary indicator of eye health," he said. "We [optometrists] really need to focus our message on the importance of regular eye exams to detect conditions such as glaucoma, hypertension and diabetes that don't cause blurred vision — or other markers such as redness or pain — in the early stages, but that have much better prognoses with early intervention."

Of course, none of this education can happen if patients don't walk through the door in the first place. Just 17% of patients said their last eye exam occurred because the doctor's office reminded them it was time for an appointment, according to the survey.

Annual reminders to patients would be a great first step in ensuring Americans of all backgrounds get access to the care they need and an opportunity to learn more about protecting their eyes and vision.

Optometric Management, Issue: February 2007