Guest Editor's Page
Print edition page number(s) 383-384
There are about 4 million older people in the United States who are blind or have severe vision impairment. This population is expected to double over the next 35 years to exceed 10 million. Among people who are older and have vision loss, there are some things we know very well: visual impairment is associated with age and, therefore, it is more prevalent in the oldest age groups. Vision impairment is more likely to affect women, racial or ethnic minorities, people who are poor, and people who have less education. Older people with vision loss report poorer health-related quality of life, they are more likely to report chronic conditions than their peers who are not visually impaired, they are more likely to fall and have injuries related to those falls, and older people with vision impairments have higher rates of mortality. Given the magnitude and complexity of the problem, this population is poorly served. People with vision loss have less access to eye care, medical care, and oral health care. Significant gaps remain in access to rehabilitation services, and the rehabilitation system remains fragmented; is poorly funded, with little third-party funding; has few standards of practice, few outcome measures; and is not linked to vision and eye care providers in a systematic way. If the past is a prologue, then the coming decades will see these disparities magnified, with hundreds of thousands or millions of older people without the ability to obtain quality vision rehabilitation services, good health, and high quality of life.
Given the problems we can identify, all of them can be solved or greatly ameliorated with the knowledge we have. Although difficult to manage, these problems are not intractable. The field of vision rehabilitation has lamented for decades the fragmentation in service delivery and funding, and the apparent inability to compete with other disciplines. At the same time, others have anticipated the surging population of older people that is now driven by the first wave of aging baby boomers.
What can be done? This Special Issue on Aging and Vision of the Journal of Visual Impairment & Blindness (JVIB) demonstrates the continuing commitment of leaders in vision rehabilitation to make a difference in the lives of older people with visual impairments. These examples are instructive and promising. Farrow and Steverson, for example, report on the funding for the older blind program, and they summarize the number of people served and the cost of services. The results are not encouraging insofar that the demand in all probability outstrips the capacity to provide services. As Sheffield and Rogers note in their commentary, only about 2% of older people with vision impairment receive vision rehabilitation services of any kind.
In spite of funding constraints, novel and innovative strategies are emerging. Current and emerging telemedicine-like technology has the potential to revolutionize access to eye care. Ihrig, for example, demonstrates an example of how telemedicine strategies can reach underserved or remote populations.
Steinman addresses health as an outcome among older people with vision impairment. McDonnall and her colleagues point to the complex needs of people experiencing both vision and hearing impairments. These insights are useful for older people with vision loss who have hearing impairments as well as other chronic conditions. The interaction of two chronic conditions is not additive; it is compounding, and that complexity requires special knowledge and insight.
Casten and her colleagues demonstrate that vision rehabilitation is a science that requires an evidence base and evidence-based interventions to justify policies that support vision rehabilitation. The rigor of the science of vision rehabilitation is further explored by the assessment of color perception and its implication for vision rehabilitation by Rassi and colleagues and in Matchinski and Winters' assessment of the reading and writing performance of subjects using various portable electronic magnifiers.
The experiences of older people with visual impairments surviving recent earthquakes in Christchurch, New Zealand, is chronicled by Good and colleagues. Although the narrative points to the policy issues surrounding people with vision impairment and disaster preparedness, more importantly, the paper reminds us of the imperative of the vision rehabilitation field to address the lived experiences of people with vision impairment. We are, after all, talking about real lives.
This set of papers underlines the continuing evolution of the field of visual impairment to be more rigorous, more accountable, and more sensitive to human needs. Sheffield and Rogers declare the importance of sustaining a public policy agenda to advance vision impairment through a call to action in the broad aging agenda. Finally, Morse argues that the newly released National Academies of Sciences, Engineering, and Medicine report, Making Eye Health a Population Health Imperative: Vision for Tomorrow, serves as a national agenda to commit the United States to assert a comprehensive approach to promote vision and eye health, vision rehabilitation, and health promotion among people with vision loss.
Despite the demographic forces that challenge the field of visual impairment, the evidence provided by these papers is surprisingly encouraging, since they demonstrate elements of an integrated, evidence-based agenda to promote independence and quality of life among older people with visual impairments. Those of us in vision rehabilitation, and especially those of us affiliated with the American Foundation for the Blind, often look to Helen Keller's insight into the human condition and the optimism her life represented. She observed, "Although the world is full of suffering, it is also full of the overcoming of it."
Bernard Steinman, Ph.D.
Department of Family and Consumer
Sciences, College of Agriculture and
Natural Resources, University
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