The Healthy Sight Institute was conceived as a house of education and a comprehensive resource for vision care professionals and other healthcare professionals with a stake in Healthy Sight—including, but certainly not limited to, optometrists, ophthalmologists, opticians, general practitioners, family practice physicians, internists, nutritionists, endocrinologists, wellness experts, pediatricians, dermatologists, and nurses.

The aim of the Healthy Sight Institute is to take on the Healthy Sight challenges of the 21st century and provide tools and support to vision care and allied professionals that will enable them to serve their patients and lead to a world of Healthy Sight.

To read more about the Mission and Vision of the Healthy Sight Institute, and who we are, click here.

Attaining Healthy Sight Worldwide

Vision care professionals have a unique perspective on Healthy Sight. While many people take their ability to see for granted until a problem arises, vision care professionals, by the very nature of the work they do, tend to take a proactive approach to vision care, preferring to prevent problems now that might threaten Healthy Sight rather than to treat them at some point in the future. For the knowledgeable vision care professional good vision means both the best in quantity and quality of vision and the thoughtful implementation of maintenance and preventive vision care to protect and preserve that good vision for a lifetime of Healthy Sight.

Refraction is the first and the most basic component of vision care. However, for the vision care professional practicing Healthy Sight Counseling, refraction is just the beginning. The numeric eyeglass prescription obtained as a result of the refraction becomes a customized eyeglass prescription, including recommendations on the use of specific eyeglass lens materials and enhancements to address quality of vision issues aimed at maximizing contrast and reducing glare to provide visual comfort and convenience.

The approach of “going beyond the numbers” in prescribing eyeglasses can also impact on medical and preventive vision care. Eyeglass lenses and lens enhancements are used to protect the eyes from potential hazards related to trauma and ultraviolet radiation (UVR) exposure. The vision care professional provides education and counseling on Healthy Sight and how to lead a healthy life.

Healthy Sight Counseling is a comprehensive and multidimensional approach to eye care.

What Is Healthy Sight Counseling?

Healthy Sight is defined as the enhancement of the overall everyday quality of vision and the preservation of long-term ocular health—simply put, seeing well now and in the future.

Healthy Sight Counseling emphasizes the intimate relationship between ocular health and ocular function, erasing the often artificial distinction that has sometimes been made between vision and vision care, and stressing the importance of maintenance and preventive vision care to achieve Healthy Sight.

The goal of Healthy Sight Counseling is to foster Healthy Sight now and for the future, and to provide educational resources that highlight the interrelationships between ocular and systemic health, so that Healthy Sight and a Healthy Life exist in a continuum. The Healthy Sight Institute aims to keep these relationships in the foreground for vision care professionals, allied healthcare professionals, and patients under their care.

More information on Healthy Sight and Healthy Sight Counseling can be found here.

The Challenge of Healthy Sight

Achieving Healthy Sight worldwide is a formidable challenge. Integrating Healthy Sight with a Healthy Life represents an even greater challenge. The Healthy Sight Institute has been created to assist the vision care professional in attaining these goals.

The Challenge of Avoidable Blindness

As of 2002 there were an estimated 161 million people worldwide who were classified as visually impaired (defined as best corrected acuity less than 6/18); of these, 37 million were blind (defined as best corrected acuity less than 3/60 or visual field less than 10 degrees).

Blindness is largely a disease of later life; 82% of all cases of blindness occur in individuals over age 50, although this segment represents a disparate 19% of the overall population. Blindness is also largely a disease of poverty and deprivation; more than 90% of the blind live in developing countries.

Among the most common causes for blindness are cataract, glaucoma, corneal opacities, diabetic retinopathy, age-related macular degeneration (AMD), trachoma, vitamin A deficiency, and onchocerciasis—most of which are potentially preventable or treatable. In fact, the World Health Organization (WHO) has estimated that up to 75% of cases of disease-related blindness worldwide are avoidable.

The Challenge of Uncorrected Refractive Error

There is another category of visual disability and blindness that must also be considered. In 2004, the WHO estimated that there were an additional 153 million individuals globally who were visually impaired due not to disease, but to uncorrected refractive errors; of these, 8 million were blind. Potentially all of these 153 million people can be visually rehabilitated through simple vision correction. That means that of the total of more than 300 million individuals worldwide who are visually impaired either due to disease or to uncorrected refractive errors, 120 million of the disease-related visually impaired (ie, 75% of 161 million) and 153 million (ie, all) of the refractive error-related visually impaired, or a total of 273 million visually impaired people overall, can be helped. Healthy Sight Counseling, with its emphasis on vision correction and maintenance and preventive medicine for the eye, represents a powerful tool for the vision care professional to use in the quest to eliminate preventable blindness and visual disability throughout the world.

The Challenge of Visual Impairment and Blindness in Children

Although blindness and visual disability are more common in the older population, the possible consequences of blindness and visual disability in the child can be far greater than in the elderly. Globally there are an estimated 1.4 million children under age 15 who are blind. Thinking in terms of the number of blind years (ie, years spent in blindness), the impact of visual impairment is obviously greater in the youthful as compared to the older visually impaired individual. Potential effects of impaired vision on psychosocial development, education, productivity, future employability, self-sufficiency, and well-being are tremendous. Sadly people who don’t see well, particularly those living in underdeveloped countries, have shorter life spans, as well.

The Challenge of an Aging Population

The world population is aging. It is estimated that in 2006, almost 500 million people worldwide were aged 65 years and older. Projections are that this number will climb to 1 billion by 2030. This translates into 1 in every 8 of the world’s inhabitants being elderly. While much of this growth will occur in the developed world, the most rapid increases in the 65-and-older population are actually occurring in developing countries, which are expected to see an increase of 140% in the elderly population by 2030.

Aging populations have important implications for Healthy Sight; 82% of blind individuals worldwide are 50 years old or older. Three of the major ocular diseases leading to blindness and visual impairment—ie, cataract, glaucoma, and AMD—are primarily diseases of later life. This could lead to a future world where people will live longer but see less well. The socioeconomic and healthcare cost implications of this trend are enormous. The preventive medicine aspects of Healthy Sight Counseling can prove crucial in addressing these problems, especially with regards to UVR exposure, which has been strongly linked to the development of cataracts and AMD. Education and services for low-vision patients will become an increasingly more relevant component of vision care. Furthermore, in older visually impaired individuals, where quantity of vision has been comprised, quality of vision concerns will assume greater importance in order to help maximize their visual functioning under sub-optimal conditions.

The Challenge of a Worldwide Diabetes Epidemic

Diabetes mellitus is now considered to be a global epidemic. The WHO estimates that more than 180 million people worldwide have diabetes, a number likely to double by 2030. In 2005, the WHO estimated that 1.1 million people died from diabetes, with 80% of those deaths occurring in low- and middle-income countries.

This epidemic has a special relevance for vision care professionals because diabetes-related eye disease is one of the major causes of visual impairment and blindness throughout the world, and up to 90% of diabetic ocular complications are potentially preventable or treatable.

An estimated 40% of all people with diabetes will experience some significant degree of disease-related visual impairment. Such disability includes both direct ocular sequelae of diabetes (eg, diabetic retinopathy) and indirect sequelae (eg, increased incidence of such vision-threatening ocular diseases as cataract, glaucoma, and AMD). In addition, quality of vision issues, such as impaired contrast and increased glare sensitivity, may be more pressing considerations in patients with diabetes due to the disease itself, its visual sequelae, and side effects of medications used to treat it.

Healthy Sight Counseling is especially relevant for people with diabetes, because of its emphasis on the intimate relationship between ocular and systemic disease, as it encourages a therapeutic partnership between the vision care professional and the medical professionals involved in the treatment of patients with diabetes. As a matter of fact, since ocular symptoms and signs may be the initial indicators of diabetes, and its ocular complications represent some of the most serious and disabling sequelae of the disease, vision care professionals often find themselves on the front line in the diagnosis and therapy of diabetes.

The Challenge of UV Light Exposure

Exposure to UVR and certain components of visible light is being increasingly linked to some common vision-threatening eye diseases; cataract is a prime example. Ongoing laboratory, clinical, and epidemiologic research is increasing knowledge about possible underlying physiologic mechanisms for ocular damage related to light exposure. For instance, sorbitol may accumulate in retinal pigment epithelial cells, as a result of cumulative exposure to UVR and to certain wave lengths of visible light (eg, blue light). This accumulation leads to increased production of advanced glycation endproducts, increased oxidative stress, and eventual physiologic impairment and cellular death. Light exposure may also be a factor in promoting lipid peroxidation in photoreceptor cells because light of the appropriate wavelength may trigger photo-oxidative reactions. Age and disease (particularly diabetic retinopathy) may increase the vulnerability of photoreceptors and retinal pigment epithelial cells to damage precipitated by prolonged exposure to UVR and visible light.

These findings highlight the importance of educating patients about the need to protect their eyes from UVR and sunlight, particularly during outdoor work and recreational activities, and in climates and environments where sun exposure is intensified by altitude, water, or snow cover. The appropriate prescription of eyeglass lenses that provide 100% UVA and UVB protection for the eyes is a crucial component of the preventive medicine message of Healthy Sight Counseling.

The Challenge of Providing Vision Care That Meets Specific Occupational, Recreational, and Environmental Needs

Healthy Sight is all about seeing well, and seeing well truly lies in the eyes of the beholder. Visual needs—particularly when it comes to quality of vision, visual comfort, and visual convenience—may vary greatly from one individual to another. This is where the customized eyeglass prescription, which is one of the mainstays of Healthy Sight Counseling, comes into play. While the numbers remain important in prescribing eyeglass lenses to correct refractive errors and improve the quantity of vision, it is only with the customized eyeglass prescription that “going beyond the numbers” can address specific quality of vision issues in the individual.

Occupational, recreational, and environmental needs all have to be considered. A bus driver who goes boating on weekends may have different eyewear needs than a lawyer who works long hours at the computer and likes to play racquetball on his lunch hour. Protection from impact injury and UVR exposure, computer vision syndrome, and glare relief are among the important factors to be considered in customized prescribing. Many occupations—ranging from arc welder to dentist, homemaker to business executive, airline pilot to computer programmer—present unique challenges to Healthy Sight. Recreational and sports protection is another important area of concern, especially in children.

The Challenge of Providing Vision Care that Meets the Needs of Specific Demographic Groups

Meeting the challenge of Healthy Sight also means addressing the specific needs of particular demographic groups including, but not limited to children and the elderly, the impoverished, and certain ethnic groups who have been shown to be at increased risk for diseases like diabetes. Healthy Sight Counseling takes an individualized approach to vision care.

Leading the Way to Healthy Sight

Education is a cornerstone of Healthy Sight Counseling. This education is multi-directional: education directed to the vision care professional, as well as education directed from the vision care professional to the patient and to other healthcare professionals, including primary care physicians and specialists involved in the medical care of the patient.

Ultimately, our aim is to take on the Healthy Sight challenges of the 21st century and provide tools and support to vision care professionals that will enable them to serve their patients and lead to a world of Healthy Sight.

To read more about the Mission and Vision of the Healthy Sight Institute, and who we are, click here.

References:

• Ciulla TA, Amador AG, Zinman B. Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies. Diabetes Care. 2003;26:2653-2664.
• Dolin PJ, Johnson GJ. Solar ultraviolet radiation and ocular disease: a review of the epidemiological and experimental evidence. Ophthalmic Epidemiol. 1994;1:155-164.
• National Institute on Aging, National Institutes of Health, US Department of Health and Human Services, US Department of State. Why Population Aging Matters: A Global Perspective. Available at: http://www.state.gov/documents/organization/81775.pdf. Accessed May 20, 2008.
• van Kuijk FJ. Effects of ultraviolet light on the eye: role of protective glasses. Environ Health Perspect. 1991;96:177-184.
• World Health Organization. Diabetes Factsheet. Available at: http://www.who.int/mediacentre/fastsheets/fs312/en/print.html.
• World Health Organization. Vision 2020: The Right to Sight: Global Initiative for the elimination of avoidable blindness: Action Plan 2006-2011. Available at: http://www.who.int/blindness/Vision2020%20-report.pdf

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