Poor vision costs Medicare more than $2 billion per year in non-eye-related maladies and health-care needs, according to a study published in the February issue of Ophthalmology.

Specifically, Medicare beneficiaries with coded diagnoses of vision loss incurred significantly higher costs than those with normal vision; approximately 90% of those costs were non-eye related. Those with moderate, severe and total vision loss experienced increases in depression, injuries and the need for nursing home facilities, the researchers concluded. Preventing vision loss is not only a medical imperative but also an economic one, they wrote.

Researchers from the Potomac Institute for Policy Studies, the Wilmer Eye Institute at Johns Hopkins University and Pfizer, Inc., performed the study. The researchers reviewed the records of a sample of 5% (approximately 1.5 million people) of Medicare beneficiaries continuously enrolled from 1999 to 2003. Compared with Medicare patients with normal vision, Medicare patients with moderate vision loss, severe loss and blindness had average annual eye-related costs of $345, $407 and $237, respectively. Annual excess non-eye-related costs were $2,193, $3,301 and $4,443, respectively.

We have always understood the devastating personal impact of blinding eye disease on patients and their families, says lead researcher Jonathan C. Javitt, M.D., M.P.H., of the Wilmer Eye Institute. With this study, we are seeing the serious economic impact of poor vision health on the health-care system and those who pay for it.

Some of the findings:

Blindness and vision loss are associated with $2.14 billion in 2003 non-eye-related medical costs, calculated by extrapolating to the entire Medicare population.

$460 million was associated with those with existing vision loss and $1.68 billion was associated with those who developed vision loss during the study period.

For those with newly developed vision loss, the adjustment to the new eye disorder may have contributed to the increased costs for depression, injuries and the need for skilled nursing home assistance.

More than half the cases were due to age-related macular degeneration (AMD) and glaucoma. Several cases of vision loss were due to cataracts that had not been surgically removed.

These are all treatable conditions. If identified early, the adverse effects of glaucoma and AMD can be minimized, and cataracts can easily be treated, says H. Dunbar Hoskins, M.D., executive vice president of the American Academy of Ophthalmology. Taking care of your eyesight is not only in the best interest of patient health, but it also is a benefit to the countrys Medicare system.

This study suggests a stronger need for preventive eye care. Medicare has provided eye exam coverage for diabetics since 1998, and annual glaucoma screenings for patients at risk since 2001. Still, awareness of these benefits is lowfewer than 45% of Medicare diabetics have had an eye exam, for example.

 Medicare has already taken an important first step in making screenings available for those who are most at risk, Dr. Javitt says. CMS Welcome to Medicare physical examination should make vision assessment a key component of these visits with primary-care physicians. If problems are found, physicians can refer those with problems for further care.

 
Javitt JC, Zhou Z, Willke RJ. Association between vision loss and higher medical care costs in Medicare beneficiaries: Costs are greater for those with progressive vision loss. Ophthalmology 2007 Feb;114(2):238-45.