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DISCLAIMER:

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by the Committee on Public Health Approaches to Reduce Vision

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content of this article rests with the author and does not necessarily

represent the views of the National Academies of Sciences,

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The Future of Vision

The Preventable Burden of

Untreated Eye Disorders

FINAL REPORT

PRESENTED TO:

JULY 16, 2016

Meg McCoy

The National Academy of Sciences,

Engineering, and Medicine

500 Fifth Street, NW, Room 857

Washington, DC 20001

PRESENTED BY:

John Wittenborn

David Rein

NORC at the

University of Chicago

55 East Monroe Street

30th Floor

Chicago, IL 60603

(312) 759-4000

(312) 759-4004

FINAL REPORT

| The Preventable Burden of Untreated Eye Disorders

Contents

1.

Executive Summary ........................................................................................................ 10

2.

Methods ........................................................................................................................... 13

Overview of Approach ....................................................................................................... 13

Data Sources .................................................................................................................... 14

Vision Problems in the U.S. (VPUS) - ........................... 14

National Health and Nutrition Examination Survey (NHANES) ................................. 14

Cost of Vision Problems - costofvision. ................................... 15

Approach for Calculating Uncorrected Refractive Error ...................................................... 19

Overview of Approach ....................................................................................................... 19

Step 1. Identify the prevalence rate of URE ............................................................. 19

Step 2. Calculate Prevalent Population with URE .................................................... 21

Step 3. Estimate cost and impact of treatment ......................................................... 21

Approach for Calculating Eye Diseases ................................................................................ 22

Overview of Approach ....................................................................................................... 22

Step 1. Estimate undiagnosed prevalence rates for each disease ........................... 22

Step 2. Allocating blindness and visual impairment by condition .............................. 24

Step 3. Estimate current and predicted future undiagnosed prevalence of each

disease, including the resulting number impaired and blind .......................... 26

Step 4. Apply a treatment efficacy estimate to estimate the potential benefits of

identification and treatment .......................................................................... 26

Step 5. Apply costs of treatment, and cost offsets of avoided impairment and

blindness ...................................................................................................... 28

Adjusting Costs for Inflation and Cost Growth ..................................................................... 29

Real and Nominal Costs .......................................................................................... 29

Nominal cost inflators .............................................................................................. 29

Real medical cost inflators ....................................................................................... 29

Discounting .............................................................................................................. 30

Results ..................................................................................................................................... 31

Uncorrected Refractive Error ............................................................................................ 31

Prevalence .............................................................................................................. 31

Impact on Costs ....................................................................................................... 33

Impact on QALYs..................................................................................................... 36

Age-related Macular Degeneration ¨C Choroidal Neovascularization .................................. 37

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FINAL REPORT

| The Preventable Burden of Untreated Eye Disorders

Prevalence .............................................................................................................. 37

Diagnosis Rate ........................................................................................................ 39

Treatment ................................................................................................................ 40

Impact on Costs ....................................................................................................... 43

Impact on QALYs..................................................................................................... 44

AMD ¨C Geographic Atrophy .............................................................................................. 46

Prevalence .............................................................................................................. 46

Diagnosis Rate ........................................................................................................ 49

Proportion of GA Patients with Vision Loss .............................................................. 49

Treatment ................................................................................................................ 50

Impact on Costs ....................................................................................................... 51

Impact on QALYs..................................................................................................... 54

Cataract ............................................................................................................................ 55

Prevalence .............................................................................................................. 55

Diagnosis Rate ........................................................................................................ 58

Vision Loss Attributable to Cataract ......................................................................... 59

Treatment ................................................................................................................ 59

Impact on Costs ....................................................................................................... 61

Impact on QALYs..................................................................................................... 63

Glaucoma ......................................................................................................................... 64

Prevalence .............................................................................................................. 64

Diagnosis Rate ........................................................................................................ 67

Vision Loss Attributable to Glaucoma ...................................................................... 68

Treatment ................................................................................................................ 68

Impact on Costs ....................................................................................................... 70

Impact on QALYs..................................................................................................... 73

Diabetic Retinopathy ......................................................................................................... 74

Prevalence .............................................................................................................. 74

Diagnosis Rate ........................................................................................................ 77

Proportion of DR Patients with Vision Loss .............................................................. 78

Treatment for DR ..................................................................................................... 78

Prevalence of Vision Loss with and Without Treatment............................................ 80

Impact on Costs ....................................................................................................... 81

Impact on QALYs..................................................................................................... 83

Prevalence .............................................................................................................. 85

Diagnosis Rates ...................................................................................................... 87

Undiagnosed/Untreated Prevalence ........................................................................ 88

Vision Loss from Treatment ..................................................................................... 90

Impact on Costs ....................................................................................................... 91

Impact on QALYs..................................................................................................... 93

FINAL REPORT | 3

FINAL REPORT

| The Preventable Burden of Untreated Eye Disorders

Per-person Results ................................................................................................................. 96

Prevalence of Eye Disorders Per-person ................................................................. 96

Prevalence of Vision Loss Per-person ..................................................................... 99

Impact of Treatment on Vision Loss Prevalence .................................................... 101

Per-person Net Costs and QALY Impacts from Treatment..................................... 102

Sensitivity Analysis .............................................................................................................. 105

Description of Parameter Group Variation ....................................................................... 105

Summary Results of Sensitivity Analysis ......................................................................... 119

CNV Treatment Sensitivity ..................................................................................... 120

Cataract Treatment Sensitivity ............................................................................... 121

Glaucoma Treatment Sensitivity ............................................................................ 122

DR Treatment Sensitivity ....................................................................................... 123

URE Treatment Sensitivity ..................................................................................... 124

Limitations and Major Assumptions .................................................................................... 125

Data limitations ............................................................................................................... 125

Methodological limitations and major assumptions.......................................................... 126

Limits of the knowledge claim ......................................................................................... 128

Addressing Data Limitations and the Need for Vision and Eye Health Surveillance ....... 130

Introduction ..................................................................................................................... 130

Limits of Current Evidence .............................................................................................. 130

Requirements for a national vision and eye health surveillance system .......................... 132

Unique Challenges posed by Vision and Eye Health ....................................................... 132

Complex and Difficult to Measure Outcomes ......................................................... 133

Broad Range of Included Conditions ..................................................................... 133

High Undiagnosed Prevalence............................................................................... 133

Separation of Eye Care among Multiple Health and Payment Systems ................. 133

Building a Comprehensive Vision and Eye Health Surveillance System.......................... 134

Selecting Conditions and Measures ....................................................................... 134

Identifying and selecting data sources ................................................................... 134

Developing National Surveillance Estimates .......................................................... 138

Conclusion ............................................................................................................................ 140

References ............................................................................................................................ 142

FINAL REPORT | 4

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