A Vision for Healthier and Active Aging

By Michael Hodin

Whether you’re in Oklahoma City or Calvin, and you’re stopping by Costco for two dozen eggs or some garden equipment, now, it seems, you may also be in line to have an eye exam. A proposed state ballot measure could allow Oklahoma to join most other states across the U.S. in making cheap, walk-in eye exams available at retailers like Walmart and Costco statewide. It’s both the health needs of a growing cohort of 60+ Americans who, as we age, begin to experience vision loss, and a new market opportunity aligned to what is increasingly understood as our longevity economy. A great example of that win-win-win: expand the market for vision care that meets the needs of an aging population and saves families and government lots of money through earlier detection and diagnosis of vision loss, leading to better, more effective, and less expensive treatment. Catching macular degeneration or cataracts earlier, in addition to the general vision loss that historically accompanies older age, can only be a good thing for all of us.

Nor are we in America alone. Worldwide, only about half of all people at high risk of serious vision loss and about a third of those not at high risk obtain dilated eye examinations. In fact, globally, about 2.5 billion people with vision problems are not using glasses or any other corrective measure. The reasons for these gaps are many, but chief among them are financial burden, poor access, and the burden of treatment, all real challenges further normalized by our ageist view that vision loss is just part of growing old. Not so much in our 21st century; nor is it at all in society’s interests, let alone the interests of the individual or family.

So this ballot measure in Oklahoma is interesting in its own right and a signal for all of us across the land and globally. If passed, the new proposal would expand access to preventive eye care for anyone and everyone making their weekly Target run, be it a homeowner picking up a pack of light bulbs for the garage, a family caregiver taking mom or dad out for the day, or even that paid elder caregiver, if they’re given the proper tools and knowledge. This change would be an important step for Oklahoma toward making vision care more accessible and more affordable, particularly significant in a state where low-income patients can wait months to see an optometrist in the office. Americans claim to care a lot about our sight — in fact, we rank losing our eyesight ahead of memory loss among our chief health concerns — yet protecting our vision still remains low on our priority list.

But it shouldn’t be. Today, aligned with the aging of America, more and more of us are at risk of losing our sight. Yet, roughly 80% of global vision loss is avoidable. Significantly, eye and vision disorders often end up being even more costly than heart disease, Alzheimer’s, diabetes, or cancer, once you factor in the costs related to care. Think of the impact of poor or lost vision on falls, for example. Oklahoma is the latest example of who is now, finally, doing something about this manageable situation.

But others still have an outdated approach to vision when it comes to those growing old. A full 81% of people who are blind or who have moderate or severe visual impairment are aged 50 years and above. This means that millions and millions of seniors around the world are living with visual impairment that could have been prevented or at least addressed and treated. Ironically, it is precisely the sheer volume of visual impairment in older adults that feeds the misguided notion that poor vision is an expected, and even acceptable, tradeoff for the privilege of growing old. So wrong, with economic, social, and health consequences far beyond necessary, we now know, and the Oklahoma Legislature must have been cued in, that 80% of vision loss is avoidable.

Aging presents a bit of a paradox when it comes to vision. We neglect to prioritize our vision because of ageism, yet population aging is the driving reason why we cannot afford to look away. As our current global megatrend of aging continues, with 2 billion over age 60 by mid-century, the number of visually impaired will skyrocket, and so will the costs, unless we begin to change thinking, habits, and public policy — as in Oklahoma. Take for example, age-related macular degeneration (AMD), by far the leading cause of vision loss in those over 50 in OECD countries. The total costs related to visual impairment from AMD alone are projected to reach $392 billion by 2020. So whether you’re in Oklahoma, the EU, or in Japan or China, you might want to look at these progressive and, yes, self-interested, approaches that rapidly translate to overall social benefit.

Moreover, we are beginning to understand that changing our approach to vision and aging will also have positive impact on lifestyle — and costs — beyond vision. Older adults with untreated visual impairment are significantly more likely to suffer from Alzheimer’s disease and other forms of dementia, not to mention the catastrophic falls, and recent research suggests that vision loss can even be an early indicator of neurological problems.

So, three cheers for Oklahoma and the private sector stores that will be part of this solution: preventive vision care and early diagnosis and screening are investments with benefits that ripple positively across the healthcare system. We need to put aside our ageist notions and place eye health front and center on the American and global health and economic policy agendas.