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Non-white elders in U.S. less likely to use low-vision devices

[October 05, 2018] By Lisa Rapaport

(Reuters Health) - Older white people with very impaired eyesight are more likely to use low-vision devices that may improve independence, compared to elderly people in other racial and ethnic groups, a U.S. study suggests.

"Low vision" involves defects in the retina, optic nerve, brain or other part of the visual system that can't be corrected with glasses. It can be caused by eye diseases like glaucoma and macular degeneration. Rehabilitation services like occupational therapy can train people how to function better with their current vision abilities. Other treatment options include devices like magnifiers or head-mounted computerized glasses that enhance what patients can see.

Medicare, the U.S. health insurance program for people over age 65, covers rehabilitative services but it doesn't cover low-vision devices, the study team notes in JAMA Ophthalmology.

To see if this lack of coverage influences racial or ethnic differences in who gets access to the devices, researchers examined data on 3,058 older adults with low vision who were insured by Medicare. Overall, just 26 percent used low-vision devices and only 3.5 percent had vision rehabilitation.

"What we found most impressive in this study was that there were no racial or ethnic disparities in the use of vision rehabilitation, the low vision service that Medicare does cover," said senior study author Dr. Joshua Ehrlich of the Kellogg Eye Center at the University of Michigan in Ann Arbor.

"However, when it came to low vision devices, the service that is not covered, there were significant and worrisome disparities," Ehrlich said by email.

After accounting for the cause of individuals' low vision, Hispanic participants were 39 percent less likely to use low-vision devices than white participants, the researchers found.

Black people appeared to have similar odds of using low vision devices as white people. But non-white individuals from other racial and ethnic groups had 61 percent lower odds of getting the devices.

The vast majority of people in the study, 86 percent, were white, while about 8 percent were black and about 4 percent were Hispanic.

Left untreated, low-vision can lead to decreased quality of life and an increased risk of depression, falls and premature death, the researchers note.

More than 3.8 million Americans over 45 years old have low vision, and this is expected to double by 2050, the study authors write.

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One drawback of the study is that only a small proportion of participants received vision services. It's also not clear how many people may have needed services or were prescribed services that they didn't get, the researchers acknowledge.

Still, the results suggest that many people may not be getting care they need, said Dr. Nicole Ross of the New England College of Optometry in Boston.

"Awareness, cost and lack of insurance coverage are all barriers that my patients have reported to me on a day-to-day basis," Ross, who wasn't involved in the study, said by email.

Costs for assistive equipment can range from $100 for reading aids like optical magnifiers to $4,000 for electronic magnification systems for people with severely reduced vision or blind spots, Ross said.

While it's possible that non-economic factors are influencing whether people get this equipment, the study results suggest that expanding Medicare coverage to include low-vision devices in addition to rehab services might help more patients get needed care, said Dr. Stephen Schwartz, medical director of the Bascom Palmer Eye Institute in Naples, Florida.

"We know that most, or almost all, people with low vision can be helped at least somewhat by low vision services, which include both devices (such as magnifying lenses for reading, telescopes for distance vision, and electronic options) and rehabilitation (such as mobility training, eccentric viewing, and other techniques)," Schwartz, who wasn't involved in the study, said by email.

"And we know that, unfortunately, not all people with low vision take advantage of the low vision services available to them," Schwartz added. "We don't know why some people who could benefit from low vision services don't actually get these services."

SOURCE: https://bit.ly/2E5SJMD JAMA Ophthalmology, online September 6, 2018.

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