Download Census of Alabama Eye Care Providers

Census of Alabama
Eye Care Providers
Prepared for
By
Paul A. MacLennan, MPH, PhD
Cynthia Owsley, PhD, MSPH
Karen Searcey, MPSH
Gerald McGwin, Jr., MS, PhD
June 2012
Author Information:
Paul MacLennan PhD
Assistant Professor
Department of Surgery
School of Medicine
University of Alabama at Birmingham
Cynthia Owsley PhD, MSPH
Nathan E. Miles Chair of Ophthalmology
Vice Chair for Clinical Research
Department of Ophthalmology
School of Medicine
University of Alabama at Birmingham
Karen Searcey, MSPH
Clinical Research Unit Manager
Department of Ophthalmology
School of Medicine
University of Alabama at Birmingham
Gerald McGwin Jr. MS, PhD
Professor of Epidemiology, Ophthalmology, and Surgery
Vice Chair of Epidemiology
School of Public Health
University of Alabama at Birmingham
2
FUNDING SUPPORT
This work was funded by the EyeSight Foundation of Alabama, with supplementary support
from UAB’s Comprehensive Diabetes Center; Department of Ophthalmology, School of
Medicine; Minority Health and Disparities Research Center; School of Public Health; and Vision
Science Research Center.
3
ACKNOWLEDGMENTS
We appreciate the guidance of Torrey V.A. DeKeyser, Executive Director, and Shirley
Hamilton, Director of Grants and Communications; Stephen A. Yoder, JD, Chairman, Board of
Trustees; and N. Carlton Baker Jr., Immediate Past Chairman, Board of Trustees, all of The
EyeSight Foundation of Alabama.
We thank the following individuals for facilitating our efforts in surveying eye care providers in
Alabama: Amanda Buttenshaw, CAE, Executive Director, Alabama Optometric Association;
Mike Merrill, JD, Executive Director, Alabama Academy of Ophthalmology; Fred Wallace, OD,
Executive Director, Alabama Board of Optometry; Dawn DeCarlo, OD, Associate Professor of
Ophthalmology, UAB; Jennifer Elgin OTR/L, CDRS, Occupational Therapist, Department of
Ophthalmology, UAB and Tammy Than OD, Associate Professor of Optometry, UAB.
In addition, we thank Melissa Braswell, Research Specialist, Clinical Research Unit, UAB
Department of Ophthalmology, for assistance with data collection.
4
TABLE OF CONTENTS
EXECUTIVE SUMMARY .........................................................................6
BACKGROUND .........................................................................................8
METHODS ................................................................................................10
RESULTS ..................................................................................................15
Provider characteristics
Ophthalmologists ...........................................................................19
Optometrists ...................................................................................20
Rehabilitation providers .................................................................21
Practice characteristics
Ophthalmologists ...........................................................................22
Optometrists ...................................................................................25
Rehabilitation providers .................................................................28
Patient characteristics
Ophthalmologists ...........................................................................31
Optometrists ...................................................................................33
Rehabilitation providers .................................................................35
Provider opinions
Ophthalmologists ...........................................................................37
Optometrists ..................................................................................40
Rehabilitation providers .................................................................43
DISCUSSION ............................................................................................46
REFERENCES ..........................................................................................51
APPENDICES
Appendix A. Eligible and participating providers by county ........57
Appendix B. Provider surveys .......................................................60
Appendix C. Domains and subcategories for written responses....81
5
Executive Summary
In 2010 the EyeSight Foundation of Alabama commissioned a survey of eye care providers in
Alabama as part of a needs assessment for eye health and eye care issues in Alabama. The
survey’s specific purpose was to obtain information about the characteristics of providers
(ophthalmologists, optometrists, visual rehabilitation specialists), and their practices and patients.
In addition, providers’ opinions were solicited on major unmet eye care needs in Alabama. This
report is a summary of the survey methodology and its results. A survey with similar although
not identical content was previously conducted in 1999 shortly after the Foundation was created.
The current survey, carried out about ten years after the original survey, was conducted in order
to get an up-to-date picture on the topic. The results of this survey will provide guidance to the
Foundation for potential areas of need. It is also hoped that this report will serve as a resource to
clinicians, researchers and policy-makers in Alabama.
Surveys specific to each provider group were developed and administered. These surveys
requested information regarding four domains: provider characteristics, practice characteristics,
patient characteristics and provider opinions as elicited by two opened-ended questions. Survey
participants were identified from August 2010 to October 2010 through information obtained
from professional associations, licensing boards, and internet searches. The final group of
eligible participants consisted of 1,033 vision care providers: 217 ophthalmologists, 638
optometrists and 178 rehabilitation providers. Survey participants were contacted over a tenmonth period from November 2010 through August 2011. Overall, 438 of eligible vision health
providers participated in the survey. Participation varied by provider group with
ophthalmologists having the highest participation rate (51.2%), followed by rehabilitation
providers (45.5%) and optometrists (38.6%).
The survey found that many Alabama communities are geographically isolated from eye care
services. Due to long travel distances, people who live in rural areas have increased barriers to
receive basic and specialized eye care, and vision rehabilitation services. Among survey
participants, Jefferson County had the highest number of participants, followed by Madison,
Mobile, Shelby and Montgomery. The majority of participating vision care providers was located
in urban counties. All rehabilitation providers located in rural areas were in northern rural
counties but none were located in southern counties.
The majority of participating ophthalmologists, optometrists and rehabilitation providers
identified themselves as white of non-Hispanic origin. According to 2010 US Census estimates,
over one-quarter of Alabama’s population is African American. Previous research indicates that
rates of vision impairment and eye disease among African Americans are two times higher than
those of whites, especially uncorrected refractive error, cataract, glaucoma, and diabetic
retinopathy. Research suggests that provider-patient communication and the use of preventive
services can be facilitated when there is racial/ethnic concordance between providers and
patients. Thus, it is possible that an increase in the number of African American
ophthalmologists and optometrists in Alabama would have positive benefits on eye health in the
state.
6
The growing prevalence of diabetes in Alabama is likely to result in more people, and at younger
ages, at risk for diabetic eye diseases. Diabetic retinopathy is the leading cause of blindness
among working age adults in the United States. Those with diabetes are also at increased risk for
glaucoma and cataracts. Based on Centers for Disease Control & Prevention estimates, Alabama
has a higher prevalence of diabetes than any other state. In the current survey, ophthalmologists
and optometrists estimated that 27% and 22%, respectively, of their patients had diabetes;
however, providers estimated that the proportion that adhered to eye care guidelines was 61%
among ophthalmology patients and 53% among optometry patients. Programs that enhance the
likelihood of early detection and monitoring with timely treatment could stop or slow disease
progression.
A frequently expressed opinion among participating ophthalmologists, optometrists and vision
rehabilitation providers was the need for more providers. A recent analysis concluded that due to
changing patient demographics, retirement, and a fixed number of ophthalmology residency slots
nationwide, ophthalmology will face substantial challenges in manpower by year 2020.
Four priority focus areas were identified that can potentially deliver significant benefit to the eye
health of Alabamians. They are: 1) Identify strategies to increase the number of eye care
providers, including more African American providers; 2) Develop and implement strategies in
the eye care system for improved detection and follow-up management of the ocular
complications of diabetes; and 3) Develop and implement strategies to improve access to eye
care, satellite eye care practices, telemedicine approaches and possibly transportation systems.
(4) Scientifically evaluate these and any other public eye health interventions to improve the
quality of and access to eye care in Alabama, in terms of their impact on both health outcomes
and cost, so that eye health strategies in the state are evidence-based.
7
BACKGROUND
Vision health is an important public health concern that affects Alabama’s children, adults and
the elderly. Even though research has shown that early detection and treatment are effective in
preventing many vision problems, adequate vision care remains an unmet need for many
Americans.1 Compared to many other chronic diseases, the personal and economic burden
associated with eye disease is high.2,3 Those with vision impairment have difficulties with
communication, mobility and performance of everyday tasks, and among older adults visual
deficits can result in increased isolation, depression, disability and premature death.4,5 Among
infants and children, the most prevalent and disabling problems include amblyopia, strabismus,
and uncorrected refractive error.6 For adults younger than 40, problems related to refractive error
are common but eye injury is also prevalent.7 Other eye diseases that can be detected and treated
early among at risk adults include glaucoma and diabetic eye conditions. For people 40 and
older, the most common eye diseases are age-related macular degeneration, cataract, diabetic
retinopathy, and glaucoma.1 With increasing age the prevalence of blindness and vision
impairment increase dramatically and is greatest for those older than 75; as the population ages,
the number at risk also increases.8 Moreover, the prevalence of diabetes in the United States has
more than doubled over the past 20 years,9 a trend that is expected to continue,10 increasing the
numbers at risk for diabetic retinopathy.
Inadequate access to eye care results in delayed diagnosis, causing unnecessary increases in
burden of disease, disability and costs.2,3 For some eye diseases such as cataract, glaucoma, agerelated macular degeneration, and diabetic eye conditions and retinopathy, by the time symptoms
are apparent, damage is permanent that could have been avoided or delayed. A recent Centers for
Disease Control and Prevention (CDC) Vision Impairment Task Force reported that the primary
barriers related to individuals’ decisions not to seek vision care (i.e., screening, diagnosis,
treatment and rehabilitation) were related to behavior, costs, and accessibility.11 Many people are
unaware of the importance of eye care and often cite the reason for not seeking care as “did not
feel a need.”12 However, barriers to eye care are not equivalent for all groups. For example, a
recent investigation of perceptions and beliefs of vision care among older African Americans
who resided in Birmingham and Montgomery reported that the most frequently cited barrier to
care was transportation, followed by trusting the doctor, communicating with the doctor, and
costs.13 A similar investigation of eye care beliefs among elderly African Americans in Maryland
reported that cost was the most important barrier.14
Prohibitively high cost is frequently identified as a barrier to eye care.12 As an example,
researchers utilizing the CDC’s Behavioral Risk Factor Surveillance System reported that among
women 40 and older diagnosed with diabetic retinopathy, glaucoma and age-related macular
degeneration, those without eye care insurance less frequently followed recommended guidelines
for visiting an eye-care provider.15 The proportion of Alabama’s population without health
insurance is relatively large and has increased in a short time from a low of 12.5% in 2005 to
approximately 16% in 2011.16 Medicaid is a state run health insurance program for certain,
qualifying low income populations; however, not all people with low incomes or those without
insurance qualify for Medicaid. For those who do qualify, coverage may not be accepted by
providers because it fails to cover their costs. Among Medicare patients, routine eye
examinations for those without eye conditions are not covered. The costs for spectacles and
8
contact lenses are not covered (except for spectacles following cataract surgery). For those with
health care insurance, coverage may be insufficient for purchasing spectacles and prescription
medications, or high co-pays may act as disincentives to seeking care. Among adults with selfreported severe vision impairment, eye care utilization in the preceding 12 months was no
greater than 61% for those with vision care insurance and 34% for those with no insurance.
Overall, those with vision care insurance are more than twice as likely to have an annual eye
examination. Other factors associated with increased likelihood of eye care utilization include
higher income, and greater educational attainment.17
Accessibility is also an important barrier to eye care and is related to patients’ geographic
location and the lack of general and specialized providers in some geographic areas.12 Research
has reported that rural populations are at increased risk for vision problems relative to urban
populations.18 Owsley et al. (2006) reported that transportation was the most frequently
perceived barrier among older African Americans.13 Interestingly, study participants were drawn
from Birmingham and Montgomery, two of the largest cities in Alabama where, compared to
other locations in the state, the prevalence of providers is high and transportation options
greater.13
Previous research has advocated an integrated approach to reduce the burden of vision
impairment through multilevel interventions of a number of identified modifiable factors
(system, provider and patient) associated with increased disease incidence.11 Information about
the prevalence of these risk factors can be used to inform policy makers and stakeholders to
identify and understand gaps in care. Ultimately, information can be used for targeted multilevel
interventions, directed at those in greatest need and ensuring that scarce public health care
dollars are focused on areas identified through scientific evidence.11
A survey carried out by the Alabama Eye Institute (former name of the EyeSight Foundation of
Alabama) in 1999 identified eye care providers working in Alabama, the services available to
address vision problems, and services provided by ophthalmologists and optometrists, and
reported participating eye care providers’ perceptions of what the major eye care needs were in
their communities.19 The researchers summarized the major gaps in service availability for eye
health and vision problems as needs for: (1) public education concerning the importance of
routine screening and preventative eye care; (2) financial support for eye health services; (3)
greater availability of rehabilitation and adaptive aids and services; and (4) improved geographic
access to specialty services.19 Over ten years has passed since the previous survey and although
informative, the current survey aims to provide up to date information on many of the topics
included in the previous survey. It also aims to increase the numbers of participants, and to
enquire more deeply into the characteristics of providers, their practices, and patients. The
current assessment of Alabama’s eye care providers, their patients, and available services will
help to identify gaps in services by aligning known resources to population needs.
9
METHODS
This is a survey of eye care providers delivering eye care in the State of Alabama. The
Institutional Review Board of the University of Alabama at Birmingham reviewed and approved
the survey’s protocol.
Study Population
The survey population consisted of three provider groups: (1) Ophthalmologists, defined as
physicians (MD or DO) who have a medical license in Alabama per the Alabama State Board of
Medical Examiners, have completed residency training in ophthalmology, and practice at least
part time in Alabama; (2) Optometrists, defined as those who have a Doctor of Optometry
degree, are licensed by the Alabama Board of Optometry to practice optometry in Alabama, and
practice at least part time in Alabama; and (3) Vision rehabilitation providers, defined as those
who provide vision rehabilitation services and practice at least part time in Alabama.
Ophthalmologists or optometrists who provide vision rehabilitation services were categorized
with their respective profession (ophthalmologist or optometrist), not in the vision rehabilitation
provider category.
Survey participants were identified from August 2010 through October 2010. Identification and
contact information was initially obtained from professional associations, licensing boards, and
internet searches. Attempts were made to contact all potential participants via telephone to verify
that providers still worked in Alabama and that their contact information was correct. When
incorrect, contact information was updated; however, participants who met the exclusion criteria,
e.g., retired and no longer practicing, deceased, or relocated outside of Alabama, were deemed
ineligible.
Overall, 1,337 potential participants were identified: 378 ophthalmologists, 759 optometrists, and
200 rehabilitation providers (Table 1). Of these, 42.6% of ophthalmologists (161 of 378), 15.9%
of optometrists (121 of 759), and 11.0% of rehabilitation providers (22 of 200) were deemed
ineligible of whom, 88.2%, 92.6%, and 72.7%, respectively, were excluded because they no
longer worked in Alabama. In addition, 8.1% and 1.7% of the ineligible ophthalmologists and
optometrists, respectively, were excluded because they were still in training. The final group of
eligible participants consisted of 1,033 vision care providers: 217 ophthalmologists (21.0%), 638
optometrists (61.8%) and 178 rehabilitation providers (17.2%).
Jefferson County had the greatest number of eligible providers overall and in each provider
group; 36.4% of ophthalmologists, 27.4% of optometrists, and 39.9% of rehabilitation providers
(Table 2). The majority of vision care providers (94.0% of ophthalmologist, 79.6% of
optometrists, and 85.4% of rehabilitation providers) were located in urban counties. There were
ten counties for which no eligible providers were identified: Bullock, Clay, Coosa, Hale,
Lawrence, Lowndes, Monroe, Randolph, Washington, and Wilcox. A detailed list of county level
eligibility and participation by provider type is found in Appendix A.
10
Table 1. Determination of eligibility status among study subjects by provider group
Ophthalmologists
Optometrists
Rehabilitation
Potential participants
378
759
200
Eligibility (%)
Eligible
217 (57.4)
638 (84.1)
178 (89.0)
Ineligible
161 (42.6)
121 (15.9)
22 (11.0)
Ineligible reason (%)
Not practicing in Alabama
142 (88.2)
112 (92.6)
16 (72.7)
Medical leave/disability
2 ( 1.2)
0 ( -- )
0 ( -- )
Residency
13 ( 8.1)
2 ( 1.7)
0 ( -- )
Duplicate entry
1 ( 0.6)
4 ( 3.3)
1 ( 4.6)
Other
3 ( 1.9)
3 ( 2.5)
5 (22.7)
Table 2. County and region location of eligible participants by provider group
Ophthalmologists
Optometrists
Rehabilitation
217
638
178
Top ten counties by numbers of
eligible participants, N (%)
Jefferson
79 (36.4)
175 (27.4)
71 (39.9)
Madison
19 ( 8.8)
53 ( 8.3)
9 ( 5.1)
Mobile
26 (12.0)
33 ( 5.2)
12 ( 6.7)
Shelby
5 ( 2.3)
49 ( 7.7)
9 ( 5.1)
Montgomery
20 ( 9.2)
31 ( 4.9)
9 ( 5.1)
Houston
19 ( 8.8)
18 ( 2.8)
3 ( 1.7)
Tuscaloosa
6 ( 2.8)
18 ( 2.8)
9 ( 5.1)
Baldwin
5 ( 2.3)
23 ( 3.6)
1 ( 0.6)
Talladega
3 ( 1.4)
5 ( 0.8)
16 ( 9.0)
Calhoun
4 ( 1.8)
16 ( 2.5)
3 ( 1.7)
Eligibility by regiona (%)
Urban
204 (94.0)
508 (79.6)
152 (85.4)
North rural
7 ( 3.2)
68 (10.7)
22 (12.4)
South rural
3 ( 1.4)
53 ( 8.3)
2 ( 1.1)
Black Belt
3 ( 1.4)
9 ( 1.4)
2 ( 1.1)
a
20
Based on regional classification defined by the Alabama Department of Public Health
Survey Instrument
Surveys specific to each provider group were developed by the authors of this report with input
from providers in the fields of ophthalmology, optometry, and vision rehabilitation. For all
provider types, survey structure was similar and requested information regarding four areas of
interest: provider characteristics, practice characteristics, patient characteristics and provider
opinions as elicited by two opened-ended questions. In general, the length of all three surveys
was similar, for example, ophthalmologists were asked 31 questions while optometrists and
rehabilitation providers were asked 30 questions. Many of the questions were similar, but a
moderate proportion of survey questions were unique to each provider type (see Appendix B).
11
Provider characteristics questions inquired about demographics (i.e., race/ethnicity, age and
gender) and training. With respect to training, information was requested from ophthalmologists
regarding the year of residency completion, whether residency was followed by a fellowship, and
if yes, the field of training; from optometrists, the year of receiving optometry degree, whether
specialty training was completed, and if yes, the field of specialty training; and from
rehabilitation providers, the year of receiving highest degree and vision rehabilitation specialty.
Practice characteristics questions inquired about practice types, other settings where services
were provided, practice organization and function, types of insurance accepted, and available
patient services. Practice type information included whether respondents worked in group
practice with another ophthalmologist or optometrist, and whether their practice was based at a
university, Department of Veterans Affairs facility, rehabilitation hospital, general hospital,
outpatient rehabilitation clinic, independent service for the visually impaired, State agency,
optical retail shop, or other type. Those who selected other were asked to be specific. In addition,
information was requested about other settings where participants provided services. Other
settings included: day programs in public or private schools, residential schools, general
hospitals, in-patient psychiatric hospitals, nursing homes, State or Federal prisons or local jails,
and other. Those who selected other were asked to be specific.
Requested practice organization and function information included whether services were
provided in group practice, whether an optical shop was located at the practice, if services were
provided in Spanish, the typical amount of time from patients’ seeking an appointment to seeing
the provider, if walk in appointments were accepted, the average number of patients personally
seen per week, and sources of patient referral. We also asked whether insurance was accepted
and if yes, the types of insurance.
The final practice characteristics questions were specific to each provider type and solicited
information about types of services provided. Both ophthalmologists and optometrists were
asked whether services provided included: comprehensive eye care for adults, comprehensive
eye care for infants and children, and contact lens fitting and dispensing. Ophthalmologists were
asked whether they provided any of the following services: cataract surgery, refractive surgery,
retinal – vitreal surgery, glaucoma surgery, corneal surgery, oculo-plastic surgery, visual
rehabilitation services, neuro-ophthalmological services and other. Optometrists were asked
whether they provided vision therapy and/or low vision rehabilitation services. Those who
selected other were asked to be specific. Rehabilitation providers were asked whether they
provided in-home services, and the following training services: the use of assistive devices (e.g.,
optical, non-optical), orientation and mobility, eccentric viewing or preferred retinal loci,
scanning strategy, strategies to perform everyday visual tasks (e.g., household activities,
managing money, preparing meals), and the use of computers and software. Rehabilitation
providers were also asked if they offered any of the following services: psychological or
counseling, support groups (for clients and/or families), social work, driving rehabilitation,
home-based visits for education or training, vocational rehabilitation or career counseling, and
other. Those who selected other were asked to be specific.
Patient characteristics questions inquired about the providers’ patient or client base,
specifically demographics, i.e., the estimated proportions of patients by age group, race, and
12
gender; and the estimated proportions of patients by insurance type (e.g., Medicare, Medicaid,
and private insurance).
All providers were asked to estimate the prevalence of each of the following eye conditions
among their patients: refractive error, amblyopia, strabismus, dry eye, age-related macular
degeneration, glaucoma, diabetic eye conditions including retinopathy, cataract, vision loss from
brain injury including stroke, juvenile or young adult onset retinal degenerations, optic neuritis
or other optic nerve disorders, retinopathy of prematurity, corneal problems, complications from
contact lens wear, conjunctivitis, ocular trauma, and refractive error. Participants were asked to
estimate the prevalences of diabetes and low-vision among their patients; ophthalmologists and
optometrists were asked to estimate the proportion of diabetic patients that adhere to eye care
guidelines. In addition ophthalmologists and optometrists were asked where low-vision patients
in need of rehabilitative services were referred. Finally, rehabilitation providers were asked to
estimate the proportion of their patients with the following specific difficulties or problems:
reading, writing, financial management, other detailed near tasks, independent living, mobility,
driving, identification of objects/ people/ events from a distance, self care/domestic activity, and
emotional or psychological adjustment.
Provider opinions were sought for two open ended questions: 1) “What are the greatest unmet
eye care needs in your community?” and 2) “What single action by a private foundation (such as
the EyeSight Foundation of Alabama) would make the greatest improvement in eye care in your
community?” Responses were reviewed by two researchers with experience in health care
research, and general domains were defined and within those domains, specific subcategories
were delineated. For the first question regarding unmet community needs, five general domains
were defined: clinical care, education, accessibility, eye care organization, and policy. For the
clinical care domain, subcategories included eye care, glaucoma screening, diabetic retinopathy
screening, pediatric in general, pediatric screening, pediatric comprehensive eye exams, and
Hispanic care. For the education domain, subcategories included education to the public and
provider education. For the accessibility domain, subcategories included transportation to
appointments, satellite clinics, and nursing homes. For the eye care organization domain,
subcategories included more providers, new eye hospital, dyslexia services, disparities, blind
services, VA services, handicapped children, dual sensory impairment screening, sports related,
and support groups. For the policy domain, subcategories included financial assistance with
prescriptions, lower co-pays for office visits, higher reimbursements, spectacles for Medicare,
state funds for disability services, pedestrian mobility paths, school screenings, funding for
school spectacles, assistance to indigent patients, and vision rehabilitation funding.
General domains and subcategories for the second question regarding what single action by a
private foundation would make the greatest improvement in community’s eye care included:
fund research, education (public and provider), accessibility (transportation to appointments),
policy, clinical care and screening, and building relationships.
Text responses were reviewed by two members of the research team, and each independent
statement (many participants gave several) was classified according to its corresponding general
domain and subcategory. For example, a response that stated that glaucoma screening was an
unmet eye care need would fall into the clinical care domain and the specific category of
13
glaucoma screening. A thorough description of the general domains and specific categories
within them is available in Appendix C.
Survey Conduct
Study participants were contacted over a ten-month period from November 2010 through August
2011. Eligible subjects (N=1,033) were first contacted via mail informing them of the study
goals and requesting their participation. Included in the mail contact was a survey specific to
subject provider type and a pre-paid return envelope. Additional steps were taken to encourage
participation among non-responders; these included: telephone calls to practices to remind the
provider about the opportunity to participate, faxes and emails by study personnel to the
provider, attendance at several professional seminars and conferences where surveys were made
available, two announcements of the survey in the Alabama Optometric Association monthly
newsletter, a mass email to members of the Alabama Optometric Association, and the option of
completing the survey online.
Analysis
Results are presented for each survey domain (provider characteristics, practice characteristics,
patient characteristics and provider opinions) by provider group. Calculated percentages are
based on the numbers of providers who responded to the question. For example, although 111
ophthalmologists participated in the survey, only 109 responded to the race/ethnic group
question and 107 responded to the gender question; thus, for those questions, denominators for
calculating percentages were 109 and 107, respectively.
14
RESULTS
Overall, 438 (42.4%) of 1,033 eligible vision health providers participated in the survey (Table
3). Participation varied by provider group with ophthalmologists having the highest participation
(51.2%), followed by rehabilitation providers (45.5%) and optometrists (38.6%).
Table 3. Region and county of participants by provider group
Ophthalmologists
Optometrists
Participants
111
246
Top ten counties by numbers of
participants, N (%)
Jefferson
46 (41.4)
80 (32.5)
Madison
10 ( 9.0)
23 ( 9.4)
Mobile
11 ( 9.9)
15 ( 6.1)
Shelby
2 ( 1.8)
22 ( 8.9)
Montgomery
10 ( 9.0)
15 ( 6.1)
Houston
9 ( 8.1)
6 ( 2.4)
Tuscaloosa
4 ( 3.6)
8 ( 3.3)
Baldwin
2 ( 1.8)
4 ( 1.6)
Talladega
3 ( 2.7)
1 ( 0.4)
Calhoun
1 ( 0.9)
4 ( 1.6)
Participants by region (%)
Urban
105 (94.6)
200 (81.3)
North rural
6 ( 5.4)
23 ( 9.4)
South rural
0 ( -- )
21 ( 8.5)
Black Belt
0 ( -- )
2 ( 0.8)
Rehabilitation
81
27 (33.3)
7 ( 8.6)
7 ( 8.6)
5 ( 6.2)
5 ( 6.2)
0 ( -- )
3 ( 3.7)
1 ( 1.2)
11 (13.6)
0 ( -- )
67 (82.7)
14 (17.3)
0 ( -- )
0 ( -- )
By county of location, Jefferson County had the highest number of participants, followed by
Madison, Mobile, Shelby and Montgomery. The majority of participating vision care providers
was located in urban counties. However, relative to ophthalmologists (5.4%), a greater number
of optometrists (18.7%) and rehabilitation providers (17.3%) were located in rural areas. All
rehabilitation providers located in rural areas were in northern rural counties but none were
located in southern counties. Only two survey participants were from Black Belt counties; both
were optometrists.
Figures 1 – 3 provide information on the numbers of ophthalmologists and optometrists per
10,000 county residents eligible for the survey, regardless of whether they participated or not,
organized by county location. Figures 2 and 3 provide additional information regarding the
number of ophthalmologists and optometrists per county.
15
Figure 1. County Location of Ophthalmologists and Optometrists for every 10,000
County Residents, Alabama (2010)
16
Figure 2. County Location of Alabama Ophthalmologists (2010)
17
Figure 3. County Location Alabama Optometrists (2010)
18
PROVIDER CHARACTERISTICS
Ophthalmologists
The majority of participating ophthalmologists identified themselves as non-Hispanic White
(94.5%), with only one or two reporting for each of the other race/ethnicity groups (Table 4).
Respondents’ average age was 53 years and most (88.8%) were male.
Table 4. Demographic characteristics of ophthalmologists
Race/ethnicity group (%)
White, non-Hispanic
African-American
Hispanic
Asian
Native American
Other
Average age (SD)
Gender (%)
Male
Female
103 (94.5)
1 ( 0.9)
1 ( 0.9)
2 ( 1.8)
1 ( 0.9)
1 ( 0.9)
53.0 (11.8)
95 (88.8)
12 (11.2)
Among ophthalmologists, 25.2% completed their residency training in 2000 or after, 19.8% in
the 1990s, 19.8% in the 1980s, and 35.2% before 1980 (Table 5). Approximately 50% of
ophthalmologists had completed a fellowship, and among those, the most common areas of
specialty were retina (20.4%), cornea (18.5%), glaucoma (16.7%), pediatric ophthalmology
(13.0) and oculoplastics (13%). Other specialties specified by respondents included: anterior
segment, aviation ophthalmology, cataract, general ophthalmology, nuclear ophthalmology,
ocular trauma, and refractive surgery.
Table 5. Training characteristics of ophthalmologists
Year residency training completed
2000 and after
1990 – 1999
1980 – 1989
Before 1980
Fellowship post residency?
Yes
Fellowship field
Retina
Glaucoma
Cornea
Pediatric Ophthalmology & Strabismus
Neuro-Ophthalmology
Oculoplastics
Visual Rehabilitation
Ophthalmic Pathology
Ocular Inflammatory Disease
Other
N (%)
28 (25.2)
22 (19.8)
22 (19.8)
39 (35.2)
53 (49.5)
11 (20.4)
9 (16.7)
10 (18.5)
7 (13.0)
4 ( 7.4)
7 (13.0)
0 ( -- )
1 ( 1.9)
1 ( 1.9)
7 (13.0)
19
Optometrists
Among participating optometrists, most (89.6%) identified themselves as non-Hispanic White
(Table 6). On average they were 45 years of age and though most (55.7%) were male, a large
proportion (44.3%) was female.
Table 6. Demographic characteristics of optometrists
Race/ethnicity group (%)
White, non-Hispanic
African-American
Hispanic
Asian
Native American
Other
Average age (SD)
Gender (%)
Male
Female
216 (89.6)
16 ( 6.6)
4 ( 1.7)
2 ( 0.8)
2 ( 0.8)
1 ( 0.4)
45.7 (12.0)
136 (55.7)
108 (44.3)
Among optometrists, 31.7% received their optometry degree in 2000 or after, 27.2% in the
1990s, 24.4% in the 1980s, and 16.7% before 1980 (Table 7). Among those who reported
completing a residency (21.3%), the most frequently areas of specialty training were family
practice (26.9%), geriatric optometry (26.9%), low vision rehabilitation (23.1%) and primary eye
care (21.1%). Less frequently listed areas of specialty included cornea and contact lenses (9.6%),
pediatric optometry (7.7%), vision therapy (3.8%), and refractive and ocular surgery (1.9%).
Other areas of specialty training specified by participants included hospital based and ocular
diseases.
Table 7. Training characteristics of optometrists
Year O.D. degree received
2000 and after
1990 – 1999
1980 – 1989
Before 1980
Following O.D., residency in specialty?
Yes
Residency specialty (%)
Community Health Optometry
Cornea and Contact Lenses
Family Practice Optometry
Geriatric Optometry
Low Vision Rehabilitation
Pediatric Optometry
Primary Eye Care
Refractive and Ocular Surgery
Vision Therapy
Other. Specify
N (%)
78 (31.7)
67 (27.2)
60 (24.4)
41 (16.7)
52 (21.3)
0 ( -- )
5 ( 9.6)
14 (26.9)
14 (26.9)
12 (23.1)
4 ( 7.7)
11 (21.1)
1 ( 1.9)
2 ( 3.8)
16 (30.8)
20
Vision Rehabilitation Providers
Among participating rehabilitation providers, 84.0% were non-Hispanic White and 13.6% were
African Americans (Table 8). On average participants were 47 years of age and most (80.3%)
were female.
Table 8. Demographic characteristics of rehabilitation providers
Race/ethnicity group (%)
White, non-Hispanic
African-American
Hispanic
Asian
Native American
Other
Average age (SD)
Gender (%)
Male
Female
68 (84.0)
11 (13.6)
1 ( 1.2)
0 ( -- )
1 ( 1.2)
0 ( -- )
47.8 (11.1)
16 (19.8)
65 (80.2)
Among rehabilitation providers, 33.3% received their highest degree in 2000 or after, 25.9% in
the 1990s, 16.1% in the 1980s, and 24.7% before 1980 (Table 9). Rehabilitation providers’
specialties included educator (30.7%), vision rehabilitation therapist (20.0%) and rehabilitation
counselor (16.0%), and vocational rehabilitation counselor (9.3%). It should be noted that these
categories are not mutually exclusive and that some of the participants selected more than one
answer. Very few participants identified themselves as low vision therapists (5.3%); however,
many participants specified another specialty (30.7%) outside of the ones offered in the survey.
Other specialties specified included administration, assistive technology, case manager, and
consultant.
Table 9. Rehabilitation providers’ year of highest degree and specialties
Year degree received
N (%)
2000 and after
27 (33.3)
1990 – 1999
21 (25.9)
1980 – 1989
13 (16.1)
Before 1980
20 (24.7)
Specialty
Occupational therapist
7 ( 9.3)
Occupational therapist assistant
0 ( -- )
Vision rehabilitation therapist
15 (20.0)
Certified low vision therapist
4 ( 5.3)
Social worker
2 ( 2.7)
Rehabilitation counselor
12 (16.0)
Vocational rehabilitation counselor
7 ( 9.3)
Psychologist
2 ( 2.7)
Educator
23 (30.7)
Other
23 (30.7)
21
PRACTICE CHARACTERISTICS
Ophthalmologists
Most ophthalmologists (82.0%) worked in a private practice with one or more ophthalmologists;
a lower proportion (24.3%) reported working in a practice with at least one optometrist and
11.7% worked at a university-based practice (Table 10). Very few ophthalmologists reported
working in a Department of Veterans Affairs clinic or medical center (2.7%) or in a general
hospital (3.6%). No participants reported working in a rehabilitation hospital, outpatient
rehabilitation center, independent service for the visually impaired, or state agency. Few
ophthalmologists (7.2%) worked in a practice identified as an optical retail store. Other practice
types specified by ophthalmologists included a practice based at a hospital, a multi-specialty
group, and a common management group of multi-sole practitioners.
Table 10. Practice types of ophthalmologists
Private practice with at least one
Ophthalmologist
Private practice with at least one Optometrist
Practice based in a university
Department of Veterans Affairs clinic or
medical center
Rehabilitation hospital
General hospital
Outpatient rehabilitation center
Independent service for the visually impaired
State agency
Optical retail store
Other
N (%)
91 (82.0)
27 (24.3)
13 (11.7)
3 ( 2.7)
0(
4(
0(
0(
0(
8(
4(
-- )
3.6)
-- )
-- )
-- )
7.2)
3.6)
Relatively few ophthalmologists reported that they provided services in other settings (Table
11). Other settings ophthalmologists offered services included general hospitals (18.2%), inpatient psychiatric hospitals (1.8%) and nursing homes (2.7%).
Table 11. Other settings where ophthalmologists provide services
Public or private schools (day programs)
Residential schools (e.g., Alabama Institute
for the Deaf & Blind, residential schools for
the developmentally delayed)
General hospitals
In-patient psychiatric hospitals
Nursing homes
State or Federal prisons or local jails
Other
N (%)
0 ( -- )
1 ( 0.9)
20 (18.2)
2 ( 1.8)
3 ( 2.7)
0 ( -- )
1 ( 0.9)
22
A large proportion of ophthalmologists reported providing comprehensive eye care for adults
(78.2%) and children (52.7%), as well as dispensing and fitting of contact lenses (41.8%) (Table
12). Approximately 80% (N=89) of ophthalmologists reported that they performed any type of
surgery; 61% of ophthalmologists reported that they performed cataract surgery but fewer
performed surgeries that were refractive (20.0%), retinal (13.5%), glaucoma (31.8%), corneal
(18.2%) and oculoplastic (33.6%). Few ophthalmologists reported that they provided visual
rehabilitation services (2.7%). A greater proportion (13.6%) provided neuro-ophthalmological
services. Other services respondents specified included: diagnostic testing, adult strabismus,
ocular inflammatory and other immune diseases, and ocular trauma.
Table 12. Services provided by ophthalmologists
Comprehensive eye care for adults
Comprehensive eye care for infants and
children
Contact lens fitting and dispensing
Cataract surgery
Refractive surgery
Retinal – vitreal surgery
Glaucoma surgery
Corneal surgery
Oculo-plastic surgery
Visual rehabilitation services
Neuro-ophthalmological services
Other
N (%)
86 (78.2)
58 (52.7)
46 (41.8)
67 (60.9)
22 (20.0)
15 (13.5)
35 (31.8)
20 (18.2)
37 (33.6)
3 ( 2.7)
15 (13.6)
9 ( 8.2)
A large number of ophthalmologists reported that they provided services in a group practice
(72.2%) (Table 13). Although very few had previously answered that their practice was an
optical shop (Table 10), a greater number (50.0%) reported that an optical shop was located
within their practice. Nearly one third (32.7%) provided services in Spanish.
Most ophthalmologists (77.0%) estimated that patients would be seen within two weeks of
seeking an appointment but 9.6% estimated that patients could expect to wait for a month or
more. Most accepted walk-in appointments (67.0%); 31.1% accepted walk-in appointments only
from established patients in an emergency. The median number of patients seen per week was
120, and ranged from 15 to 240. The most common source of referrals was patients’ family and
friends (33.5%), followed by patients themselves (24.8%), a physician (17.4%), another
ophthalmologist (17.2%), and an optometrist (16.1%). Respondents estimated that very few of
their patients were referred by hospitals or emergency rooms (3.9%) and school or pre-school
vision screening programs (2.5%).
Most ophthalmologists accepted Blue Cross Blue Shield (93.6%), Medicare (86.4%), Medicaid
(85.5%), Tricare/Champus (84.6%), United Healthcare (83.6%), and Medicare Complete
(83.6%) (Table 14). Acceptance of other types of insurance plans varied by type, for example,
many providers accepted Aetna (79.1%), and Cigna (74.6%); but fewer accepted Viva (61.8%)
and Viva Medicare Plus (52.7%); and less than half accepted GEHA (41.8%), Veterans
Administration coverage (38.2%), CHIP (38.1%), and Multiplan (30.9%).
23
Table 13. Practice characteristics of ophthalmologists
Provide services in group practice
Optical shop at practice/agency
Services provided in Spanish
Time for appointment:
< 1 week
1 – 2 weeks
3 – 4 weeks
> 1 month
Do not know
Walk in appointments accepted?
Yes
Only in an emergency w/ est. patient
No
Average number of patients seen per week
(SD)
Median
Range
Sources of patient referral (%):
Themselves
Family or friends
An ophthalmologist
An optometrist
Physician, e.g., a family physician
Hospital emergency room
School or pre-school vision screening
program
Other
N (%)
78 (72.2)
52 (50.0)
34 (32.7)
48 (46.2)
32 (30.8)
12 (11.5)
10 ( 9.6)
2 ( 1.9)
69 (67.0)
32 (31.1)
2 ( 1.9)
119.8 (47.5)
120
15-240
24.8
33.5
17.2
16.1
17.4
3.9
2.5
2.1
Table 14. Patient health insurance plans accepted by ophthalmologists
Insurance plans
N (%)
Medicare
95 (86.4)
Medicare Complete
92 (83.6)
Medicaid
94 (85.5)
Blue Cross Blue Shield
103 (93.6)
Viva
68 (61.8)
Viva Medicare Plus
58 (52.7)
United Healthcare
92 (83.6)
Cigna
82 (74.6)
Aetna
87 (79.1)
Multiplan
34 (30.9)
GEHA
46 (41.8)
Tricare/Champus
93 (84.6)
Veterans Administration coverage
42 (38.2)
CHIP (Children’s Health Insurance Program)
42 (38.2)
Others
9 ( 8.2)
Do not accept health insurance
0 ( -- )
24
Optometrists
About 2/3 of optometrists (61.0%) worked in a private practice with one or more other
optometrists; a low proportion (10.2%) reported working in a practice with at least one
ophthalmologist and 8.5% worked at a university-based practice (Table 15). Very few
optometrists practiced in a clinic or medical center associated with the Department of Veterans
Affairs (4.1%) or in a general hospital (1.2%). A few participants reported working in a
rehabilitation hospital (0.4%), general hospital (1.2%), outpatient rehabilitation center (0.4%),
independent service for the visually impaired (0.4%), or state agency (0.8%). Few optometrists
(18.7%) worked in a practice identified as an optical retail store. Other practice areas reported by
optometrists included a non-profit agency, an educational facility, a federally qualified health
center, a corporate optometric office, an independent practice within a Wal-Mart, a Lasik center,
an Indian reservation, a referral center and a health care center.
Table 15. Practice types of optometrists
Private practice with at least one
Ophthalmologist
Private practice with at least one Optometrist
Practice based in a university
Department of Veterans Affairs clinic or
medical center
Rehabilitation hospital
General hospital
Outpatient rehabilitation center
Independent service for the visually impaired
State agency
Optical retail store
Other
N (%)
25 (10.2)
150 (61.0)
21 ( 8.5)
10 ( 4.1)
1 ( 0.4)
3 ( 1.2)
1 ( 0.4)
1( 0.4)
2 ( 0.8)
46 (18.7)
18 ( 7.3)
Few optometrists reported that they provided services in other settings (Table 16). Other settings
where providers offered services included public or private schools (4.9%), residential schools
(1.6%), general hospitals (3.7%), in-patient psychiatric hospitals (1.6%), nursing homes (11.4%),
state or federal prisons and local jails (2.9%). Other settings written that were outside of the
choices offered in the survey, included National Guard, community free clinics, and homeless
shelters.
Table 16. Other settings where optometrists provide services
Public or private schools (day programs)
Residential schools (e.g., Alabama Institute
for the Deaf & Blind, residential schools for
the developmentally delayed)
General hospitals
In-patient psychiatric hospitals
Nursing homes
State or Federal prisons or local jails
Other
N (%)
12 ( 4.9)
4 ( 1.6)
9 ( 3.7)
4 ( 1.6)
28 (11.4)
7 ( 2.9)
25 (10.2)
25
A large proportion of optometrists reported providing comprehensive eye care for adults (95.1%)
and children (81.3%), as well as fitting and dispensing contact lenses (86.2%) (Table 17).
Optometrists reported that 12.6% provided vision therapy and 15.0% provided low vision
rehabilitation services. Optometrists also offered other services not listed in the survey,
including: occupational and environmental services, and pre- and post- surgery care and
management.
Table 17. Services provided by optometrists
Comprehensive eye care for adults
Comprehensive eye care for infants and
children
Contact lens fitting and dispensing
Vision therapy
Low vision rehabilitation services
Other
N (%)
234 (95.1)
200 (81.3)
212 (86.2)
31 (12.6)
37 (15.0)
20 ( 8.1)
Approximately half of optometrists reported that they provided services in a group practice
(48.8%) (Table 18). Although very few had previously reported that their practice was an optical
shop (Table 15), most (92.5%) reported that an optical shop was located within their practice.
Over one quarter (27.3) provided services in Spanish.
Most optometrists (90.5%) estimated that patients would be seen within two weeks of seeking an
appointment and only 3.0% estimated that patients would not be seen for a month or more. Most
accepted walk-in appointments (75.2%), 22.5% accepted only walk-in appointments from
established patients in an emergency. The median number of patients seen per week was 60, and
ranged from four to 200. The most common estimated source of referrals was patients’ family
and friends (38.1%), followed by patients themselves (34.3%), and a physician (12.3%). Less
common sources of referrals were from school or pre-school vision screening programs (8.2%),
an ophthalmologist (5.1%), another optometrist (4.2%), and hospitals or emergency rooms
(2.0%).
Many optometrists accepted Blue Cross Blue Shield (85.0%), Medicare (78.5%), United
Healthcare (65.5%), Tricare/Champus (58.9%), Medicare Complete (56.9%), and Medicaid
(61.8%) (Table 19). Acceptance of other types of insurance plans varied by type, for example,
many providers accepted Cigna (48.4%), Aetna (47.2%), Viva (45.5%) and Viva Medicare Plus
(41.5%); but few accepted CHIP (23.6%), Veterans Administration coverage (12.2%), GEHA
(10.2%), and Multiplan (6.5%). Optometrists also reported accepting reimbursement from
various health plans including: All Kids, VSP, Humana Vision Care/VCP, and Eye Med.
26
Table 18. Practice characteristics of optometrists
Provide services in group practice
Optical shop at practice/agency
Services provided in Spanish
Time for appointment (%)
< 1 week
1 – 2 weeks
3 – 4 weeks
> 1 month
Do not know
Walk in appointments accepted?
Yes
Only in an emergency w/ est. patient
No
Average number of patients seen per week
(SD)
Median
Range
Sources of patient referral:
Themselves
Family or friends
An ophthalmologist
An optometrist
Physician, e.g., a family physician
Hospital emergency room
School or pre-school vision screening
program
Other
Table 19. Patient health insurance plans accepted by optometrists
Insurance plans
Medicare
Medicare Complete
Medicaid
Blue Cross Blue Shield
Viva
Viva Medicare Plus
United Healthcare
Cigna
Aetna
Multiplan
GEHA
Tricare/Champus
Veterans Administration coverage
CHIP (Children’s Health Insurance
Program)
Others
Do not accept health insurance
N (%)
117 (48.8)
211 (92.5)
63 (27.3)
151 (65.4)
58 (25.1)
12 ( 5.2)
7 ( 3.0)
3 ( 1.3)
170 (75.2)
51 (22.6)
5 ( 2.2)
64.3 (36.3)
60
4-200
34.3
38.1
5.1
4.2
12.3
2.0
8.2
5.0
N (%)
193 (78.5)
140 (56.9)
152 (61.8)
209 (85.0)
112 (45.5)
102 (41.5)
161 (65.5)
119 (48.4)
116 (47.2)
16 ( 6.5)
25 (10.2)
145 (58.9)
30 (12.2)
58 (23.6)
35 (14.2)
1 ( 0.4)
27
Vision Rehabilitation Providers
No rehabilitation providers listed their practice type as private practice with one or more
ophthalmologists or optometrists. Most worked in a state agency (54.3%) and a large proportion
practiced at a Department of Veterans Affairs clinic (13.6%) or independent service for visually
impaired (13.6%) (Table 20). A few listed practices based in a university (4.9%) and one each
worked in a rehabilitation hospital or outpatient rehabilitation center. Among other practice types
specified, responses included: ADRS, Alabama Institute for Deaf and Blind (AIDB), public
school system, private non-profit rehabilitation center, and home-private office.
Table 20. Practice types for rehabilitation providers
Private practice with at least one
Ophthalmologist
Private practice with at least one
Optometrist
Practice based in a university
Department of Veterans Affairs clinic or
medical center
Rehabilitation hospital
General hospital
Outpatient rehabilitation center
Independent service for the visually
impaired
State agency
Optical retail store
Other
N (%)
0 ( -- )
0 ( -- )
4 ( 4.9)
11 (13.6)
1 ( 1.2)
0 ( -- )
1 ( 1.2)
11 (13.6)
44 (54.3)
0 ( -- )
21 (25.9)
Other settings where rehabilitation providers offered services included public and private school
day programs (25.9%) and residential schools such as the AIDB (22.2%) (Table 21). No
participants provided services in a general hospital or an in-patient psychiatric hospital but
approximately 10% provided services to nursing homes. Other setting specified included, homes
as requested, colleges or universities, and ADRS.
Approximately 40% of responding rehabilitation providers worked in a group practice and over
one-third provided services in Spanish (Table 22). Patients were able to be seen within twoweeks of seeking an appointment for approximately 60.9% of providers, 11.1% accepted only
walk-in appointments from established patients in an emergency. The median number of patients
seen per week was 10, and ranged from one to 40. The most common source for referrals was
ophthalmologists (15.2%), followed by schools (13.4%), family (13.3%), optometrists (11.1%),
vision screening programs (7.0%) and non-ophthalmologist physician (5.6%). Few patients
(0.3%) were estimated referred by hospitals or emergency rooms. Other sources specified
included ADRS, Vocational Rehabilitation, and VA Services.
28
Table 21. Other settings where rehabilitation participants provide services
N (%)
Public or private schools (day programs)
21 (25.9)
Residential schools (e.g., Alabama Institute
18 (22.2)
for the Deaf & Blind, residential schools for
the developmentally delayed)
General hospitals
0 (----)
In-patient psychiatric hospitals
0 (----)
Nursing homes
8 (9.9)
State or Federal prisons or local jails
3 (3.7)
Other
17 (21.0)
Table 22. Practice characteristics of rehabilitation providers
Provide services in group practice?
Optical shop at practice/agency?
Services provided in Spanish?
Time for appointment?
< 1 week
1 – 2 weeks
3 – 4 weeks
> 1 month
Do not know
Do you take walk in appointments?
Yes
Only in an emergency w/ est. patient
No
Average number of patients seen per week
Median
Range
Sources of patient referral
Themselves
Family or friends
Ophthalmologist
Optometrist
Another physician including a family
physician
Hospital emergency room
Schools
Vision screening program
Other
N (%)
30 (40.5)
5 ( 6.7)
25 (34.7)
17 (24.6)
25 (36.2)
9 (13.0)
6 ( 8.7)
12 (17.4)
27 (42.9)
7 (11.1)
29 (46.0)
12.9
10
1-40
11.2
13.3
15.2
11.1
5.6
0.3
13.4
7.0
25.8
Few rehabilitation providers accepted health insurance plans for payment (Table 23). For
example, the most commonly accepted was Medicaid (14.8%), followed by Medicare (11.1%)
and Blue Cross Blue Shield (11.1%). Of those responding, 49.4% did not accept health
insurance.
29
Table 23. Patient health insurance plans accepted by rehabilitation providers
Insurance plans
N (%)
Medicare
9 (11.1)
Medicare Complete
5 (6.2)
Medicaid
12 (14.8)
Blue Cross Blue Shield
9 (11.1)
Viva
2 ( 2.5)
Viva Medicare Plus
2 ( 2.5)
United Healthcare
4 ( 4.9)
Cigna
3 ( 3.7)
Aetna
3 ( 3.7)
Multiplan
0 ( -- )
GEHA
0 ( -- )
Tricare/Champus
4 ( 4.9)
Veterans Administration coverage
4 ( 4.9)
CHIP (Children’s Health Insurance
1 ( 1.2)
Program)
Others
8 ( 9.9)
Do not accept health insurance
40 (49.4)
Approximately 50% of rehabilitation participants provided in-home services (Table 24). The
most frequent service provided was training in the use of assisted devices (63.3%), training in
strategies to perform everyday tasks (55.7%), orientation and mobility training (43.0%), homebased education or training (40.5%), computer and software training (39.2), vocational
rehabilitation and career counseling services (36.7), and support groups for clients and families
(32.9%). Other services specified by respondents included administrative, awareness and
outreach, teaching Braille, and cognitive testing.
Table 24. Service characteristics of rehabilitation providers
Provide in-home services
Services provided:
Training in the use of assistive devices (e.g.,
optical, non-optical)
Orientation and mobility training
Eccentric viewing training or training in
preferred retinal loci
Scanning strategy training
Training in strategies to perform everyday visual
tasks (e.g., household activities, managing
money, preparing meals)
Psychological or counseling services
Support groups (for clients and/or families)
Social work services
Driving rehabilitation
Home-based visits for education or training
Vocational rehabilitation or career counseling
services
Training in the use of computers and software
Other
40 (49.4)
50 (63.3)
34 (43.0)
15 (19.0)
20 (25.3)
43 (55.7)
10 (15.2)
26 (32.9)
6 ( 7.6)
3 ( 3.8)
32 (40.5)
29 (36.7)
31 (39.2)
18 (22.2)
30
PATIENT CHARACTERISTICS
Ophthalmologists
Ophthalmologists reported that a large proportion of their patients were 60 years and older
(57.4%), followed by patients aged 20-59 (26.8%), and younger than 20 (15.3%) (Table 25). The
majority of patients were white (57.1%), followed by African American (32.6%). Relatively few
patients were estimated to be Hispanic (5.1%) and from other racial/ethnic groups (3.4%). About
half of patients were female (54.4%). A large proportion of patients were covered by Medicare
(50.2%) and private insurance (36.7%). Smaller proportions of patients had Medicaid (16.2%)
and no insurance (4.1%).
Table 25. Ophthalmologists’ patient characteristics
Patient age (%)
<5
5-19
20-59
60-79
80+
Patient race/ethnic groups (%)
White
African American
Hispanic
Asian
Native American
Other
Patient gender (%)
Male
Female
Patient insurance plans (%)
Medicare
Medicaid
Private insurance
No insurance
Others
6.3
9.0
26.8
42.1
15.3
57.1
32.6
5.1
2.5
0.4
0.5
45.6
54.4
50.2
16.2
36.7
4.1
2.5
Ophthalmologists were asked to estimate the proportion of their patients with specific eye
conditions and eye diseases (Table 26). Large proportions of patients had problems with
refractive error (66.8%), dry eye (39.6%), cataract (36.9%), glaucoma (25.7%), diabetic eye
conditions including retinopathy (20.3%) and age-related macular degeneration (19.7%). Fewer
patients suffered from corneal problems (12.6%), conjunctivitis (8.2%), strabismus (7.0%), and
amblyopia (6.4%). Providers estimated that low numbers of patients had ocular trauma (5.4%),
vision loss from brain injury (4.7%), complications from contact lens wear (4.7%), optic neuritis
(3.7%), juvenile or young adult onset retinal degenerations (1.9%), or retinopathy of prematurity
(1.2%).
31
Ophthalmologists estimated that approximately 27% of their patients had diabetes and of those,
61.4% adhered to eye care guidelines (Table 26). Patients with low vision made up 14.4% of all
patients. For low vision patients in need of rehabilitation services, 13.1% of ophthalmologists
provided those services, 61.6% referred patients to the UAB Center for Low Vision
Rehabilitation, and 29.3% referred to the UAB School of Optometry Low Vision Clinic. Other
places low vision patients were referred to included ADRS (47.5%), state, county and city
educational services (13.1%), St. Vincent’s East (6.1%), and other (27.3%). Other rehabilitation
service providers specified included AIDB, Community Services for Vision Rehabilitation
(CSVR) in Mobile, and VA low vision rehabilitation.
Table 26. Ophthalmologists’ patient eye conditions, and those with diabetes and low vision
Patient eye conditions (%)
Refractive error
66.8
Amblyopia
6.4
Strabismus
7.0
Dry eye
39.6
Age-related macular degeneration
19.7
Glaucoma
25.7
Diabetic eye conditions including
20.3
retinopathy
Cataract
36.9
Vision loss from brain injury including
4.7
stroke
Juvenile or young adult onset retinal
1.9
degenerations
Optic neuritis or other optic nerve
3.7
disorders
Retinopathy of prematurity
1.2
Corneal problems
12.6
Complications from contact lens wear
4.7
Conjunctivitis
8.2
Ocular trauma
5.4
Other
4.2
Diabetic patients (%)
27.3
% who adhere to guidelines
61.4
Low vision patients (%)
14.4
Where low vision patients in need of
rehabilitation services referred (%)
Practice provides
13.1
ADRS
47.5
State, county, or city/town educational
13.1
services
UAB School of Optometry Low Vision
29.3
Clinic
UAB Center for Low Vision
61.6
Rehabilitation
St. Vincent’s East
6.1
Other
27.3
32
Optometrists
Optometrists reported that the largest proportion of their patients were aged 20-59 years (41.7%),
followed by patients aged 60 and older (33.5%) and younger than 20 (23.8%) (Table 27). The
majority of patients were white (59.2%), followed by African American (30.3%). Relatively few
patients were Hispanic (6.3%) and other racial/ethnic groups (4.0%). Patients were more often
female (52.6%). A large proportion of patients were covered by private insurance (41.6%);
however, smaller proportions of patients had Medicare (26.6%) and Medicaid (15.2%) and
18.1% had no insurance.
Table 27. Optometrists’ patient characteristics
Patient age (%)
<5
5-19
20-59
60-79
80+
Patient race/ethnic groups (%)
White
African American
Hispanic
Asian
Native American
Other
Patient gender (%)
Male
Female
Patient insurance plans (%)
Medicare
Medicaid
Private insurance
No insurance
Others
4.5
19.3
41.7
25.9
7.6
59.2
30.3
6.3
3.0
0.6
0.4
47.2
52.6
26.6
15.2
41.6
18.1
3.4
Optometrists were asked to estimate the proportion of their patients with specific eye conditions
and eye diseases (Table 28). Large proportions of patients had problems with refractive error
(86.3%), dry eye (36.8%), cataract (25.9%), glaucoma (13.8%), diabetic eye conditions including
retinopathy (13.7%), conjunctivitis (11.7%), complications from contact lens wear (11.4%),
corneal problems (11.0%), and age-related macular degeneration (10.9%). Providers estimated
that fewer numbers of patients had amblyopia (6.0%), strabismus (5.0%), ocular trauma (4.3%),
vision loss from brain injury (3.0%), optic neuritis (2.6%), juvenile or young adult onset retinal
degenerations (1.4%), or retinopathy of prematurity (0.8%).
Optometrists estimated that approximately 22.3% of their patients had diabetes and that 52.9%
adhered to eye care guidelines (Table 28). Patients with low vision made up 6.6% of all patients.
For low vision patients in need of rehabilitation services, 17.5% of optometrists provided those
33
services, 68.2% referred patients to the UAB School of Optometry Low Vision Clinic, and
40.8% referred patients to the UAB Center for Low Vision Rehabilitation. Other places low
vision patients were referred to included ADRS (32.7%), state, county and city educational
services (13.1%), St. Vincent’s East (0.9%), and other (20.5%). Other rehabilitation service
providers specified included AIDB, CSVR, and VA low vision rehabilitation.
Table 28. Optometrists’ patient eye conditions, and those with diabetes and low vision
Patient eye conditions (%)
Refractive error
86.3
Amblyopia
6.0
Strabismus
5.0
Dry eye
36.8
Age-related macular degeneration
10.9
Glaucoma
13.8
Diabetic eye conditions including
13.7
retinopathy
Cataract
25.9
Vision loss from brain injury including
3.0
stroke
Juvenile or young adult onset retinal
1.4
degenerations
Optic neuritis or other optic nerve
2.6
disorders
Retinopathy of prematurity
0.8
Corneal problems
11.0
Complications from contact lens wear
11.4
Conjunctivitis
11.7
Ocular trauma
4.3
Other
1.4
Diabetic patients (%)
22.3
% who adhere to guidelines
52.9
Low vision patients
6.6
Where low vision patients in need of
rehabilitation services referred (%)
Practice provides
17.5
ADRS
32.7
State, county, or city/town educational
13.1
services
UAB School of Optometry Low Vision
68.2
Clinic
UAB Center for Low Vision
40.8
Rehabilitation
St. Vincent’s East
0.9
Other
20.5
34
Vision Rehabilitation providers
Rehabilitation providers reported that the largest proportion of their patients were aged 20-59
years (39.9%), followed by patients aged 60 and older (37.7%), and younger than 20 (19.3%)
(Table 29). The majority of patients were white (61.3%), followed by African American
(33.3%). Relatively few patients were Hispanic (2.3%) and other racial/ethnic groups (1.4%).
Patients were more often male (54.6%). A large proportion of patients were covered by Medicare
(46.9%); however, smaller proportions of patients had Medicaid (30.1%) and private insurance
(19.4%), and 23.3% had no insurance.
Table 29. Rehabilitation providers’ patient/client characteristics
Age group (%)
<5
5-19
20-59
60-79
80+
Race/ethnic group (%)
White
African American
Hispanic
Asian
Native American
Other
Gender (%)
Male
Female
Insurance plan (%)
Medicare
Medicaid
Private insurance
No insurance
Others
2.8
16.5
39.9
25.0
12.7
61.3
33.3
2.3
0.7
0.1
0.6
54.6
45.4
46.9
30.1
19.4
23.3
--
Rehabilitation providers were asked to estimate the proportion of their patients with specific eye
conditions and eye diseases (Table 30). Large proportions of patients had age-related macular
degeneration (24.9%), diabetic eye conditions including retinopathy (20.8%), glaucoma (18.0%),
cataract (15.2%), problems with refractive error (15.1%), juvenile or young adult onset retinal
degenerations (11.4%), vision loss from brain injury (10.8%). Fewer patients had optic neuritis
(7.9%), retinopathy of prematurity (7.1%), dry eye (6.7%), ocular trauma (4.8%), strabismus
(3.5%), corneal problems (3.3%), amblyopia (2.4%), conjunctivitis (0.8%), and complications
from contact lens wear (0.2%). Rehabilitation providers estimated that approximately 28% of
their patients had diabetes and that patients with low vision made up 67% of all patients.
35
Table 30. Rehabilitation providers’ patient eye conditions, those with diabetes and low
vision
Patients with eye condition (%)
Refractive error
15.1
Amblyopia
2.4
Strabismus
3.5
Dry eye
6.7
Age-related macular degeneration
24.9
Glaucoma
18.0
Diabetic eye conditions including
20.8
retinopathy
Cataract
15.2
Vision loss from brain injury including
10.8
stroke
Juvenile or young adult onset retinal
11.4
degenerations
Optic neuritis or other optic nerve
7.9
disorders
Retinopathy of prematurity
7.1
Corneal problems
3.3
Complications from contact lens wear
0.2
Conjunctivitis
0.8
Ocular trauma
4.8
Other
3.4
Diabetic patients
27.9
Patients with Low Vision
66.7
Rehabilitation providers estimated the proportion of their patients who experienced specific
problems (Table 31). The majority of patients had difficulties reading (63.8%) and driving a car
(55.2%), and large proportions had problems with mobility (50.1%), identifying objects, people
or events from a distance (48.8%), writing (48.3%), independent living (40.8%), and other
detailed near tasks (37.3%). Many patients also had difficulty with emotional or psychological
adjustment (35.4%), self care and domestic activity (32.8%), and financial management (31.1%).
Table 31. Rehabilitation providers’ patients with specific difficulties or problems
(%)
Reading
63.8
Writing
48.3
Financial management
31.1
Other detail near tasks
37.3
Independent living
40.8
Mobility
50.1
Driving
55.2
Identification of objects, people, events from a
48.8
distance
Self care/domestic activity
32.8
Emotional or psychological adjustment
35.4
36
PROVIDER OPINIONS
Ophthalmologists
Overall, 71.2% (N=79) of the 111 participating ophthalmologists responded to the question
regarding their community’s greatest unmet eye care needs (Table 32). The most common
comments were about clinical care (41.8%), policy (34.2%), and eye care organization (25.3%).
Less frequent (7.6%) were comments regarding eye health education for patients and the public,
and accessibility (6.3%). A small portion of ophthalmologists reported that their community had
no unmet needs (3.8%) or that they did not know (2.5%).
Table 32. Ophthalmologists’ responses to “greatest unmet community eye care needs” question
Participants responding, N (%)
79 (71.2)
General domains (%)
Clinical care
41.8
Education
7.6
Accessibility
6.3
Eye care organization
25.3
Policy
34.2
No needs
Do not know
3.8
2.5
Approximately 42% of ophthalmologists made comments that the greatest unmet need involved
clinical care (Table 33). Of those, 60.6% fell into the eye care subcategory. A typical answer
was, “caring for and covering the uninsured; helping low income patients without Medicaid to
pay for glasses.” Of those who felt that clinical care was the greatest unmet need, 15.2%
specifically mentioned glaucoma screening and 6.1% mentioned screening for diabetic
retinopathy. Approximately 12% favored pediatric screening. A small proportion of
ophthalmologists thought Hispanic eye care (3.6%) was the greatest unmet need.
Table 33. Ophthalmologists’ subcategories for clinical care responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
33 (41.8)
Clinical care subcategories (%)
Eye care
60.6
Glaucoma screening
15.2
Diabetic retinopathy screening
6.1
Pediatric in general
3.0
Pediatric screening
12.1
Pediatric comprehensive eye exams
0.0
Hispanic care
3.0
Dry eye
3.0
Refractive error
9.1
37
Only six responses (7.6%) from ophthalmologists were related to education (Table 34). Of those,
all concerned eye health education for the public.
Table 34. Ophthalmologists’ subcategories of education responses to “greatest unmet community
eye care needs” question
Participants responding, N (%)
6 (7.6)
Education subcategories (%)
Public education
100
Provider education
--
Comments from five ophthalmologists (6.3%) were related to accessibility, and of those, 100%
were about the need to provide patients with transportation to appointments (Table 35).
Table 35. Ophthalmologists’ subcategories of accessibility responses to “greatest unmet community
eye care needs” question
Participants responding, N (%)
5 (6.3)
Accessibility subcategories (%)
Transportation to appointments
100
Satellite clinics
-Nursing homes
--
Approximately 25% of ophthalmologist made comments related to eye care organization. Most
(75%) were about the need for more providers (Table 36). For example, several
ophthalmologists stated there was a need for more neuro-ophthalmologists, pediatric
ophthalmologist, and low vision specialists. Others were concerned about the need for a new eye
hospital (10.0%), dyslexia services (5.0%), disparities (5.0%), and services for the blind (5.0%).
Table 36. Ophthalmologists’ subcategories of eye care organization responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
20 (25.3)
Eye care organization subcategories (%)
More providers
75.0
New eye hospital
10.0
Dyslexia services
5.0
Disparities
5.0
Blind services
5.0
VA services
0.0
Handicapped children
0.0
Dual sensory impairment screening
0.0
Sports related
0.0
Support groups
0.0
A large proportion (34.2%) of ophthalmologists made comments that were related to policy
(Table 37). The majority (59.3%) of responses fell into the financial assistance to patients for
prescriptions subcategory, frequently regarding glaucoma medications. A smaller proportion
(29.6%) said that the greatest need was for assistance to indigent patients. One ophthalmologist
38
wrote “services for uninsured patients, financial aid for glaucoma medications,” while another
answered “patients unable to afford eye meds.”
Table 37. Ophthalmologists’ subcategories of policy responses to “greatest unmet community eye
care needs” question
Participants responding, N (%)
27 (34.2)
Policy subcategories (%)
Financial assistance with prescriptions
59.3
Lower co-pays for office visits
3.7
Higher reimbursements
3.7
Spectacles for Medicare
3.7
State funds for disability services
0.0
Pedestrian mobility paths
0.0
School screenings
0.0
Fund school spectacles
0.0
Assistance to indigent patients
29.6
Vision rehabilitation funding
0.0
Ophthalmologists were asked “what single action by a private foundation (such as the EyeSight
Foundation of Alabama) would make the greatest improvement in eye care in your community?”
(Table 38). Of those ophthalmologists who answered the question (60.4%), most responses
(59.2%) fell into the clinical care and screening subcategory. For example, responses from
ophthalmologists included: “free vision screening clinics,” and “preschool screening programs
expanded,” and “program for financial assistance for the uninsured.” Several participants
believed that the role of a private foundation should be with building relationships. One
ophthalmologist answered, “support the development of regional/national eye trauma care at
UAB. UAB and EFH already have many well developed resources in ocular trauma and the
development of such a center benefits virtually all eye care practitioners and eye care facilities in
the state.” Another ophthalmologist answered, “make it easier and faster for patients to get the
assistance needed.”
Table 38. Ophthalmologists’ responses to “What single action by a private foundation (such as the
EyeSight Foundation of Alabama) would make the greatest improvement in eye care in your
community?”
Participants responding, N (%)
67 (60.4)
Domains specified (%)
Fund research
1.5
Education (%)
20.9
Public education
100
Provider education
14.3
Accessibility (%)
6.0
Transportation to appointments
75.0
Policy
14.9
Clinical care and screening
52.2
Build relationships
6.0
Not sure
3.0
None
1.5
39
Optometrists
Overall, 63.4% (N=156) of the 246 participating optometrists responded to the question
regarding their community’s greatest unmet eye care needs (Table 39). The most common
comments were about clinical care (53.9%), education (21.2%), policy (12.2%), and eye care
organization (10.9%). Less frequent were comments regarding accessibility (5.1%). Of
responding optometrists, 9.0% reported that their community had no unmet needs or that they did
not know (1.9%).
Table 39. Optometrists’ responses to “greatest unmet community eye care needs” question
Participants responding, N (%)
156 (63.4)
General domains (%)
Clinical care
53.9
Education
21.2
Accessibility
5.1
Eye care organization
10.9
Policy
12.2
No needs
Do not know
9.0
1.9
Approximately 54% of optometrists made comments that the greatest unmet need involved
clinical care (Table 40). Most responses (61.0%) were categorized as being related to eye care.
For example, one optometrist wrote, “patients who have too much income to receive government
assistance, but cannot afford routine or medical eye care due to lack of insurance.” Of those who
felt that clinical care was the greatest unmet need, none specifically mentioned glaucoma
screening and diabetic retinopathy. Approximately 10% favored pediatric comprehensive eye
exams and pediatric screening was mentioned by 3.6%. Comments regarding refractive error
were mentioned by 14.3% of responding optometrists. Approximately 10% of responses
mentioned Hispanic eye care (3.6%) as the greatest unmet need.
Table 40. Optometrists’ subcategories for clinical care responses to “greatest unmet community eye
care needs” question
Participants responding, N (%)
84 (53.9)
Clinical care subcategories (%)
Eye care
61.9
Glaucoma screening
0.0
Diabetic retinopathy screening
0.0
Pediatric in general
9.5
Pediatric screening
3.6
Pediatric comprehensive eye exams
9.5
Hispanic care
9.5
Dry eye
0.0
Refractive error
14.3
40
Approximately 21% of responses from optometrists were related to education (Table 41). Of
those, 90.9% concerned public education. A typical response from an optometrist was, “diabetic
patients who do not know or understand why they need comprehensive eye care on a yearly
basis.” Provider education was mentioned by 9.1%. For example, one optometrist responded,
“primary care physicians and pediatricians not referring patients to optometrist due to their lack
of medical training education & understanding optometrists’ scope of practice.”
Table 41. Optometrists’ subcategories of education responses to “greatest unmet community eye
care needs” question
Participants responding, N (%)
33 (21.2)
Education subcategories (%)
Public education
90.9
Provider education
9.1
Comments from eight responding optometrists (5.1%) were related to accessibility, and of those,
50% were related to nursing home accessibility, and 37.5% were about the need to for
transportation to appointments (Table 42).
Table 42. Optometrists’ subcategories of accessibility responses to “greatest unmet community eye
care needs” question
Participants responding, N (%)
8 (5.1)
Accessibility subcategories (%)
Transportation to appointments
37.5
Satellite clinics
0.0
Nursing homes
50.0
Approximately 11% of responding optometrists made comments related to eye care organization
(Table 43). Most (70.6%) were about the need for more providers. Others were concerned about
the need for dyslexia services (5.9%), VA services (5.9%), handicapped children (5.9%), and
sports related (5.9%).
Table 43. Optometrists subcategories of eye care organization responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
17 (10.9)
Eye care organization subcategories (%)
More providers
70.6
New eye hospital
0.0
Dyslexia services
5.9
Disparities
0.0
Blind services
0.0
VA services
5.9
Handicapped children
5.9
Dual sensory impairment screening
0.0
Sports related
5.9
Support groups
0.0
41
A small proportion (12.2%) of optometrists made comments that were related to policy (Table
44). A large proportion of those responses were related to the need to provide financial assistance
to patients for prescriptions (26.3%). Smaller proportions mentioned spectacles for Medicare
patients (10.5%), lower co-pays for office visits (5.3%), higher reimbursements (5.3%), school
screenings (5.3%) and assistance to indigent patients (5.3%).
Table 44. Optometrists’ subcategories of policy responses to “greatest unmet community eye care
needs” question
Participants responding, N (%)
19 (12.2)
Policy subcategories (%)
Financial assistance with prescriptions
26.3
Lower co-pays for office visits
5.3
Higher reimbursements
5.3
Spectacles for Medicare
10.5
State funds for disability services
0.0
Pedestrian mobility paths
0.0
School screenings
5.3
Fund school spectacles
0.0
Assistance to indigent patients
5.3
Vision rehabilitation funding
0.0
Optometrists were asked “what single action by a private foundation (such as the EyeSight
Foundation of Alabama) would make the greatest improvement in eye care in your community?”
Of those optometrists who answered the question (52.4%), most responses (59.2%) fell into the
education category, and of those, 86% were about public education (Table 45). For example, one
optometrist answered, “provide education about the need for regular eye and other medical care
and coordinate agencies and sources to help with funding and transportation for the underserved,
non insured population.” Many of the responses (35.7%) fell into the clinical care category. One
optometrist answered, “assist patients in getting their prescription medication filled (those who
cannot afford to) or provide a central source that can refer.” Few respondents listed funding
research (3.9%) or accessibility (7.0%). Slightly more responses were related to policy (10.1%)
and to building relationships (10.9%).
Table 45. Optometrists’ responses to “What single action by a private foundation (such as the
EyeSight Foundation of Alabama) would make the greatest improvement in eye care in your
community?”
Participants responding, N (%)
129 (52.4)
Domains specified (%)
Fund research
3.9
Education (%)
38.8
Public education
86.0
Provider education
14.0
Accessibility (%)
7.0
Transportation to appointments
88.9
Policy
10.1
Clinical care and screening
35.7
Build relationships
10.9
Not sure
8.5
None
0.8
42
Vision rehabilitation providers
Overall, 67.9% (N=55) of the 81 participating rehabilitation providers responded to the question
regarding their community’s greatest unmet eye care needs (Table 46). The most frequent
comments were about clinical care (30.9%), education (30.9%), and accessibility (25.5%). Less
frequent were comments regarding eye care organization (16.4%) and policy (10.9%). A few
participants responded that their community had no needs (3.6%) or that they did not know
(3.6%).
Table 46. Rehabilitation providers’ responses to “greatest unmet community eye care needs”
question
Participants responding, N (%)
55 (67.9)
General domains (%)
Clinical care
30.9
Education
30.9
Accessibility
25.5
Eye care organization
16.4
Policy
10.9
No needs
Do not know
3.6
3.6
Approximately 31% of rehabilitation provider made comments that the greatest unmet need
involved clinical care (Table 47). Most responses (52.9%) fell into the eye care subcategory. For
example, one rehabilitation providers wrote, “affordable eye care and drug costs.” Refractive
error was mentioned by 17.7%, pediatric in general by 11.8% and glaucoma screening by 5.9%.
Table 47. Rehabilitation providers’ subcategories for clinical care responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
17 (30.9%)
Clinical care subcategories (%)
Eye care
52.9
Glaucoma screening
5.9
Diabetic retinopathy screening
0.0
Pediatric in general
11.8
Pediatric screening
0.0
Pediatric comprehensive eye exams
0.0
Hispanic care
0.0
Dry eye
0.0
Refractive error
17.7
43
Approximately 31% of responses from rehabilitation providers were related to education (Table
48). Of those, 82.5% concerned public education. A large proportion mentioned provider
education, for example, a typical response from a rehabilitation provider was, “ensuring that
persons who have low vision or vision impairment from brain injury are being referred for low
vision rehab services,” and another wrote, “there is a lack of understanding among/training of
ophthalmology residents in functional low vision.”
Table 48. Rehabilitation provider’s subcategories of education responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
17 (30.9)
Education subcategories (%)
Public education
82.5
Provider education
29.4
Fourteen comments from responding rehabilitation providers (25.5%) were related to
accessibility, and of those, 85.7% were about the need for transportation to appointments, 14.3%
for satellite clinics and 7.1% were related to nursing home accessibility (Table 49).
Table 49. Rehabilitation providers’ subcategories of accessibility responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
14 (25.5)
Accessibility subcategories (%)
Transportation to appointments
85.7
Satellite clinics
14.3
Nursing homes
7.1
Approximately 16% of responding rehabilitation providers made comments related to eye care
organization (Table 50). Most (55.6%) were about the need for more providers. Other comments
were concerned about the need for support groups (22.2%) and dual sensory impairment
screening (11.1%).
Table 50. Rehabilitation subcategories of eye care organization responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
9 (16.4)
Eye care organization subcategories (%)
More providers
55.6
New eye hospital
0.0
Dyslexia services
0.0
Disparities
0.0
Blind services
0.0
VA services
0.0
Handicapped children
0.0
Dual sensory impairment screening
11.1
Sports related
0.0
Support groups
22.2
44
A small proportion (10.9%) of rehabilitation providers made comments that were related to
policy (Table 51). Of those, most comments had to do with the need to provide financial
assistance to patients for prescriptions (50.0%). Smaller proportions mentioned pedestrian
mobility paths (16.7%), funding for school spectacles (16.7%) and vision rehabilitation funding
(16.7%).
Table 51. Rehabilitation providers’ subcategories of policy responses to “greatest unmet
community eye care needs” question
Participants responding, N (%)
6 (10.9)
Policy subcategories (%)
Financial assistance with prescriptions
50.0
Lower co-pays for office visits
0.0
Higher reimbursements
0.0
Spectacles for Medicare
0.0
State funds for disability services
0.0
Pedestrian mobility paths
16.7
School screenings
0.0
Fund school spectacles
16.7
Assistance to indigent patients
0.0
Vision rehabilitation funding
16.7
Rehabilitation providers were asked “what single action by a private foundation (such as the
EyeSight Foundation of Alabama) would make the greatest improvement in eye care in your
community?” A large proportion (67.9%) answered the question (Table 52). Of those
rehabilitation providers who answered, 38.2% of comments fell into the clinical care and
screening subcategory and 30.9% concerned education (75.5% public and 23.5% provider).
Categories of other responses included 10.9% accessibility (100% transportation to
appointments), 9.1% policy, and 7.3% to build relationships. Approximately 7% were not sure.
One rehabilitation provider wrote, “low income kids who receive glasses through agencies and
they are broken before they are eligible for new pair; schools deal with this issue,” while another
wrote, “continue to support rural eye care and teacher training since we are finally reaching the
persons who may move to these areas or go there for education and eye care.”
Table 52. Rehabilitation providers’ responses to “What single action by a private foundation (such
as the EyeSight Foundation of Alabama) would make the greatest improvement in eye care in your
community?”
Participants responding, N (%)
55 (67.9)
Domains specified (%)
Fund research
0.0
Education (%)
30.9
Public education
76.5
Provider education
23.5
Accessibility (%)
10.9
Transportation to appointments
100
Policy
9.1
Clinical care and screening
38.2
Build relationships
7.3
Not sure
7.3
None
0.0
45
DISCUSSION
This report presents details about the numbers of eye care providers in Alabama and their county
of location, and among survey participants, descriptive information about provider
demographics, training, and experience; practice and patient characteristics, as well as provider
opinions. It is our hope that survey results will be utilized and referenced by researchers and
policy makers interested in the eye health of Alabamians. Below we discuss some highlights of
our survey results in terms of relevance to public eye health in Alabama.
The majority of participating ophthalmologists, optometrists and rehabilitation providers in
Alabama identified themselves as white of non-Hispanic origin. Few minorities were represented
in any of the provider groups; 0.9% of ophthalmologists, 6.6% of optometrists and 13.6% of
rehabilitation providers indicated they were African American. Over one-quarter of Alabama’s
population is African American according to the 2010 U.S. Census.21 Research suggests that
provider-patient communication and the use of preventive services can be facilitated when there
is racial/ethnic concordance between providers and patients.22 Communication problems with
eye care providers have been identified by African Americans as a barrier to seeking eye
care.13,14 Research also indicates that African American physicians are more likely to care for
patients in predominantly African American communities, underinsured patients, underserved
patients, and those covered by Medicaid.23,24 Thus, it is possible that an increase in the number of
African American ophthalmologists and optometrists in Alabama would have positive benefits
on eye health in the state.
Compared to optometrists, ophthalmologists were on average, approximately seven years older
and fewer were women (11.2% versus 44.3%). The vast majority (80.3%) of rehabilitation
providers were women. These demographic results for all three types of eye care providers in
Alabama are consistent with national demographic estimates for these providers in the United
States. For example, the Association of Schools and Colleges of Optometry estimates that a
small proportion of optometrists graduating in 2009-2010 were African American (2.7%) and
that the majority (65%) were women.25 The American Academy of Ophthalmology (AAO),
whose membership included 95% of practicing ophthalmologists does not collect race
information; however, AAO estimates for year 2012 that approximately 20% of practicing
ophthalmologists are women, whereas 42% of ophthalmologists in training (residency and
fellowships) are women.26
Ophthalmologists and optometrists reported that on average 32.6% and 30.3% of the patients
they treated, respectively, were African American. Previous research indicates that rates of
vision impairment and eye disease among African Americans are two times higher than those of
whites, especially uncorrected refractive error, cataract, glaucoma, and diabetic retinopathy.27-29
Glaucoma is at least four to five times higher in African Americans as compared to persons of
European descent.29,30 In addition, the disease progresses more rapidly and appears about 10
years earlier in African Americans.27,31-36 Older African Americans are less likely to receive
routine, comprehensive eye care, when newly emerging eye conditions could be detected and
treated in a timely fashion,37-39 which could be contributing to their higher rates of eye disease
and vision impairment. When they eventually enter treatment, their eye conditions are often in
46
more advanced forms accompanied by irreversible vision impairment, and thus more difficult to
treat, as compared to whites.
The public health challenges to decrease blindness and vision impairment in Alabama are likely
to increase, not only due to the aging of the population, but because of the growing prevalence of
diabetes. In addition to diabetic retinopathy, those with diabetes are at increased risk for
glaucoma,30,41 and cataracts.42,43 Based on CDC estimates, Alabama has a higher prevalence of
diabetes than any other state, i.e., 13.2% of those persons over the age of 16.44 In 2008, African
American Alabamians had a diabetes mortality rate (52.0/100,000 people) that was 2.5 times
greater than White Alabamians (20.6/100,000 people).45 The increased incidence of diabetes
nationwide is in large part due to increased obesity, 46 .and it is estimated that over 80 percent of
those diagnosed with type 2 diabetes are obese.47 Recently, the CDC estimated that over 32% of
Alabama adults were obese (body mass index > 30 km/m2), second to Mississippi (34%), which
is first among states in obesity rates.48 Even more troubling is that greater numbers of children
are now obese. Nationwide, beginning in the early 1970s, the prevalence of obesity increased
from 5.0% to 10.4% among children aged 2-5, from 4.0% to 19.6% among children aged 6-11,
and from 6.1% to 18.1% for those aged 12-19. Further, African American girls have the highest
obesity rates (29.2%) among all childhood gender-racial groups.49 Since obesity is a risk factor
for diabetes and more children are now obese, it is not surprising that more young people are
being diagnosed with type 2 diabetes.50,51 Thus, it is expected that more people, including more
at younger ages, will be at risk for diabetic eye diseases.
Nearly all people with diabetes will have diabetic retinopathy to some degree.52 Diabetic
retinopathy is the leading cause of blindness among working age adults in the United States.
Recent estimates suggest a prevalence rate of 3.4% (approximately 4 million people), of which
approximately 20% is vision threatening.53 The 2008 prevalence of diabetic retinopathy in
Alabama among those with diabetes 40 years and older and based on self-report is estimated to
be 23.6%.54 The natural history of diabetic retinopathy is well characterized and is due to leakage
and blockage of small vessels in the retina, resulting in swelling of retinal tissue, angiogenesis,
cell death and retinal detachments.52. Those with type 1 or type 2 diabetes are at risk, and
duration of diabetes and glycemic control are associated with onset of diabetic retinopathy.
In the current survey, ophthalmologists, optometrists, and rehabilitation providers estimated that
27%, 22% and 28%, respectively, of their patients had diabetes. Providers estimated the
proportion of diabetic patients that adhered to eye care guidelines was 61.4% among
ophthalmology patients and 53% among optometry patients. In addition, ophthalmologists and
optometrists estimated that 20% and 14%, respectively, of their patients had diabetic eye
conditions including diabetic retinopathy. Alabama’s prevalence of diabetic retinopathy among
those 65 and older is in the top 25% of reporting states.55 Fortunately, early detection and
monitoring with timely treatment, e.g., retinal laser photocoagulation, can stop or slow disease
progression. Diabetic retinopathy is detected by eye care providers through a comprehensive eye
examination that includes pupil dilation and examination of the fundus; however, only about half
of all people with diabetes receive recommended annual comprehensive eye examinations.56
Compared to ophthalmologists and optometrists, a greater number of rehabilitation providers
stated that accessibility, e.g., transportation to appointments, was the greatest unmet eye care
47
need in their community. This is not surprising since their patient base, by definition, consists of
visually impaired persons experiencing difficulties with the visual activities of daily living.
Based on figures within the report, it is apparent that many Alabama communities are
geographically isolated from eye care services. Due to long travel distances, people who live in
rural areas have increased barriers to receive basic and specialized eye care, and vision
rehabilitation services. Those that are geographically isolated with early asymptomatic eye
diseases are more likely to delay eye care until their symptoms become apparent. Early detection
of eye diseases can help reduce disability through timely intervention, slowing disease
progression. Compounding the inherent lack of access due to distance, many rural and Black Belt
counties have large African American populations, who are at increased risk for glaucoma, and
due to the high prevalence of diabetes, increased risk for diabetic eye conditions. Due to income
and geographic disparities, the Black Belt region has long suffered from lack of healthcare
services necessary for early detection and treatment of chronic diseases.57
Additional disparities are related to the decreasing numbers of general and specialty
ophthalmologists. A frequently expressed opinion among participating ophthalmologists,
optometrists and vision rehabilitation providers was the need for more providers. A recent
analysis concluded that due to changing patient demographics, retirement, and a fixed number of
ophthalmology residency slots nationwide, ophthalmology will face substantial challenges in
manpower by year 2020.58 Even with existing numbers of providers, current care patterns often
fail to meet AAO Preferred Practice Patterns; for example, studies have reported that open-angle
glaucoma patients are likely to have incomplete assessments,59 receive less than recommended
testing,60,61 and otherwise receive wide variation in treatment.62 In addition, fewer
ophthalmologists are sub-specializing in a number of ophthalmology fields. For example, fewer
ophthalmologists are entering the field of neuro-ophthalmology because of poor compensation
compared to other subspecialities.63 For similar reasons, other ophthalmology subspecialties
experiencing dwindling numbers of practitioners include uveitis, pediatrics, and pathology.64
There are currently no programs that provide encouragement (e.g., financial incentives, tuition
coverage) for optometrists to practice in rural areas. Before 2002, optometrists were able to
participate in the National Health Service Corps student loan program administered by the
Centers for Medicare and Medicaid Services that supports new graduates to work in underserved
communities in exchange for educational loan repayment; however, due to a legislative
oversight, they were excluded from the program when it was restructured.65 Potentially, new
federal legislation, i.e., H.R. 1195 (National Health Service Corps Improvement Act of 2011),
introduced in March 2011 and currently before committee, will address this and optometrists will
once again be able to participate in the program.66 In addition, the University of Alabama’s
College of Community Health Sciences’ has had success through their Rural Health Leaders
Pipeline in increasing the numbers of rural students who prepare for health and medical careers.
As of 2011, 84 participants of their Rural Medical Scholars Program have graduated from
medical school, and of these physicians, 21 practice in rural Alabama counties, the majority in
primary care and family medicine.67
By utilizing current technologies, telemedicine has the potential to fill some of the gaps in rural
eye care services by removing distance barriers and providing patients remote access to eye care
specialists who screen, diagnose, and manage eye diseases. Telemedicine is well suited for vision
48
and eye disease screening services and also monitoring of disease through imaging and other
specialized tests because of the low invasiveness of testing, wider spread availability and
affordability of imaging technologies, high levels of diagnostic reliability,68 and ease of training
of testing personnel.69 Telemedicine has the potential to be used to screen for and monitor
diabetic retinopathy, retinopathy of prematurity, age-related macular degeneration, and
glaucoma.70 Research has established the effectiveness of using digital fundus imaging with
remote image interpretation for screening of diabetic retinopathy in developing nations,71 among
a prison population with type 2 diabetes,72 and by the Indian Health Service for screening of
Alaskan Natives.73 Acceptance of telemedicine has increased steadily over the years stemming
from its proven efficacy and cost-effectiveness, specifically in the areas of screening for diabetic
eye conditions through fundus photography.
UAB investigators are currently participating in the Insight Collaborative Network Research
Study, a CDC sponsored multi-center study of diabetes eye screening in the community setting.
The UAB site location is the Internal Medicine Clinic at Cooper Green Hospital in Birmingham.
The objective of the study, lead by the UAB Department of Ophthalmology, is to determine the
feasibility and effectiveness of using an automated, non-invasive, non-mydriatic (no dilating
drops needed) fundus camera to screen and detect diabetic retinopathy and other ocular diseases.
Each of the four sites will recruit 500 adult patients with diabetes. Those who screen positive
will be referred for a follow-up comprehensive eye examination. Questions that the study will
help answer include: determining the number of patients undergoing retinal image screening at
each site; the rates of positive screening for diabetic retinopathy and diabetic macular edema; the
rate for follow-up scheduling for comprehensive eye examinations among those who screen
positive; and the rate of those who actually receive follow-up care.
To develop a telemedicine eye care program for under-served areas of Alabama would require
strong health care organization leadership supported by an organizational framework that
includes all stakeholders, e.g., community leaders, eye care providers, and policy makers to
secure financing and direct where resources are best used. Similar programs are currently
underway in other regions of the US,73-75 but still require rigorous evaluation. In addition to
increased access, telemedicine has been shown to be efficient and effective. Relative to other
screening programs, telemedicine programs may require high startup costs for infrastructure that
are often supported by federal,76 and state initiatives;77 however, successful programs that are
accepted by communities, ultimately lead to decreased costs.78,79 Scientific evaluation, e.g., the
proportion of those who screen positive who are ultimately seen by an ophthalmologist, would
be necessary to judge the effectiveness of any intervention. It is also critical to evaluate the costeffectiveness of the program, as compared to a system that does not rely on telemedicine.
Strengths and Limitations of the Survey
The study was strengthened by involving a number of organizations and individuals who assisted
in comprehensively identifying eye care providers currently practicing in the state of Alabama.
By survey participation standards, participation was adequate among ophthalmologist (> 50%)
but was less than optimal for optometrists (38.6%) and rehabilitation providers (45.5%). The
current survey exceeded the previous survey in total number of providers identified and
49
contacted, and in participation rates, i.e., the previous survey reported a 34.0% participation rate
(127 of 373) for ophthalmologists (38%) and optometrists (30%).19
Future Considerations
Four challenges emerge from this survey that, if addressed by well thought-out strategies in the
coming decade, could potentially deliver significant benefit to the eye health of Alabamians.
These topics are not listed in any recommended priority, but rather, are offered for consideration
by the Foundation, professionals in this area, and the public.
There is a need for more eye care providers, including more African American providers.
Policies and programs that introduce incentives to eye care providers to provide services in more
rural areas of the state could be beneficial to the eye health of the state.
With the high rate of diabetes in Alabama, there is a need to develop and implement an eye care
system that improves detection and follow-up management of the ocular complications of
diabetes, both medically and in terms of cost.
Many Alabama communities are geographically isolated from eye care services. Improved
access to eye care may be achievable by creating satellite eye care practices in underserved
communities, introducing telemedicine to eye care organization, and improving transportation
services in the state.
Regardless of the types of programs introduced, there will be a need to scientifically evaluate
these and any other public eye health interventions to improve the quality of and access to eye
care in Alabama, in terms of their impact on both health outcomes and cost, so that eye health
strategies in the state are evidence-based.
50
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56
APPENDIX A
ELIGIBLE AND PARTICIPATING PROVIDERS BY COUNTY
57
Provider counties by eligibility and participations
County
Autauga
Baldwin
Barbour
Bibb
Blount
Butler
Calhoun
Chambers
Cherokee
Chilton
Choctaw
Clarke
Cleburne
Coffee
Colbert
Conecuh
Covington
Crenshaw
Cullman
Dale
Dallas
DeKalb
Elmore
Escambia
Etowah
Fayette
Franklin
Geneva
Greene
Henry
Houston
Jackson
Jefferson
Lamar
Lauderdale
Lee
Limestone
Macon
Madison
Marengo
Marion
Marshall
Mobile
Montgomery
Ophthalmologist
Eligible
Participants
0
5
0
0
0
0
4
1
0
0
2
0
0
1
2
0
0
0
0
0
1
0
0
0
5
0
0
0
0
0
19
0
79
0
5
5
1
0
19
0
0
0
26
20
-2
----1
0
--0
--0
1
-----0
---3
-----9
-46
-1
2
1
-10
---11
10
Optometrists
Eligible
Participants
7
23
4
1
1
3
16
1
1
6
0
2
1
10
6
1
6
1
9
5
1
6
4
5
10
3
5
1
1
2
18
8
175
1
13
12
10
1
53
2
4
17
33
31
1
4
1
0
1
1
4
0
0
4
-1
1
2
4
0
3
1
2
0
1
3
0
2
4
1
2
0
0
1
6
2
80
0
7
2
3
0
23
0
3
6
15
15
Vision rehabilitation
Eligible
Participants
1
1
0
0
1
0
3
0
0
0
0
0
0
0
1
0
0
0
4
0
0
1
0
0
5
0
0
0
0
0
3
0
71
0
3
4
1
1
9
1
0
1
12
9
0
1
--1
-0
-------0
---3
--0
--2
-----0
-27
-1
1
1
0
7
0
-0
7
5
58
Provider counties by eligibility and participations
County
Morgan
Perry
Pickens
Pike
Russell
St Clair
Shelby
Sumter
Talladega
Tallapoosa
Tuscaloosa
Walker
Winston
Ophthalmologist
Eligible
Participants
2
0
0
0
1
0
5
0
3
1
6
1
0
1
---1
-2
-3
0
4
1
--
Optometrists
Eligible
Participants
13
1
2
5
3
8
49
1
5
5
18
7
1
1
0
0
3
0
0
22
1
1
2
8
2
0
Vision rehabilitation
Eligible
Participants
5
0
0
2
0
4
9
0
16
0
9
0
0
3
--0
-3
5
-11
-3
---
No providers were identified in the following counties: Bullock, Clay, Coosa, Hale, Lawrence,
Lowndes, Monroe, Randolph, Washington, and Wilcox.
Regional classifications based on ALDPH definitions:
Metro (Autauga, Baldwin, Blount, Calhoun, Colbert, Dale, Elmore, Etowah, Houston, Jefferson,
Lauderdale, Lawrence, Lee, Limestone, Madison, Mobile, Montgomery, Morgan, Russell, Saint Clair,
Shelby, Tuscaloosa);
North rural (Cherokee, Clay, Cleburne, Cullman, DeKalb, Fayette, Franklin, Jackson, Lamar, Marion,
Marshall, Randolph, Talladega, Walker, Winston);
South rural (Barbour, Bibb, Butler, Chambers, Chilton, Clarke, Coffee, Conecuh, Coosa, Covington,
Crenshaw, Escambia, Geneva, Henry, Monroe, Pike, Tallapoosa, and Washington);
Black belt (Bullock, Choctaw, Dallas, Greene, Hale, Lowndes, Macon, Marengo, Perry, Pickens, Sumter,
and Wilcox)
59
APPENDIX B
PROVIDER SPECIFIC SURVEYS FOR:
1. Ophthalmologists
2. Optometrists
3. Vision rehabilitation providers
60
Survey of Alabama Ophthalmologists
Thank you for taking a brief moment out of your day to complete this survey. You’ll notice that
it is short and goes quickly. We’d appreciate it if the person this survey is addressed to is the one
who actually completes the survey, rather than someone from your staff. Thank you!
What is the name of your
business/practice/clinic/agency where you
provide eye care services?
City or Town:
County:
Day/Hours you provide service to patients
or clients?
Days:
Hours:
If you have a website, please list it.
1. What is the type of clinic/agency where you are primarily based? Please check all that apply.
Private practice with at least one Ophthalmologist
Private practice with at least one Optometrist
Practice based in a university
Department of Veterans Affairs clinic or medical center
Rehabilitation hospital
General hospital
Outpatient rehabilitation center
Independent service for the visually impaired
State agency
Optical retail store
Other, specify: ____________________________________
2. What is your race/ethnicity?
White, non-Hispanic
African-American
Hispanic
Asian
Native American
Other
3. What is your age?
years
4. What is your gender?
Male
Female
5. In what year did you complete your Residency Training in Ophthalmology?
______________
61
Survey of Alabama Ophthalmologists
6. Following your Residency, did you complete Fellowship Training in a Subspecialty?
No
Yes
7. If Yes, what is your Subspecialty?
Retina
Glaucoma
Cornea
Pediatric Ophthalmology & Strabismus
Neuro-Ophthalmology
Oculoplastics
Visual Rehabilitation
Ophthalmic Pathology
Ocular Inflammatory Disease
Other ___________________________
8. Please list the city/town of all office locations in Alabama where you yourself provide in-clinic
services.
1.___________________________
2.___________________________
3.___________________________
4.___________________________
5.___________________________
9. Please list all the hospitals or surgery centers where you yourself provide surgical services along
with their town or city.
1. Hospital or surgery center name:__________________________ City/town _____________________
2. Hospital or surgery center name:__________________________ City/town _____________________
3. Hospital or surgery center name:__________________________ City/town _____________________
4. Hospital or surgery center name:__________________________ City/town _____________________
5. Hospital or surgery center name:__________________________ City/town _____________________
10. Other than the clinic setting that you answered above, are you currently providing eye care services
in any of the following settings? Please check all that apply.
Public or private schools (day programs)
Residential schools (e.g., Alabama Institute for the Deaf & Blind, residential schools for the
developmentally delayed)
General hospitals
In-patient psychiatric hospitals
Nursing homes
State or Federal prisons or local jails
Other. Specify: _________________________________________________________
62
Survey of Alabama Ophthalmologists
11. Please place a check by any of the following services you yourself provide:
Comprehensive Eye Care for Adults
Comprehensive Eye Care for Infants and Children
Contact Lens fitting and dispensing
Cataract Surgery
Refractive Surgery
Retinal – Vitreal Surgery
Glaucoma Surgery
Corneal Surgery
Oculo-plastic Surgery
Visual Rehabilitation Services
Neuro-Ophthalmological Services
Other. Specify: _______________________________________________
12. Do you provide services in a group practice?
Yes
No
13. If Yes, what are the names of the ophthalmologists and/or the other health care providers who
practice in your group? Please circle what type of healthcare provider they are.
1. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
2. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
3. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
4. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
5. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
6. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
7. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
14. Do you have an optical service or shop at your practice?
Yes
No
15. Does your practice/clinic provide services in Spanish?
Yes
No
16. What is your best estimate of the typical time between the call for an appointment and the first
available appointment in your clinic/agency/practice?
Less than 1 week
1 to 2 weeks
3 to 4 weeks
More than a month
Don’t know
63
Survey of Alabama Ophthalmologists
17. Do you take “walk-ins”, that is, a person who does not have an appointment?
Yes
Only if it is an emergency and an established patient
No
18. Please estimate the number of patients you see personally (regardless of location) in a typical week.
This includes both clinic patients and surgery patients. We realize this may vary from week to week.
Just estimate for what you would consider a typical week.
Approximate number of patients/week_______
19. Below is a list of age ranges. Please estimate what percentage (%) of your patients fall within the
following age categories. You do not have to know precisely. We are just looking for your best estimate.
_______ Under 5 years
_______ 5 to 19 years
_______ 20 to 59 years
_______ 60 to 79 years
_______ 80 years and over
20. Below is a list of ethnic/racial groups. Please estimate what percentage (%) of your patients fall
into each group. You do not have to know precisely. We are just looking for your best estimate.
_______ White, non-Hispanic
_______ African-American
_______ Hispanic
_______ Asian
_______ Native American
_______ Other
21. Please estimate what percentage (%) of your patients are male and female. You do not have to know
precisely. We are just looking for your best estimate.
_______ Male
_______ Female
22. Below is a list of health insurance types. Please estimate what percentage (%) of your patients have
the following kinds of insurance. You do not have to know precisely. We are just looking for your best
estimate. (These don’t have to add up to 100% because patients may have more than one type of
insurance.)
_______ Medicare
_______ Medicaid
_______ Private insurance
_______ No insurance
_______ Other (Specify: __________________________)
64
Survey of Alabama Ophthalmologists
23. What types of health insurance do you accept toward payment in your practice or clinic? Please
place a check by each type you accept.
_______ Medicare
_______ Medicare Complete
_______ Medicaid
_______ Blue Cross Blue Shield
_______ Viva
_______ Viva Medicare Plus
_______ United Healthcare
_______ Cigna
_______ Aetna
_______ Multiplan
_______ GEHA
_______ Tricare/Champus
_______ Veterans Administration coverage
_______ CHIP (Children’s Health Insurance Program)
_______ Others, Specify: ___________________________________________________
_______ I don’t accept health insurance as payment.
24. Below is a list of eye conditions. What percentage (%) of your patients has each of the following eye
conditions or diseases? You do not have to know precisely. We are just looking for your best estimate.
(These don’t have to add up to 100% because patients may have multiple problems.)
_______ Refractive error
_______ Amblyopia
_______ Strabismus
_______ Dry eye
_______ Age-related macular degeneration
_______ Glaucoma
_______ Diabetic eye conditions including retinopathy
_______ Cataract
_______ Vision loss from brain injury including stroke
_______ Juvenile or young adult onset retinal degenerations (e.g. retinitis pigmentosa,
rod-cone dystrophies)
_______ Optic neuritis or other optic nerve disorders
_______ Retinopathy of prematurity
_______ Corneal problems
_______ Complications from contact lens wear
_______ Dry eye
_______ Conjunctivitis
_______ Ocular trauma
_______ Other. Specify: __________________________________________________
65
Survey of Alabama Ophthalmologists
25. What percentage (%) of your patients are diabetics (either Type 1 or Type 2)? You do not have to
know precisely. We are just looking for your best estimate.
_________%
26. What percentage (%) of your diabetic patients adhere to guidelines for annual comprehensive eye
examination? You do not have to know precisely. We are just looking for your best estimate.
_________%
27. We are interested in how your patients “find you”. What percent (%) of your patients are referred
from the following sources. You do not have to know precisely. We are just looking for your best
estimate. (These don’t have to add up to 100% because a client may be referred by multiple sources.)
_______Refer themselves.
_______Referred by family or friends
_______Referred by an ophthalmologist.
_______Referred by an optometrist
_______Referred by another physician including a family physician.
_______Referred by hospital emergency room.
_______Referred by school or pre-school vision screening program.
_______Other, specify: ___________________________________________________
28. What percentage (%) of your patients have “low vision”. A commonly used definition for low
vision is visual acuity worse than 20/60 in both eyes with best refraction, and/or visual field loss in
both eyes of less than 10 degrees from fixation.
_________%
29. For your patients with low vision who are in need of visual rehabilitation services, where do you
refer them? Please check all that are appropriate.
_______ My own practice provides rehabilitation services so they are taken care of in my own practice.
_______ Alabama Department of Rehabilitation Services (e.g., OASIS, vocational rehab)
_______ State, county, or city/town educational services
_______ UAB School of Optometry low vision clinic
_______ UAB Center for Low Vision Rehabilitation
_______ St. Vincent’s East, Birmingham AL
_______ Other, Specify: ___________________________________________________
66
Survey of Alabama Ophthalmologists
30. What are the greatest unmet eye care needs in your community?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
___________________________________________________________________________________
31. What single action by a private foundation (such as the EyeSight Foundation of Alabama) would
make the greatest improvement in eye care in your community? Please explain why?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
67
Survey of Alabama Optometrists
Thank you for taking a brief moment out of your day to complete this survey. You’ll notice that it is
short and goes quickly. We’d appreciate it if the person this survey is addressed to is the one who
actually completes the survey, rather than someone from your staff. Thank you!
What is the name of your
business/practice/clinic/agency where you
provide eye care services?
City or Town:
County:
Day/Hours you provide service to patients
or clients?
Days:
Hours:
If you have a website, please list it.
1. What is the type of clinic/agency where you are primarily based? Please check all that apply.
Private practice with at least one Ophthalmologist
Private practice with at least one Optometrist
Practice based in a university
Department of Veterans Affairs clinic or medical center
Rehabilitation hospital
General hospital
Outpatient rehabilitation center
Independent service for the visually impaired
State agency
Optical retail store
Other, specify: ____________________________________
2. What is your race/ethnicity?
White, non-Hispanic
African-American
Hispanic
Asian
Native American
Other
3. What is your age?
years
4. What is your gender?
Male
Female
5. In what year did you receive your O.D. degree?
______________
68
Survey of Alabama Optometrists
6. Following optometry school, did you do a residency in a specialty area of optometry?
No
Yes
7. If Yes, what was your specialty training in? Please check all that apply.
Community Health Optometry
Cornea and Contact Lenses
Family Practice Optometry
Geriatric Optometry
Low Vision Rehabilitation
Pediatric Optometry
Primary Eye Care
Refractive and Ocular Surgery
Vision Therapy
Other. Specify: ___________________________________
8. Please list the city/town of all office locations in Alabama where you yourself provide in-clinic
services.
1.___________________________
2.___________________________
3.___________________________
4.___________________________
5.___________________________
9. Other than the clinic settings you listed above, are you currently providing eye care services in any
of the following settings? Please check all that apply.
Public or private schools (day programs)
Residential schools (e.g., Alabama Institute for the Deaf & Blind, residential schools for the
developmentally delayed)
General hospitals
In-patient psychiatric hospitals
Nursing homes
State or Federal prisons or local jails
Other. Specify: _________________________________________________________
10.
Please place a check by any of the following services you yourself provide:
Comprehensive Eye Care for Adults
Comprehensive Eye Care of Infants and Children
Contact Lens Fitting and Dispensing
Vision Therapy
Low Vision Rehabilitation Services
Other. Specify: ________________________________________________
69
Survey of Alabama Optometrists
11.
Do you provide services in a group practice?
Yes
No
12.
If Yes, what are the names of the optometrists, ophthalmologists, and/or the other health care
providers who practice in your group? Please circle what type of healthcare provider they are.
1.
2.
3.
4.
5.
6.
7.
13.
_________________________Optometrist/Ophthalmologist/Other: Specify ________________
_________________________Optometrist/Ophthalmologist/Other: Specify ________________
_________________________Optometrist/Ophthalmologist/Other: Specify ________________
_________________________Optometrist/Ophthalmologist/Other: Specify ________________
_________________________Optometrist/Ophthalmologist/Other: Specify ________________
_________________________Optometrist/Ophthalmologist/Other: Specify ________________
_________________________Optometrist/Ophthalmologist/Other: Specify ________________
Do you have an optical service or shop at your practice?
Yes
No
14.
Does your practice/clinic provide services in Spanish?
Yes
No
15. What is your best estimate of the typical time between the call for an appointment and the first
available appointment in your clinic/agency/practice?
Less than 1 week
1 to 2 weeks
3 to 4 weeks
More than a month
Don’t know
16. Do you take “walk-ins”, that is, a person who does not have an appointment?
Yes
Only if it is an emergency and an established patient
No
17. Please estimate the number of patients you see personally (regardless of location) in a typical week.
We realize this may vary from week to week. Just estimate for what you would consider a typical week.
Approximate number of patients/week_______
18. Below is a list of age ranges. Please estimate what percentage (%) of your patients fall within the
following age categories. You do not have to know precisely. We are just looking for your best estimate.
_______ Under 5 years
_______ 5 to 19 years
_______ 20 to 59 years
70
Survey of Alabama Optometrists
_______ 60 to 79 years
_______ 80 years and over
19. Below is a list of ethnic/racial groups. Please estimate what percentage (%) of your patients fall
into each group. You do not have to know precisely. We are just looking for your best estimate.
_______ White, non-Hispanic
_______ African-American
_______ Hispanic
_______ Asian
_______ Native American
_______ Other
20. Please estimate what percentage (%) of your patients are male and female. You do not have to know
precisely. We are just looking for your best estimate.
_______ Male
_______ Female
21. Below is a list of health insurance types. Please estimate what percentage (%) of your patients have
the following kinds of insurance. You do not have to know precisely. We are just looking for your best
estimate. (These don’t have to add up to 100% because patients may have more than one type of
insurance.)
_______ Medicare
_______ Medicaid
_______ Private insurance
_______ No insurance
_______ Other (Specify: __________________________)
22. What types of health insurance do you accept toward payment in your practice or clinic? Please
place a check by each type you accept.
Medicare
Medicare Complete
Medicaid
Blue Cross Blue Shield
Viva
Viva Medicare Plus
United Healthcare
Cigna
Aetna
Multiplan
GEHA
Tricare/Champus
Veterans Administration coverage
CHIP (Children’s Health Insurance Program)
71
Survey of Alabama Optometrists
Others, Specify: ___________________________________________________
I don’t accept health insurance as payment.
23. Below is a list of eye conditions. What percentage (%) of your patients has each of the following eye
conditions or diseases? You do not have to know precisely. We are just looking for your best estimate.
(These don’t have to add up to 100% because patients may have multiple problems.)
_______ Refractive error
_______ Amblyopia
_______ Strabismus
_______ Dry eye
_______ Age-related macular degeneration
_______ Glaucoma
_______ Diabetic eye conditions including retinopathy and macular edema
_______ Cataract
_______ Vision loss from brain injury including stroke
_______ Juvenile or young adult onset retinal degenerations (e.g. retinitis pigmentosa, rod-cone
dystrophies)
_______ Optic neuritis or other optic nerve disorders
_______ Retinopathy of prematurity
_______ Corneal problems
_______ Complications from contact lens wear
_______ Dry eye
_______ Conjunctivitis
_______ Ocular trauma
_______ Other
24. What percentage (%) of your patients are diabetics (either Type 1 or Type 2)? You do not have to
know precisely. We are just looking for your best estimate.
_________%
25. What percentage (%) of your diabetic patients adhere to guidelines for annual comprehensive eye
examination? You do not have to know precisely. We are just looking for your best estimate.
_________%
26. We are interested in how your patients “find you”. What percent (%) of your patients are referred
from the following sources. (You do not have to know precisely. We are just looking for your best
estimate.) (These don’t have to add up to 100% because a client may be referred by multiple sources.)
_______ Refer themselves.
_______ Referred by family or friends
_______ Referred by an ophthalmologist.
_______ Referred by an optometrist.
_______ Referred by another physician including a family physician.
_______ Referred by hospital emergency room.
_______ Referred by school or pre-school vision screening program.
72
Survey of Alabama Optometrists
_______ Other, specify: ___________________________________________________
27. What percentage (%) of your patients have “low vision”. A commonly used definition for low
vision is visual acuity worse than 20/60 in both eyes with best refraction, and/or visual field loss in
both eyes of less than 10 degrees from fixation.
_________%
28.
For your patients with low vision who are in need of visual rehabilitation services, where do you
refer them? Please check all that are apply.
My own practice provides rehabilitation
Alabama Department of Rehabilitation Services (e.g., OASIS, vocational rehab)
State, county, city/town educational services
UAB School of Optometry low vision clinic
UAB Center for Low Vision Rehabilitation
St. Vincent’s East, Birmingham AL
Other, Specify: ___________________________________________________
29. What are the greatest unmet eye care needs in your community?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
30. What single action by a private foundation (such as the EyeSight Foundation of Alabama) would
make the greatest improvement in eye care in your community? Please explain why.
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
73
Survey of Alabama Vision Rehabilitation Providers
Thank you for taking a brief moment out of your day to complete this survey. You’ll notice that it is
short and goes quickly. We’d appreciate it if the person this survey is addressed to is the one who
actually completes the survey, rather than someone from your staff. Thank you!
What is the name of your
business/practice/clinic/agency where you
provide eye care services?
City or Town:
County:
Day/Hours you provide service to patients
or clients?
Days:
Hours:
If you have a website, please list it.
1. What is the type of clinic/agency where you are primarily based? Please check all that apply.
Private practice with at least one Ophthalmologist
Private practice with at least one Optometrist
Practice based in a university
Department of Veterans Affairs clinic, medical center or rehabilitation center
Rehabilitation hospital
General hospital
Outpatient rehabilitation center
Independent service for the visually impaired
State agency
Optical retail store
Other, specify: ____________________________________
2. What is your race/ethnicity?
White, non-Hispanic
African-American
Hispanic
Asian
Native American
Other
3. What is your age?
years
4. What is your gender?
Male
Female
74
Survey of Alabama Vision Rehabilitation Providers
5. In what year did you receive your highest degree that is rehabilitation related?
______________
6. Which of the following best describes what type of visual rehabilitation professional you are? Please
check all that apply.
Occupational Therapist
Occupational Therapist Assistant
Vision Rehabilitation Teacher
Certified Low Vision Therapist (CLVT)
Social Worker
Orientation and Mobility Specialist
Rehabilitation Counselor
Vocational Rehabilitation Counselor
Psychologist
Educator of the Visually Impaired (Professionals with a special education degree)
Other: Specify _____________________________________________________
7. Please list the city/town of all office locations in Alabama where you yourself provide in-clinic
services.
1.___________________________
2.___________________________
3.___________________________
4.___________________________
5.___________________________
8.
Check this box if you provide in-home services.
9. Other than the clinic settings you listed above, are you currently providing eye care services in any
of the following settings? Please check all that apply.
Public or private schools (day programs)
Residential schools (e.g., Alabama Institute for the Deaf & Blind, residential schools for the
developmentally delayed)
General hospitals
In-patient psychiatric hospitals
Nursing homes
State or Federal prisons or local jails
Other. Specify: _________________________________________________________
10. Please place a check by any of the following services you yourself provide. Please check all that
apply.
Training in the use of assistive devices (e.g., optical, non-optical)
Orientation and mobility training
Eccentric viewing training or training in preferred retinal loci
Scanning strategy training
75
Survey of Alabama Vision Rehabilitation Providers
Training in strategies to perform everyday visual tasks (e.g., household activities, managing
money, preparing meals)
Psychological or counseling services
Support groups (for clients and/or families)
Social work services
Driving rehabilitation
Home-based visits for education or training
Vocational rehabilitation or career counseling services
Training in the use of computers and software
Other; specify: ____________________________________________________
11. Do you provide services in a group practice or agency where there are multiple providers?
Yes
No
12. If Yes, what are the names of the other eye care, health care, or rehabilitation providers who
practice in your group? Please circle what type of healthcare provider they are.
1. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
2. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
3. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
4. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
5. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
6. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
7. _________________________Ophthalmologist/Optometrist/Other: Specify ________________
13. Do you have an optical service or shop at your practice or agency?
Yes
No
14. Does your practice/agency provide services in Spanish?
Yes
No
15. What is your best estimate of the typical time between the call for an appointment and the first
available appointment in your clinic/agency/practice?
Less than 1 week
1 to 2 weeks
3 to 4 weeks
More than a month
Don’t know
16. Do you take “walk-ins”, that is, a person who does not have an appointment?
Yes
Only if it is an emergency and an established patient
76
Survey of Alabama Vision Rehabilitation Providers
No
17. Please estimate the number of patients/clients you see personally (regardless of location) in a typical
week. We realize this may vary from week to week. Just estimate for what you would consider a typical
week.
Approximate number of patients/ clients per week_______
18. Below is a list of age ranges. Please estimate what percentage (%) of your patients/clients fall
within the following age categories. You do not have to know precisely. We are just looking for your
best estimate.
_______ Under 5 years
_______ 5 to 19 years
_______ 20 to 59 years
_______ 60 to 79 years
_______ 80 years and over
19. Below is a list of ethnic/racial groups. Please estimate what percentage (%) of your patients fall
into each group. You do not have to know precisely. We are just looking for your best estimate.
_______White, non-Hispanic
_______African-American
_______Hispanic
_______Asian
_______Native American
_______Other
20. Please estimate what percentage (%) of your patients are male and female. You do not have to know
precisely. We are just looking for your best estimate.
_______Male
_______Female
21. Below is a list of health insurance types or 3rd party reimbursement programs. Please estimate
what percentage (%) of your patients have the following kinds of insurance. You do not have to
know precisely. We are just looking for your best estimate. (These don’t have to add up to 100% because
patients may have more than one type of insurance.)
_______Medicare
_______Medicaid
_______Private insurance
_______Vocational rehab
_______CHIP (Children’s Health Insurance Program)
_______No insurance
_______Other (Specify: __________________________)
_______I don’t accept health insurance as payment.
22. What types of health insurance or 3rd party reimbursement programs do you accept toward
payment in your practice or clinic? Please place a check by each type you accept.
77
Survey of Alabama Vision Rehabilitation Providers
Medicare
Medicare Complete
Medicaid
Blue Cross Blue Shield
Viva
Viva Medicare Plus
United Healthcare
Cigna
Aetna
Multiplan
GEHA
Tricare/Champus
Veterans Administration coverage
Vocational Rehab
CHIP (Children’s Health Insurance Program)
Others, Specify: ___________________________________________________
I don’t accept health insurance as payment.
23. Do you provide services through Alabama’s OASIS Program? (OASIS stands for Older Alabamians
System of Information and Services. It is a federally funded program designed to assist persons 55 years
and older and visually impaired in living more independently in their homes.)
Yes
No
24. Below is a list of eye conditions. What percentage (%) of your patients has each of the following eye
conditions or diseases? You do not have to know precisely. We are just looking for your best estimate.
(These don’t have to add up to 100% because patients may have multiple problems.)
_______Refractive error
_______Amblyopia
_______Strabismus
_______Dry eye
_______Age-related macular degeneration
_______Glaucoma
_______Diabetic eye conditions including retinopathy and macular edema
_______Cataract
_______Vision loss from brain injury including stroke
_______Juvenile or young adult onset retinal degenerations (e.g. retinitis pigmentosa,
rod-cone dystrophies)
_______Optic neuritis or other optic nerve disorders
_______Retinopathy of prematurity
_______Corneal problems
_______Complications from contact lens wear
_______Dry eye
_______Conjunctivitis
78
Survey of Alabama Vision Rehabilitation Providers
_______Ocular trauma
_______Other. Specify: _____________________________________________________
25. What percentage (%) of your patients/clients are diabetics (either Type 1 or Type 2)? You do not
have to know precisely. We are just looking for your best estimate.
_________%
26. We are interested in how your patients/clients “find you”. What percent (%) of your patients are
referred from the following sources. You do not have to know precisely. We are just looking for your
best estimate. (These don’t have to add up to 100% because a patient/client may be referred by multiple
sources.)
_______Refer themselves.
_______Referred by family or friends
_______Referred by an ophthalmologist.
_______Referred by an optometrist.
_______Referred by another physician including a family physician.
_______Referred by hospital emergency room.
_______Referred by a school system.
_______Referred by a vision screening program.
_______Other. Specify: ___________________________________________________
27. What percentage (%) of your patients/clients patients have “low vision”. A commonly used
definition for low vision is visual acuity worse than 20/60 in both eyes with best refraction, and/or
visual field loss in both eyes of less than 10 degrees from fixation.
_________%
28. What percentage of your rehabilitation patients/clients have difficulties or problems in the
following areas? You do not have to know precisely. We are just looking for your best estimate. (These
don’t have to add up to 100% because clients may have multiple problems.)
_____Reading
_____Writing
_____Financial Management
_____Other Detail Near Tasks
_____Independent Living
_____Mobility
_____Driving
_____Identification of objects, people, events from a distance
_____Self-Care/Domestic Activity
_____Emotional or Psychological Adjustment
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Survey of Alabama Vision Rehabilitation Providers
29. What are the greatest unmet eye care needs in your community?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
30. What single action by a private foundation (such as the EyeSight Foundation of Alabama) would
make the greatest improvement in eye care in your community? Please explain why.
____________________________________________________________________________________
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APPENDIX C
DOMAINS AND SUBCATEGORIES FOR WRITTEN RESPONSES TO:
1. What are the greatest unmet eye care needs in your community?
2. What single action by a private foundation (such as the EyeSight Foundation of
Alabama) would make the greatest improvement in eye care in your community?
81
Table B1. Domains and subcategories for the survey question, “What are the greatest unmet care
needs in your community?”
Domains/subcategory
Detailed description
CLINICAL CARE
Eye care
Provision of routine comprehensive eye care to high-risk populations
High-risk = uninsured, underinsured, poor, ethnic/racial minorities, nursing
home population, or institutionalized populations.
Glaucoma screening
Glaucoma screening for high-risk populations
High-risk = African Americans, Hispanic/Latinos, uninsured, underinsured
Diabetic retinopathy
screening
Diabetic retinopathy screening for high-risk populations
High risk = those with diabetes (any type)
Pediatric unspecified
Pediatric ophthalmology or pediatric optometry w/o screening or eye
exams specified.
Pediatric screening
Pediatric screening services for pre-K or K children to screen for refractive
error, amblyopia or strabismus
Pediatric comprehensive
eye exam
Comprehensive eye exams need to be provided for all pre-K or K children
Hispanic eye care
Services for Hispanic/Latino community in AL (most are uninsured)
Even the most basic eye care needs such as glasses or contact lenses are
not readily accessible for this population
82
Table B1. Domains and subcategories for the survey question, “What are the greatest unmet care
needs in your community?”
Domains/subcategory
Detailed description
Dry eye
Dry eye treatment
Refractive error
Treatment of refractive error
EDUCATION
Eye health education for
the public
Eye health education in general
Educating about the importance of early diagnosis and intervention for
chronic diseases of adulthood, and importance of routine comprehensive
eye care to achieve early diagnosis
Educating about compliance with follow-up appointments
Educating about medication adherence
Educating parents about early vision screening and screening for
amblyopia and strabismus in children
Educating about low vision rehabilitation services and what they are
Educating about importance of getting assessed and treatments for
hypertension
Educating about how to improve communication with doctor and his staff
Educating visually impaired persons and the public about bioptic driving
program
Provider education
Educating ophthalmologists and optometrists about low vision
rehabilitation services and the importance of making referrals for those
83
Table B1. Domains and subcategories for the survey question, “What are the greatest unmet care
needs in your community?”
Domains/subcategory
Detailed description
with irreversible vision impairment to low vision rehab specialty clinics.
Educating internists and family physicians about the importance of urging
and referring their diabetic patients to annual comprehensive eye care
Educating eye care providers about how to improve doctor-patient
communication
Educating about bioptic driving program
Better education of family medicine physicians about how to treat bacterial
eye infections.
Better education of ophthalmic assistants
ACCESSIBILITY
Transportation to
appointments
Especially appointments at ophthalmology clinics and tertiary care centers
that are primarily in the metropolitan areas and not in more rural areas of
state
Satellite clinics
Satellite clinics or providers willing to base practices outside the major
metropolitan areas
Nursing homes
Eye care providers who provide services in nursing homes
EYE CARE ORGANIZATION/EYE HEALTH SYSTEM
More providers
Shortage of providers – the following were specifically mentioned
84
Table B1. Domains and subcategories for the survey question, “What are the greatest unmet care
needs in your community?”
Domains/subcategory
Detailed description
Low vision rehabilitation specialists
Ophthalmologists who do LASIK
Pediatric Ophthalmologists
Oculoplastics specialists
Neuro-ophthalmologists
Providers willing to work in non-metropolitan areas, more rural regions of
state where providers are non-existent or too few
Orientation and Mobility Instructors and Rehab Teachers
Providers that offer “vision therapy”
New hospital
New eye hospital
Disability services
Clinics that provide services for reading disability and dyslexia
Health disparities
Implement strategies to reduce health disparities in eye care
Blind services
Better services for the blind
VA services
More service availability for eye care at Veterans Administration for
veterans (too overbooked)
Handicapped children
Clinics that serve multi-handicapped children (e.g., vision impairment,
cognitive and motor disorders)
85
Table B1. Domains and subcategories for the survey question, “What are the greatest unmet care
needs in your community?”
Domains/subcategory
Detailed description
Dual sensory impairment
Clinics that screen for dual sensory impairment
Sports
Sports vision services
Support group
Support groups for the visually impaired
POLICY CHANGES
Financial prescriptions
Financial assistance for prescription medications for the uninsured or
underinsured
Low co-pay
Lower co-pays for office visits and prescription medications
Higher reimbursements
Higher reimbursements to eye care providers so that practice is sustainable
and the latest technologies for disease management can be purchased
Medicare spectacles
Medicare coverage for spectacles (not just after cataract surgery) at some
periodic time period
State funds
More funds for state services for visually impaired persons
Mobility paths
Mobility friendly pedestrian paths
86
Table B1. Domains and subcategories for the survey question, “What are the greatest unmet care
needs in your community?”
Domains/subcategory
Detailed description
School screening
Organize and fund system wide school vision screening
School spectacles
A spectacle fund in schools for those children with uncorrected refractive
error whose parents cannot afford spectacles
Vision rehabilitation
funding
More funding for vocational rehabilitation programs for visually impaired
NO NEEDS
No unmet care needs in my community
NOT KNOWN
I don’t know
87
Table B2. Domains and subcategories for the survey question, “What single action by a private
foundation (such as the EyeSight Foundation of Alabama) would make the greatest improvement in
eye care in your community?”
Domains/specific category
Detailed description
Fund Research
Funding research on major blinding conditions (glaucoma,
diabetic retinopathy, Age related macular degeneration)
Education
Education
Public education
Eye health education for the public
Provider education
Education of providers
Accessibility
Transportation to appointments
Accessibility
Transportation to appointments
Policy
Promote policy or program changes
Clinical care and screening
Support clinical care and screening programs
Relationships
Facilitate relationships in professional communities
Not known
I don’t know
None
None
88