More people have visual disorders and it's costly

Major visual disorders in Americans older than 40 years may cost the U.S. economy an estimated $35.4 billion a year, according to a report in the December issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

Millions of Americans have visual impairment, blindness or other eye diseases, according to background information in the article.

These diseases include age-related macular degeneration (AMD), cataracts, diabetic retinopathy, primary open-angle glaucoma and refractive errors, which are correctable with glasses or contact lenses. In addition to direct medical costs, other direct costs, such as nursing home health care, are related to these major visual disorders. Productivity losses also occur when individuals with visual impairment cannot work or earn lower wages.

David B. Rein, Ph.D., of RTI International, Research Triangle Park, N.C., and colleagues analyzed the financial burden of eye diseases in 2004. The researchers used private insurance and Medicare claim data to approximate direct medical costs. Evidence from published sources provided information about other direct costs, consisting of nursing home care, government purchase programs and guide dogs for the blind. Data from a national survey about labor and income were used to estimate productivity losses.

Researchers found that major visual disorders cost the U.S. an estimated $16.2 billion in direct medical costs, $11.1 billion in other direct costs and $8 billion in productivity losses, bringing the total annual financial burden to an estimated $35.4 billion. The annual governmental budgetary impact, calculated by adding the portion of the financial burden estimate produced by the government to additional amounts of social welfare payments from the federal treasury to people with visual impairment and blindness, was found to be $13.7 billion.

Direct medical costs were estimated to be approximately $6.8 billion for cataracts, $5.5 billion for refractive error, $2.9 billion for glaucoma, $575 million for AMD and $493 million for diabetic retinopathy. The majority of direct medical costs included outpatient services and medications, while inpatient costs accounted for almost no costs. Refractive error made up the largest share of direct medical costs for those age 40 to 64 (46.2 percent), while cataracts accounted for the largest portion among patients 65 years and older (56.2 percent). "Increased overall costs for AMD and cataracts among patients aged 65 years and older were attributable to increased numbers of patients who use outpatient services for these conditions," the authors write.

Many costs are expected to increase in the future as the American population ages, the authors note. "Public health efforts to screen for and treat currently undiagnosed disease may be likely to increase direct medical care costs, but if effective, they will also improve visual outcomes, and potentially reduce productivity losses and nursing home placements associated with visual impairment and blindness," they conclude. "Technological advancements that lead to reductions in the unit costs of glasses, cataract surgery and medications to treat glaucoma have the potential to lead to substantial direct medical cost savings." (Arch Ophthalmol. 2006;124:1754-1760)